Fertility Awareness Methods (FAM) of family planning are pretty great. They’re versatile, non-invasive, all-natural ways to better understand your body and cycle. Plus, you can use them to avoid or achieve pregnancy.
Still, FAM can be a tough sell. Tracking your fertility signs such as cervical mucus, and/or basal body temperature and/or urinary hormones is more work than popping a pill or getting a birth control ring or IUD inserted. Worse, these methods still face a cultural stigma—left over from the days of the less scientific “calendar rhythm method“—of being too error-prone to work for effective family planning. And because many of the people who use FAMs also happen to have larger-than-average families (by choice!), pop culture often waves off the idea of FAMs as an ineffective form of “religious” birth control.
This stigma can be a problem when you’re interested in Fertility Awareness, but your doctor subscribes to the negative cultural ideas that unfairly surround it. You might wonder: Why don’t doctors recommend fertility awareness? Do any doctors ever recommend FAMs to their patients? And, if so, how can you find a doctor who supports your decision to use FAM for good health and family planning?
A survey of doctors’ opinions on FAMs
A 2023 study in the Kansas Journal of Medicine reviewed physicians’ opinions and knowledge of FAMs, and how these opinions affected how they counseled their patients on birth control.
79 doctors associated with the University of Kansas School of Medicine were asked to fill out a survey about FAMs and related topics [1]. These doctors represented the specialties of family medicine, internal medicine, OB/GYN, and pediatrics. The survey asked respondents questions to gauge their knowledge of FAMs, then collected opinions on the quality and effectiveness of various contraceptive methods, including four different Fertility Awareness Methods. Finally, the survey asked for opinions on FAMs, including whether respondents include Fertility Awareness in their contraceptive counseling, and why (or why not).
A surprising 60% of respondents remembered being taught about Fertility Awareness or Natural Family Planning in medical school. Most (96%) reported being “familiar with the changes in cervical mucus that occur throughout the menstrual cycle,” and most (99%) also reported being “familiar with the changes in basal body temperature that occur throughout the menstrual cycle.”
Different specialties had different rates of understanding of FAMs and how they work. The survey asked questions about perfect- and typical-use rates of FAMs, and knowledge questions about a woman’s cycle and timing of conception. The OB/GYNs and family medicine doctors in the study got 55% of these questions correct, while internal medicine doctors (36%) and pediatricians (35%) fared worse. Most doctors in this study underestimated the effectiveness of FAMs.
What percentage of surveyed doctors recommend FAMs to their patients?
When asked if they recommend Fertility Awareness Methods to their patients, 42% said yes, 24% said sometimes, and 34% said no. Family medicine was the most likely to recommend FAMs, while internal medicine was the least likely. Those who answered “no” were given an opportunity to say why, and the single most common reason given was that “they are ineffective.” Tellingly, most of the doctors in the study were unable to correctly identify the pregnancy prevention effectiveness rates of modern, evidence-based FAMs.
Other reasons for only “sometimes” or “never” recommending FAMs included the need for motivated patients with involved partners to make them work, that they’re not appropriate for all patients, they’re too complex, or there’s a lack of educational support.
Many of these criticisms may be fair. I’m a Symptothermal Method user, so I can tell you firsthand how steep the learning curve can be. This is especially true for those without proper support from their partner and/or an instructor. Switching to FAMs could be a hard sell for a lot of people, even if the doctor in the room is fully supportive.
The topic of FAM use tends to elicit strong reactions, whether yay or nay
The free response sections cited in the article highlight some very strong opinions on both sides of this topic. One doctor stated her personal belief that NFP is the “only moral option for family planning,” while another glibly quoted, “people who use NFP are called parents.” Presumably, neither of these anonymous participants allow their personal biases to spill over into how they treat their patients, but we’ve heard plenty of anecdotal stories about doctors who show disrespect to their patients who decline hormonal birth control.
Are doctors more FAM-supportive than a decade ago?
