Using fertility awareness as contraception can mean you feel endlessly judged.
You might have noticed this in some of the recent press coverage of the contraception app Natural Cycles - which is based on elements of fertility awareness.
Apparently anyone who relies on Natural Cycles, or fertility awareness, is either
That’s not true.
Natural Cycles is not perfect - they should be open with people - but it has amazing potential.
And fertility awareness can fail – but those failures aren’t random occurrences that strike like lightning out of a clear blue sky. It can work very well.
Thanks to substantial funds and all sorts of design and marketing cleverness (I’m not so sure about their algorithm) Natural Cycles have helped many, many women use a contraceptive method that they would never have considered before.
Thanks to Natural Cycles, we have more contraceptive choice.
How is that not a good thing?
OK, so it’s not a good thing if it doesn’t work. We all want our contraception to work.
NHS Choices says the version that I teach (Fertility UK) can be up to 99% effective but there are different approaches to using fertility awareness (natural family planning). It’s basically a pick n mix of fertility indicators and effectiveness.
Some of us use fertility awareness in a very cautious way, allowing for a generous "might-be-fertile" buffer zone so we can avoid (nearly) all chance of pregnancy.
Others of us are comfortable shaving days off that buffer zone to get more green days – or cutting down the amount of data we gather to simplify our lives.
We choose how we use fertility awareness.
We use our judgement and we take the consequences.
Natural Cycles takes that judgement out of our hands - we simply trust their algorithm, and their judgement - which you might prefer.
Whatever approach you choose, fertility awareness is a reasonable option.
It might be easiest to start using it when you're not so bothered about unplanned pregnancy - TTW or Trying To Whatever is the unofficial term - but some of us will have such an intolerable time with other contraception that we’d rather use a method which doesn’t have such a good reputation for effectiveness.
We might then be pleasantly surprised and discover that Natural Cycles, or fertility awareness – or withdrawal, or condoms, or LAM (if you’re breastfeeding), can work very well if you know what you’re doing.
We need options, which is why I’ve felt uneasy about the press coverage that has focussed on individual women who have had Natural Cycles abortions or unplanned pregnancies.
They might have shared – and been asked to share – their stories with the best intentions but it has felt wrong.
It's felt like a public shaming - something designed to scare and embarrass women back onto the pill or the coil – no matter how much they dislike those options.
Of course some women love the coil and the pill, I have no problem with that, but what about the rest of us?
And what about all the women who have got pregnant using other methods of contraception– often not realising for months because the method stopped their periods - why don’t we hear about them? All contraception fails.
Women need options and shaming women who dare to use an unsanctioned approach to contraception is not helping.
Instead it encourages the idea that the only “responsible” thing for women to do is use another kind of contraception – no matter how they feel about it, or what side effects they experience – because at least it’s better than unplanned pregnancy or abortion.
Of course we want our contraception to work, but half of all pregnancies are unplanned and one in three women will have an abortion at some point in her life. Half of those women are already mothers.
Do we really want all those women to feel ashamed?
The responsible option is not to scare or shame women off Natural Cycles or fertility awareness – the responsible option is to recognise that women are often making tough choices and need support.
We should be researching how to improve the effectiveness of unsanctioned methods, not dismissing them.
I’d like to see an NHS contraception app – one that is free, reliable, beautiful and open about its algorithm. It should also make the data available to researchers. Data is the new oil - it could help us uncover all sorts of unanswered questions - we should not be handing it over to the private sector.
Nor should we be encouraging the idea that women’s bodies are an unknowable mystery that can only be uncovered by folk in white coats.
Women can learn how to use fertility awareness as contraception, it’s not rocket science.
We can also help to create better approaches. We should be co-creators – not simply consumers when it comes to using fertility awareness as contraception.
That’s why I include do it yourself guides and links on my website, and why I wrote this letter to the BMJ Sexual and Reproductive Health calling for less condemnation of fertility awareness and an NHS app.
Maybe, just maybe, the women who use fertility awareness should be celebrated, and worked with, not shamed and dismissed. We are women who are helping to improve contraceptive choice, not irresponsible or “naïve”.
What do you think? Do we need an NHS app or is it best to leave this to the private sector?
Or do you think we have enough contraceptive options and women should simply persevere with those already available?