Did you see that Cosmopolitan magazine told its readers about Fertility Awareness Based Methods (FABMs) last week? Unfortunately, instead of publishing a story that educated readers about the benefits of charting and knowing their bodies, Cosmo published a piece that offered more misinformation than facts.
The title itself reveals a red flag: “15 Facts About the Rhythm Method of Contraception: What you need to know about the ‘calendar method’ of birth control.”
Starting off by calling FABMs “the rhythm method of contraception” reveals to anyone familiar with the topic that this piece is going to say little about the facts it purports to offer. The Rhythm Method not only dates back as far as 1930; it is not a fertility awareness method recommended by any serious FABM instructor today. Even the World Health Organization distinguishes between modern birth-control methods and the Rhythm Method. That Cosmo would choose to highlight the Rhythm Method instead of the modern scientifically proven symptom-based methods reveals either poor research or intentional bias; in truth, the piece reads so scrambled it’s hard to tell which.
Far from making the facts on FABMs clearer for readers, Cosmo’s article paints FABMs in broad strokes as ineffective and unadvisable, overlooks the most comprehensive research, misspells cervical mucus (furthering my theory that this was not proofread or fact-checked before published), and quotes Planned Parenthood as an expert source on the topic.
It’s fair to say that Planned Parenthood, one of the largest providers of hormonal birth control, is an unlikely source to speak knowledgeably on fertility awareness methods. While the Planned Parenthood website began offering information on fertility awareness methods last year among its long list of possible birth-control methods, its page on FABMs includes some major errors. As Gerard Migeon has pointed out, the page cites the much-circulated erroneous effectiveness rate for FABMs and directed those seeking to learn FABMs to contact their local Planned Parenthood clinic—an unlikely place to find a certified FABM instructor.
To clear up the facts and fiction in the Cosmo piece, I’ve decided to take it point by point. Below you’ll find Cosmo’s “15 facts” as published on their site, followed by my comments indicating whether they are true, false, or just confused.
Cosmopolitan Magazine: 15 Facts About the Rhythm Method of Contraception
Followed by my corrections in italics.
- “It’s not the same thing as the withdrawal method.”
This is true; the withdrawal method has nothing to do with fertility charting. That Cosmo starts with this point reveals it is targeting the piece to an audience with low awareness on FABMs.
- “With *perfect* use, studies have shown it’s about as effective as the pill.”
Yes, perfect use of fertility awareness methods reveals it’s as effective as the pill, and isn’t that something? I mean, let that sink in. No hormones or side effects; same perfect-use effectiveness rates. Let’s learn more!
- “But perfect use is hard to achieve.”
This is true, which is why it is noteworthy that the *typical use* effectiveness rate for the pill (91%) is lower than the typical use effectiveness rates of common FABMs such as Sympto-Thermal, Creighton, and Sympto-hormonal methods (98%, 96%, and 93% respectively). Again, these are *typical* not *perfect* use effectiveness rates!
These stats come from the most recent studies tracking typical use of women using FABMs after being personally trained by a certified instructor of the method. This means that if a woman is trained by a certified FABM instructor, she can expect these high results of effectiveness. If someone tries to avoid pregnancy by simply buying a book or downloading an charting app, she may experience lower effectiveness rates, which is where the rates as low as 76% come from. For these reasons, we encourage every woman interested in FABMs to choose the evidence-based method that works for her, and then immediately seek an instructor in her area.
- “…Which is why, even if you’re not using it perfectly, every other form of birth control is still more effective than typical use of fertility awareness.”
Here’s where things start to go way off the factual track. Actually, numerous forms of birth control have lower typical effectiveness rates than the evidence-based fertility awareness methods mentioned above in #3. The problem here is that Cosmo quoted Planned Parenthood and a contraception-focused site Bedsider in placing the effectiveness rates of FABMs at 76-88%, rather than the most recent research findings that show numbers between 90-98%.
The low stats are in part influenced by an erroneous stat published on the CDC website that we’ve addressed in the past: The low number comes from a survey of people who self-reported using a natural method but may not have been using an evidence-based FABM or have received training from a certified instructor. The research based on women who received proper instruction is more reliable.
- “ALSO, sperm can live inside the body for up to five days.”
This is true, and details like this are not a surprise to trained users of the symptom-based charting methods. Did you also know that the egg only lives for 12-24 hours and can be fertilized up to 24 hours after ovulation and that as a result, the window of time during which one can achieve a pregnancy is about six days per cycle?
This is why it’s silly that the Cosmo author uses this fact on sperm life to suggest FABMs don’t work; on the contrary, a defining element of most fertility awareness methods is that they take into account the lifespan of sperm and egg both to determine what’s called the “fertile window”—the period of time in which you can get pregnant.
- “This does nothing to prevent STIs.”
