“Contraceptive cost of COVID: a million unplanned pregnancies” read headlines across many major media outlets on March 11. The viral headline was in response to a March 11 United Nations (UN) announcement that the COVID-19 pandemic was responsible for 1.4 million unplanned pregnancies, due to the estimated 12 million women in poorer countries who lost access to contraception because of various pandemic-related disruptions.
Those statistics come from the United Nations Population Fund (UNFPA), the UN’s sexual and reproductive health agency, which recently released a report titled “Impact of COVID-19 on Family Planning: What we know one year into the pandemic” [1].
In its report, UNFPA lists the various pandemic-induced disruptions to contraceptive access, including hits to global manufacturing and supply chains, emptied out shelves, lockdowns and social distancing measures, fears of visiting health clinics, or the inability to visit clinics because of the overwhelm caused by the pandemic. Together, UNFPA believes that these disruptive factors, which they estimate lasted for an average of about 3.6 months in 2020, are responsible for at least 500,000 and as many as 2.7 million unplanned pregnancies (with 1.4 million being their medium estimate) across 115 low- and middle-income countries.
The UNFPA report actually highlights the reasons why pharmaceutical birth control is unsustainable in the face of a disaster (as many of these factors are not unique to a pandemic). Yet, the organization insists that further dependence on these methods of family planning is necessary, stating that contraceptive access must be prioritized for women and girls across the globe. In fact, the UN goes so far as to place contraceptives on a list of items which they consider “life-saving commodities.” But in essence, the UN is just placing more emphasis on the same unsustainable strategy, encouraging women and couples to rely on the same methods of pharmaceutical birth control that left them in a lurch this pandemic.
A new strategy for sustainable family planning
What the UN misunderstands is that the COVID-19 pandemic actually highlighted a dire need for family planning that is sustainable, independent of supply chains, and accessible beyond the clinic.
Thanks to scientifically-backed fertility awareness methods (FAM) (also known as Fertility Awareness-Based Methods, FABMs, or methods of Natural Family Planning, NFP), there are alternatives to pharmaceutical contraceptives that can better serve women and couples in meeting their family planning needs. FAMs are non-pharmaceutical, most require no or little equipment, and they provide sorely needed education and knowledge for women about their bodies and reproductive abilities—knowledge that won’t simply vanish as soon as disaster strikes.
The CDC has acknowledged that some fertility awareness methods have as low as a 2% typical use failure rate; while the CDC currently cites a range of 2-23% failure rate for FAMs, this reflects the range of fertility awareness methods with different efficacy rates. For example, FAMs that measure biological signs of fertility such as cervical fluid, basal body temperature, or hormone levels provide higher efficacy rates, while methods that use calendar estimates instead of biomarkers, are far less effective. Still, the efficacy of modern FAMs is often misrepresented, which leaves women with less quality information to make informed choices about the full scope of their family planning options.
The global applicability of FAMs
In truth, women all over the world have been successfully taught to use fertility awareness methods—and to use them with a relatively high degree of effectiveness. The Billings Ovulation Method (a cervical fluid-only method of natural family planning), in particular, has been taught to people in countries all over the world, in populations with every level of literacy (including no literacy).
For example, a 1996 field trial in India followed over 2,000 women who had been taught to use the Billings Ovulation Method; despite many of the women being illiterate, after 21 months, the method failure rate (for perfect use) was less than 2% per 100 users, and the user failure rate (typical use) was less than 17% per 100 users [2]. In a 1996 12-month multi-center study in China, the results were even more impressive, with a perfect use failure rate of 0, and a typical use failure rate of 0.5% [3]. Particularly noteworthy is the following conclusion from a World Health Organization-conducted, multi-continent study, published in 1981 in the journal Fertility and Sterility:
“The most striking finding was the demonstration that 94% of women representing a wide range of cultural, educational, and socioeconomic characteristics were able to recognize and record the cervical mucus symptom which allows self recognition of the fertile period” [4].
These studies indicate that the Billings method, a widespread and evidence-based method of fertility awareness, can be used by women across cultures and education levels to effectively prevent pregnancy. Even factoring in the initial instruction that women need to use these methods, they are still less expensive than any other form of birth control. Further, using a FAM does not require a prescription or a visit to a clinic or pharmacy to obtain, which makes them a form of uniquely sustainable family planning, especially in the face of a disaster (like a pandemic).
Diminished access to care for birth control side effects
While the UN report emphasizes increasing access to contraceptives, it does not address the increased access to healthcare women may need for side effects they could experience while on contraception (especially in the event of more serious side effects like blood clots, heart attacks, and strokes). Unmentioned in the UN report is how women in developing countries (or even women in developed countries during a disaster) may lack access to the care needed to change their birth control method, if health risks or serious side effects arise. Even more troubling in this regard are the long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs) or the Nexplanon implant, which can produce uncomfortable and adverse effects for users, but which require a clinic visit for removal. Likewise, the Depo Provera shot, which despite its link to increased HIV transmission is one of the preferred methods of contraception in poorer countries, is not reversible at all. Biomedical scientist and author of Target Africa, Obianuju Ekeocha wrote in her 2012 Open Letter to Melinda Gates: “Where Europe and America have their well-oiled health care system, a woman in Africa with a contraception-induced blood clot does not have access to 911 or an ambulance or a paramedic. No, she dies.”
