A few weeks ago a reader wrote me to challenge a statement I made in my December 2014 article titled: Who tells the truth about the effectiveness of fertility awareness methods?  Here is what I wrote: “It may take a few weeks for women to be 100% confident with their ability to accurately read the signs of fertility. But once they do, these methods always beat the Pill.”
He argued that it “is not true by the stats you provide yourself. No method when used perfectly (let’s assume people are perfect creatures), beats the 99.7% of the pill. So you’re actually misleading readers here. Or how do you explain your statement to be true?”
The reality is that right now, the bigger problem is not that most women are being misled to think that FAMs are too effective. It’s the opposite!
Here is my answer to him:
I think your objection is well-founded from a pure mathematical perspective: 99.7% is higher than 99.5 or 99.4%, hence your question: how can we claim that FAM is better than the pill?
A first comment to your objection: arguing about differences of a few decimal points in this area (comparing 99.7% to 99.5%) is likely futile because of the variations between the studies that support the data: methodology, population, etc…
With that said, a major difference between using FAM and using a pill is that couples who use FAMs can be aware of their likelihood to get pregnant at any time in the cycle. They can tell when they are likely fertile or not and can avoid intercourse. With the pill, they have to rely on the drug 100%, with no vital body signs telling them anything.
With FAM, couples who are very motivated to avoid pregnancy can be 100% certain they will, unless they made an error in their charting, but when in doubt they can simply extend the fertile window.
A large study was conducted in China with the Billing Method of Ovulation. As you can imagine, Chinese couples are very motivated to avoid pregnancy. The results were astounding: 0% with perfect use, 0.5% with typical use: better than IUDs (here is the data ).
Finally, some of these methods have a much higher typical use effectiveness compared to the pill: Billings certainly as outlined above, and Sympto-Thermal with 1.8% vs 9% for the pill. It goes back to the reasons I explained above.
There are three human factors that will impact the effectiveness of FAM:
– Training: a solid understanding of the method itself acquired by training. These methods are not rocket science, they are taught all over the world to women who often can’t even read.
– Motivation: as described above. If couples have very serious reason to not get pregnant, they can and will abstain during the fertile time
– Partner’s cooperation: it takes two to achieve or avoid pregnancy. Obviously, the partner has to be on board. Learning and practicing FAMS can actually bring about a more harmonious relationship in that area: there has to be more communication, which is good for both partners and for the couple.
One can argue that because the human factor is important with FAM they are less effective. The human factor is also important with the pill (less, of course, with LARC), but with FAM, the human factor is at the same time more significant (charting) and more effective (knowledge and control) in making a difference.
I hope this helps.