That’s right, just like the pill, implants, and IUDs. And since we’re on the topic of facts and STIs, it’s worth noting that injectables like DepoProvera are known to increase the risk of HIV transmission, and even condoms have a limited effectiveness rate as far as protection from STIs.
- “Also, during that fertile time, withdrawal doesn’t cut it.”
Right. Again, withdrawal has nothing to do with fertility charting. At this point, knowing this piece is aimed at low-awareness readers, it is all the more disappointing to read Cosmo misinforming the very readers looking to them for guidance.
- “There are several different ways to practice fertility awareness.”
Ah yes, here we should be getting to the good stuff. Tell me more about the ways I could learn to chart my body’s natural fertile signs! Unfortunately, that is not offered here. To find more about the several different and most effective ways to practice fertility awareness, read more here.
- “The temperature method involves taking your temperature in the morning.”
This is not the name of any actual method, but I think Cosmo is trying to refer to the SymptoThermal method, which tracks temperature and other signs. You can find out more on that by seeking an instructor via the Couple to Couple League or SymptoPro.
- “The cervical mucous method involves monitoring your discharge.”
Yes, and monitoring one’s cervical mucus is such an easy habit to learn, and so informative to women, and so essential to their health if they want to conceive a baby ever, that now would be a great time to point readers in the direction of such methods as the Creighton and Billings Methods. Unfortunately, Cosmo discusses charting this healthy fertility marker in an inexplicably negative tone.
- “The calendar method is… what it sounds like.”
If only Cosmo clarified the difference between these methods in greater detail, because it’s so important! While we at Natural Womanhood encourage women to learn FABMs that monitor their body’s unique fertility cycle, because we like to empower women to grow in knowledge of their bodies, some calendar methods like the Standard Days Cycle Beads method are evidence-based and heavily promoted by the World Health Organization.
- “In January 2018, 37 Swedish women filed complaints against a fertility awareness app after a wave of unintended pregnancies.”
This is true, but as we’ve covered before, using this news item to suggest FABMs are unreliable is misleading. What happened in Sweden is that 37 women out of 668 who sought an abortion at this clinic were using the Natural Cycles app. This is already a small sample, and it becomes even less significant considering the Guttmacher Institute reports that more than 50% of women who are seeking an abortion were using contraceptives at the time they got pregnant.
As it happens, the Natural Cycles app reports a 93% typical use effectiveness rate for avoiding pregnancy, which is better than the Pill. Not all fertility apps are created equal, though, and women should opt for ones backed by research. By not elucidating this, Cosmo again fumbled the opportunity to educate readers and help them avoid unplanned pregnancies.
- “Combining the temperature, cervical mucous and calendar methods is the best way to do fertility awareness. Planned Parenthood says the combination of those three practices is called the “symptothermal method,” but still, you’re looking at a 76-88 percent effectiveness rating.”
There are so many errors here—where do I start? First, combining different fertility charting methods is not recommended by fertility awareness instructors; Planned Parenthood’s definition cited here is not what the SymptoThermal method actually is; and again, the proven typical effectiveness rates of SymptoThermal is 98% at avoiding pregnancy.
- “This is really not recommended for women with polycystic ovarian syndrome. Or any other condition that causes irregular cycles.”
Actually, fertility charting with an evidence-based method such as the Creighton method or FEMM is one of the only ways to actually help people with polycystic ovarian syndrome (PCOS) and irregular periods to try to get to the root of their problems. Hormonal birth control only masks these issues and leaves them worsened or unresolved.
This doesn’t mean using FABMs will quickly resolve PCOS; for many it remains a long and difficult journey either way. But with fertility awareness, it’s a journey with fewer question marks and more understanding.
- “Most doctors will tell you this is not the best form of birth control.”
This is unfortunately true because only 6% of doctors are aware of the actual effectiveness and basic facts about modern Fertility Awareness Based Methods. Here’s an info sheet you can pass to your doctor to help increase awareness in facts, not opinion.
While some parts of the Cosmo article are laughable—and I say this as both a FABM user and as a writer and editor—most of all, I left the article feeling part sad, part angry. Sad, because most of all, it’s a missed opportunity to offer something that would equip readers to make informed decisions about their reproductive health. Angry, because Cosmo appears to be intentionally misleading women who have little knowledge of their fertility cycles, discouraging them from learning more about their bodies.
Not only are many women today tired of the side effects of hormonal birth control, many are looking for natural methods of avoiding pregnancy and understanding their cycles—methods that work and are scientifically based. In providing an article rife with factual errors, vagaries, faulty equivocations, and random asides, Cosmo has actually left readers seeking information on FABMs in the dark about which options they can trust. Without actual helpful information and guidance about which FABMs are most effective, these are exactly the people who are likely to turn to an unreliable app and miss the benefits of reading their body’s signs.