Environmentally friendly methods of family planning
In addition to being effective, sustainable methods of natural family planning, FAMs are the most environmentally friendly form of effective family planning. Most fertility awareness methods are zero waste, require no manufacturing, no shipping, and cause no endocrine-disrupting hormones to end up in our waterways.
With the UN’s continued focus on combating climate change, there is a large oversight when it comes to its dependence on pharmaceutical contraceptive drugs and devices, and its ignorance of more sustainable, “green,” and zero-waste forms of family planning. In 2019 alone, UNFPA boasts that it provided 1.3 billion male condoms, 16 million female condoms, 66.6 million oral contraceptives (28-day packs), 2.2 million IUDs, 47 million injectables, 9.9 million implants, and 2.9 million emergency contraceptives, with no mention of any provision of fertility awareness method education.
The UN is not alone in its near single-minded push of contraceptives. The World Health Organization also continues to push contraceptives, especially in poor countries, even though the organization recently acknowledged that breast cancer is now the world’s most-diagnosed form of cancer; the organization appears unconcerned about hormonal birth control’s established link to higher risk of breast cancer.
Accessible natural family planning
At the outset of the pandemic, Natural Womanhood realized that couples would need sustainable family planning more than ever. That is why we immediately published numerous articles to encourage women and couples to learn FAM when they might not have access to other forms of family planning. We have also been offering scholarships for women and couples to learn a FAM of their choice—for free. To date, we have awarded ten couples with a FAM scholarship. Some of these couples have admitted to us that without the scholarship, they might have resorted to hormonal contraception against their health preference or moral values, as their economic situation was too tenuous to allow for another child.
Although UNFPA stated in its report that “the situation could have been far worse,” and that “quick action,” “ingenuity,” and “creative efforts” “helped many health systems maintain or restore access to essential health services, including contraceptives,” those efforts were clearly not enough to help the estimated 1.4 million women avoid unplanned pregnancies [5].
Natural Womanhood is one, small non-profit organization, yet we have been humbled by our ability to make a concrete difference in the lives of the couples who have received our scholarships. Because of these scholarships, ten couples have learned how to successfully plan their families, and are not suffering any of the serious side effects that often accompany contraceptive drugs or devices. Imagine what the UN and other organizations truly committed to the welfare of women and families could do for women and couples around the world if they devoted even a fraction of their creative efforts and resources (both human and financial) to FAM education. In the meantime, Natural Womanhood will continue to do its part, and we hope you will help us by doing yours, in spreading the truth about fertility awareness and all the good it can do.
To request a scholarship to cover the costs of FAM education, click here.
Note: Currently, because of the limited funds we can devote to scholarships and for legal reasons, these scholarships are only available to couples in the United States, with a maximum grant of $150 per couple until our funding runs out. If you are a funder and would like to work with us to make FAM and NFP available to more families through this process please contact Silvia Coto at [email protected].
References:
[1] and [5] Impact Of COVID-19 On Family Planning: What We Know One Year Into The Pandemic. UNFPA-United Nations Population Fund; March 11, 2021. https://www.unfpa.org/sites/default/files/resource-pdf/COVID_Impact_FP_V5.pdf. Accessed March 22, 2021. [2] Indian Council of Medical Research Task Force on Natural Family Planning. Field trial of Billings Ovulation Method of natural family planning. Contraception. 1996;53(2). doi:10.1016/0010-7824(95)00269-3. https://www.sciencedirect.com/science/article/abs/pii/0010782495002693 [3] Education Committee of OMR&RCA. Efficacy of the Billings Ovulation Method® for Avoiding Pregnancy. WOOMB International. https://www.woombinternational.org/science-of-fertility/item/86-efficacy-of-bom-for-avoiding-pregnancy. Accessed March 26, 2021. [4] World Health Organization. A prospective multicentre trial of the ovulation method of natural family planning. I. the teaching phase* Supported by the Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland. Fertil Steril. 1981;36(2):152-158. doi:10.1016/s0015-0282(16)45671-2. https://www.fertstert.org/article/S0015-0282(16)45671-2/pdfAdditional Reading:
As Breast Cancer Rates Soar, the WHO Doubles Down on Promoting Birth Control
Investing in what the world’s poor really want: a response to Bill and Melinda Gates
Fertility Awareness Methods Can Better Serve African Women Than Contraception and I’m Living Proof
HIV Transmission & Depo-Provera, the Birth Control Shot
Pill chemicals in waste water cause endemic feminization of male fish
Journal article describes how effectiveness of FAMs is often misrepresented