A similar study in 2010 surveyed 138 Canadian OB/GYNs and family medicine doctors [2]. 50% of the doctors in this study “did not mention NFP at all” vs the 34% of the Kansas doctors who “do not include FABMs in contraceptive counseling.” Other survey responses offered a less apples-to-apples comparison, but suggested that support for FAMs by doctors may have increased in the past decade. Alternatively, it may be the case that doctors in Kansas are more supportive of FAMs than doctors in Canada.
Of course, a study of 79 doctors in one university system in Kansas may only tell us what 79 doctors in Kansas think. The survey didn’t ask where participants went to medical school, or correlate their graduation year to their other responses, so the results may not be generalizable. However, there are no real downsides to the conclusion drawn by the study, i.e., that more education of physicians about FAMs is needed.
Doctors who don’t educate their patients on FAMs believe this
Both the 2023 study and the 2010 study conclude the same thing: a need for more and better education of doctors about the effectiveness of Fertility Awareness Methods. In the 2023 study, of the 29 respondents who “do not include FABMs in contraceptive counseling,” 12 (41%) cited their belief in FAM’s ineffectiveness to be a factor in their decision. Of the table listing reasons given for not recommending FAMs, this belief is by far the most cited reason. How many FAM-unfriendly doctors would change their tune if they had learned accurate statistics about FAMs in medical school?
Even FAM-supportive doctors may not know the facts on pregnancy prevention effectiveness
On the other hand, even those supportive of FAMs don’t have all the correct data. Less than 25% of the doctors who do recommend FAMs to their patients correctly identified the typical use effectiveness rate of these methods. This is a warning for those of us who staunchly support FAMs, to get our facts straight and not sugarcoat the difficult sides. It does no justice to our family and friends to sell them on a family planning method that requires work and dedication, without being honest about what that work and dedication look like in reality.
Pregnancy prevention effectiveness is just one factor in deciding which FAM to use
The researchers also point out that, while effectiveness ratings are an important statistic when comparing contraceptive options, patients do not typically choose a method solely based on efficacy. Some methods will fit different lifestyles better. For example, the Symptothermal Method has the highest pregnancy prevention effectiveness rate, but it requires daily temperatures at the same time every morning, which might be prohibitive for some. (Though wearable devices like my Tempdrop—especially those that sync with an app—make this much, much easier!)
The researchers suggested that future studies evaluate student opinions before and after graduation, and before and after a curriculum update that spends more time on FAMs. They also want to study whether it’s more effective to teach FAMs in medical school classrooms or in clinical settings. Personally, I’d also like to see a study track whether younger doctors are more or less supportive of FAMs than their older counterparts.
How do we change the hearts and minds of the next generation of doctors?
Fortunately, FACTS is an important organization driving significant change in this area. They now offer two online electives “for medical and health professional students to learn more about modern Fertility Awareness-Based Methods (FABMs), the evidence for their effectiveness for family planning, and their role in women’s health.” Both electives are approved through Georgetown University’s School of Medicine. FACTS Executive Director Dr. Marguerite Duane is also the director of the new Center for Fertility Awareness Education and Research at Duquesne University College of Osteopathic Medicine.
As for us, the ovulating public and our partners, it’s clear that, for now, the onus to understand Fertility Awareness lies with us. Fortunately, in the internet age, finding information and the support we need is only a click away (especially if you know about Natural Womanhood already!). If your doctor is less than supportive of your family planning strategy, then the community and encouragement you’re looking for will need to come from somewhere else—friends, family, or like-minded people online. You can also consider sharing about FAM with your doctor! Click here for resources that can help you do that.
If you seek to introduce a FAM into your relationship, you’ll want to select a method and find an instructor to help you get started. It takes some work, but the benefits of a hormone-free, natural family planning method are real and worth the effort.
This article was updated by Natural Womanhood on 1/13/2025 to better clarify the Kansas Journal of Medicine‘s study results.
