When I first got off the pill and started using a Fertility Awareness Method (FAM), it was really easy for me to think that I was simply using “natural birth control.”
“It’s like the pill but without the actual pill,” I thought.
Ten years, two kids, two miscarriages, and many more grey hairs later, I feel differently. You know those posters featuring different types of contraception you see at your OB’s office while you are wearing that gown, uncomfortably awaiting the knock on the door? The posters look like they’re out of a medical textbook, with drawings and diagrams of all the contraptions and pharmaceuticals you can use for birth control.
If FAMs are on the posters at all, they’re at the bottom with the lowest efficacy rates, while the LARCs boast the top winning spot as the most effective, “set it and forget it” methods.
The mindset behind using FAM
The more I teach and use a Fertility Awareness Method, the more I believe they don’t belong on those posters to begin with. Not because you can’t use them for family planning—you can (yes, even effectively). But the means by which they aid in family planning are entirely different from every other “contraceptive” out there.
I now feel that FAMs are a way to live with your fertility and adjust your behaviors accordingly to your cyclical fertility. Pharmaceutical “birth control,” on the other hand, lives up to its name as it controls your fertility by either suppressing or blocking it (in the case of barrier methods). The outcome could be the same—avoiding a pregnancy. But the mindset behind FAMs and pharmaceutical birth control is very different.
With hormonal contraception, your fertility is shut off. Especially with LARCS, there is a switch that is flipped off—for the long term. The default is infertility until otherwise noted. To make a different choice at the last moment is nearly impossible. This is one of the reasons why LARCS are featured on the aforementioned posters as “most effective,” because they give women the least amount of control. “Set it and forget it” means you don’t have much autonomous choice over the method, which results in higher efficacy rates.
“Set it and forget it” vs. “Learn a method, chart daily, follow through”
With a FAM, you must do three things to use the method effectively:
- Learn a method properly (preferably with an instructor).
- Chart consistently.
- Follow through with your family planning goals in line with your chart.
I joke it should be: “Learn, chart, follow through (while communicating with your partner).” FAMs are anything but “set it and forget it!” But that’s not a bad thing! It means you can make decisions in real time with your partner. It means you can adjust to your needs every day.
For some couples, they know avoiding a pregnancy is of the utmost priority and they can act accordingly. For others, they may be open to a pregnancy, but not necessarily wanting to try to conceive just yet (also known as “TTW” or “Trying to…whatever!”) Some couples may decide to throw caution to the wind because it’s their anniversary and they have a romantic trip planned. Yes, this often leads to “lower efficacy rates” because people make a choice—and that’s the whole point!
With a FAM, you are constantly asking the question: “Do I want to avoid a pregnancy this cycle?” And, thus, you are interacting with this decision daily (ideally with your partner). With other types of birth control, you’re on the autopilot of “infertility.”
Working with—not against—your body
Being in touch with my fertility on a daily basis allows me to be open minded—not just to family planning, but to the whims of the universe. It’s a reminder that, ultimately, I’m not in control of every little thing in my life. What a relief! Instead, I can only make decisions with the information I have.
The thing is: hormonal contraception is not failsafe (and that’s including LARCS). When pregnancies occur for women on contraception, they often feel blindsided. They hadn’t even considered the possibility of a pregnancy. With FAM, I know each month is an invitation. With my husband, we can make choices. Like life, these choices are fluid and not set in stone.
So is FAM “natural birth control?” I don’t think so. When using a FAM, you’re working with your natural, cyclical hormones, and using that information to direct your actions, which will determine family planning outcomes.
But unlike the pill, a barrier method, or LARC, you’re not systematically changing anything about your fertility. If anything, you’re changing your actions. And that’s a lotta responsibility! (But then again, so are babies.)