A better way to judge fertility awareness and the need for a better app (letter to BMJ Sexual and Reproductive Health)
In their article about Natural Cycles, Hough et al quote a Cochrane Review that dismisses fertility awareness based contraception (natural family planning).
A Cochrane Review is an understandable choice but not an appropriate one. It would be more helpful to quote NHS Choices, the Family Planning Association or Faculty Guidance, which all have a more nuanced approach to the evidence, and say that fertility awareness is up to 99% effective.
Typical use rates are lower but many women achieve high effectiveness thanks to either their own research or appropriate support.
I loved the start of this film from the Victoria Derbyshire programme. At last, women with terrible experiences with hormonal contraception getting a hearing!
Of course it would be even better if women didn’t have a horrific time with side effects – or get “laughed out of the room” if they ask for help with the diaphragm – but at least they were being listened to.
If you want to get pregnant, the NICE Fertility guidance recommends vaginal sexual intercourse every two to three days.
You might think this is great news. At last – freedom from birth control! Woo Hoo!
Or you might not. Maybe your patience is limited, or you want to know how to improve your chances.
So you download an app. But which app should you use, how much data should you record, and how much can you trust them?
If you want to use fertility awareness to avoid pregnancy, you and your partner need to be happy with how you handle your fertile days.
That generally means about ten days a month when you use condoms or other precautions.
It's only possible to get pregnant for about six days but your fertile time can change so you add some extra days, especially while you're learning.
This might be no big deal, especially if you're already using
Using condoms might be an alarming prospect if it's a while since you last used them.
Or your most vivid memory is sniggering while you rolled one onto a banana at school...
They can work very well, but you need to know what you're doing - a bit like fertility awareness.
Here's some tips:
I wrote this letter [Free link] with Emma Pickett after reading this research about improving access to postpartum contraception.
We suggest that breastfeeding, and so child health, could be supported more effectively if those providing postpartum contraception:
1. Routinely offered the Lactational Amenorrhea Method (LAM) as a contraceptive option. LAM can be over 98% effective so long as a woman meets all three lam rules: fully breastfeeding, her child being less than six months old, and her periods not returning. The "fully breastfeeding" rule means it supports good practice in terms of breastfeeding. LAM is not always communicated effectively, but that seems like grounds for research into effective communication, not a reason to dismiss it.
2. Adopted a more cautious approach to prescribing hormonal postpartum contraception. There is substantial anecdotal evidence that this can cause breastfeeding problems for some women. Problems are less likely if women who want to use hormonal contraception start with the progestogen-only pill before moving on to the injection or implant.
Please see this web page for further information.
Can postpartum contraception do more to support breastfeeding? [Full text of letter to Journal of Family Planning and Reproductive Healthcare]
As mentioned in the above post, I wrote this letter with Emma Pickett after reading this research about how to improve postnatal contraception. The full text is here, in case the other link doesn't work:
Reading this book made me realise how lucky I was with my breastfeeding experience. Thanks to absorbing information from friends and ante-natal classes, I expected breastfeeding to be a doddle and it was. Time-consuming but a doddle. There's worse things than having to sit around for hours at a time with a baby attached to your boob.
Unfortunately, not everyone has it so easy. We might be designed to breastfeed but we are also from the generation that was most likely to be fed formula ourselves. What was once routine can now seem mysterious and intimidating.
We hear the glib message “breast is best” but that doesn’t always help. "Best" is all very well but who achieves that? Women need support not just slogans. That's what this book is all about.
BPAS kindly nominated me a Champion of Choice for my fertility awareness work so I wrote this:
Fertility awareness (natural family planning) is not a contraceptive choice for the faint-hearted.
This isn’t because the method is difficult or ineffective. You need to know what you’re doing, and you need to be able to handle your fertile time, but it’s not rocket science.
The hardest part is probably telling your doctor (and your friends) that you’re relying on it to avoid pregnancy.
I’ve heard reports of eye-rolling and angry sighs from some doctors, or more dramatically “Well, don’t come back to me if you need an abortion”. [Not all doctors are like this, mine was lovely]
Fertility awareness (natural family planning) practitioner and advocate working in London. Wants to see fertility awareness become a routine contraceptive option, not the only option. read more...
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