Is “Might Actually Work” Good Enough When It Comes to Contraception?

There's been a bit of online chatter recently about ditching hormonal birth control in favor of a return to natural methods of birth control. The problem is, 100% perfect use of these methods can be pretty tough...

This piece was written by Laura Lloyd and is cross-posted from the National Campaign’s blog, Pregnant Pause.


There’s been a bit of online chatter recently about ditching hormonal birth control in favor of a return to the more "organic" methods of birth control known as either Fertility Awareness Methods (FAM) or Natural Family Planning (NFP).

Sophie Morris writes a review of Jane Bennett & Alexandra Pope’s book, The Pill: Are You Sure It’s For You?, in which the authors question why women would use a less-than-perfect method when there are so many potential side effects. Based on her own experience with the pill, Ms. Morris agrees with Bennett and Pope that women should stop viewing it as "the default contraceptive," but she disagrees with them about the best alternative. While they encourage women to return to NFP, Morris feels as though "that remains risky business…if you can’t deal with an unplanned pregnancy."  She hasn’t figured out the best method for her, but knows there are options more effective than NFP.

Over on double x, in an article titled, Your Grandmother’s Birth Control Might Actually Work, Nona Willis Aronowitz explains how she moved to FAMs after experiencing side effects while using the NuvaRing.  Before discovering FAM, she dismissed condoms due to her partner’s aversion.  She said no to the diaphragm on account of a history of urinary tract infections. And she brushed off the thought of the oh-so-effective IUD because she didn’t like the idea of "an invasive vaginal procedure." Ms. Willis Aronowitz settled on using the most effective FAM, known as the symptothermal method. This includes understanding when she’s most fertile (and avoiding intercourse without a barrier method during those times) by measuring her basal body temperature and monitoring the consistency of her cervical mucous on a daily basis, and then charting the data.

When used correctly, this version of FAM is between 95% and 98% effective. Not too shabby, right? The problem is, 100% perfect use can be pretty tough. I’m not saying the author isn’t capable of perfect use, but many just won’t be that good at it. With "typical use" of this method (which is just like it sounds: the way many women end up using this method when regular ol’ life gets in the way and they forget to take their temperature for a few days or a night of drinking changes their body temperature, etc.), the level of effectiveness drops to as low as 80%. That means that for every 100 women who use this method in a year, 20 of them will get pregnant. Those odds aren’t so hot for young adults not planning a pregnancy in the next year (and I’m not even entertaining the thought here of most teens using this method reliably).

It can be difficult for a woman to find the right contraception for her. There are pros and cons to each method and it’s understandable why the positive aspects of FAM/NFP are appealing to some. They’re inexpensive, don’t require a prescription, and don’t demand that the user adjust to any hormones.

At the same time, there are also so many things that can get in the way of using this method perfectly and even with proper use, there are a number of other methods that are still more effective – with much less effort and chance of human error. Don’t take my word for it. Read the articles themselves and the responses, many of which are excellent. A number of women explain why FAM is great in theory, but not in practicality. As double x reader lorikay4 notes (and you should read all of her comments), "there is a difference between ‘can work’ and ‘does work,’" and many women want something much more than "might" when they’re not planning to get pregnant.