 | Between 2018 and 2023 there was a five-fold increase in the number of women having abortions who were using fertility awareness as contraception when they they got pregnant (BMJ Sexual and Reproductive Health). Five-fold means a rise from 0.4% to 2.5% of all women having abortions. A significant rise which many see as “proof” that fertility awareness doesn’t work. I don't think it's that simple. |
For one thing there's the 70% of women who were using no contraception at all when they got pregnant.
What's that about?
Cuts to contraceptive services? Men failing to “ejaculate responsibly”? Couples testing their fertility?
Worthwhile questions but let’s get back to the women who had abortions after using fertility awareness as contraception.
First, it’s worth asking which method of fertility awareness they were using.
Fertility awareness is an umbrella term that covers a range of approaches and varies in effectiveness from 2% to 34% (Guttmacher).
Some methods simply rely on cycle length or fluid changes. Others use waking temperature, and sometimes ovulation tests and cervix changes.
Period trackers are not contraception, no matter how slick and confident they look.
One of my biggest beefs with them is how they “oversell” fertility awareness by implying you only need to use condoms or other precautions for a few days a month.
You should expect at least 11 condoms days a cycle, no matter what method you use.
Period trackers could at least offer a “Standard Days” option. This is a simplified fertility awareness method for women with cycles 26 to 32 days long. It means you use precautions from days 8 to 19 of your cycle.
Effectiveness could be boosted with extra buffer days either side of the fertile window.
Waking temperature can increase effectiveness even more because it goes up (and stay up) after ovulation. It drops again as your period begins.
This helps you know if ovulation is delayed and you have more condom days than usual.
The most effective fertility awareness methods use cycle day, waking temperature and a double check like fluid, ovulation tests or an extra raised temperature to boost effectiveness.
The contraception app Natural Cycles is in this category and is doing lots of good work to popularise and improve fertility awareness but it’s expensive, their algorithm is opaque, and there’s too many stories of unplanned pregnancies.
The NHS website recommends you get support from a Fertility UK fertility awareness practitioner like me. It even funds support in some areas, but that’s not for everyone. I can see the appeal of an app.
I welcome recent calls for an NHS cycle tracking app and think it should include options for those who was to use fertility awareness as contraception. It's an absolute scandal that the NHS is letting down women by failing to provide this.
The NHS is also failing researchers. As the report authors say, women's data is a "goldmine" for advertisers but it could also help check the research that fertility awareness relies on. Maybe we are being too cautious with our buffer days? Who knows.
In the meantime, I recommend the low-cost app Read Your Body which helps make fertility awareness more accessible by providing an app version of the old-school paper charts that help women track their data.
There’s also book out called What Every Woman Needs to Know about Fertility: Your Guide to Fertility Awareness to Plan or Avoid Pregnancy. by the incredibly knowledgeable Jane Knight (who runs Fertility UK) and Toni Belfield.
One day this might all come together, and fertility awareness will become an easy and routinely recommended method of contraception, rather than one that is routinely dismissed.
In the meantime, no woman should be told she's wrong to use fertility awareness as contraception, or pressured into using a method she finds unacceptable.
And please, more research, this is valuable stuff!
What's that about?
Cuts to contraceptive services? Men failing to “ejaculate responsibly”? Couples testing their fertility?
Worthwhile questions but let’s get back to the women who had abortions after using fertility awareness as contraception.
First, it’s worth asking which method of fertility awareness they were using.
Fertility awareness is an umbrella term that covers a range of approaches and varies in effectiveness from 2% to 34% (Guttmacher).
Some methods simply rely on cycle length or fluid changes. Others use waking temperature, and sometimes ovulation tests and cervix changes.
Period trackers are not contraception, no matter how slick and confident they look.
One of my biggest beefs with them is how they “oversell” fertility awareness by implying you only need to use condoms or other precautions for a few days a month.
You should expect at least 11 condoms days a cycle, no matter what method you use.
Period trackers could at least offer a “Standard Days” option. This is a simplified fertility awareness method for women with cycles 26 to 32 days long. It means you use precautions from days 8 to 19 of your cycle.
Effectiveness could be boosted with extra buffer days either side of the fertile window.
Waking temperature can increase effectiveness even more because it goes up (and stay up) after ovulation. It drops again as your period begins.
This helps you know if ovulation is delayed and you have more condom days than usual.
The most effective fertility awareness methods use cycle day, waking temperature and a double check like fluid, ovulation tests or an extra raised temperature to boost effectiveness.
The contraception app Natural Cycles is in this category and is doing lots of good work to popularise and improve fertility awareness but it’s expensive, their algorithm is opaque, and there’s too many stories of unplanned pregnancies.
The NHS website recommends you get support from a Fertility UK fertility awareness practitioner like me. It even funds support in some areas, but that’s not for everyone. I can see the appeal of an app.
I welcome recent calls for an NHS cycle tracking app and think it should include options for those who was to use fertility awareness as contraception. It's an absolute scandal that the NHS is letting down women by failing to provide this.
The NHS is also failing researchers. As the report authors say, women's data is a "goldmine" for advertisers but it could also help check the research that fertility awareness relies on. Maybe we are being too cautious with our buffer days? Who knows.
In the meantime, I recommend the low-cost app Read Your Body which helps make fertility awareness more accessible by providing an app version of the old-school paper charts that help women track their data.
There’s also book out called What Every Woman Needs to Know about Fertility: Your Guide to Fertility Awareness to Plan or Avoid Pregnancy. by the incredibly knowledgeable Jane Knight (who runs Fertility UK) and Toni Belfield.
One day this might all come together, and fertility awareness will become an easy and routinely recommended method of contraception, rather than one that is routinely dismissed.
In the meantime, no woman should be told she's wrong to use fertility awareness as contraception, or pressured into using a method she finds unacceptable.
And please, more research, this is valuable stuff!