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Like many college students, I watch some Youtubers for weekly entertainment. One of the channels I follow is called Femmehead, where Victoria, the Youtuber, talks about clean eating, minimalism, and all things regarding menstruation and birth control. She swears by FAM, the fertility awareness method, as her main form of birth control. Since I had not heard of this form of birth control before, I was curious and skeptical. After looking up some terms, Victoria seems to use the sympto-thermal method of FAM. With this specific method of FAM, she takes her basal-body temperature right when she wakes up at the same time every morning. In addition to that, she has to test her cervical mucus to see if it has an egg white consistency. Both a change in temperature and consistency of cervical mucus indicates the ovulation period. During this fertile window, couples are supposed to refrain from sex or use other forms of birth control. Overall, this type of natural birth control seems to leave room for a lot of human error but also eliminates the negative side effects of other forms of birth control. Therefore, I wanted to dig more into the research regarding the effectiveness of this method.
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In one longitudinal study, researchers kept track of around 900 women who use the sympto-thermal method. After about one year, the researches recorded 1.8/100 unintended pregancies for those who did not use the method perfectly. Imperfect use meant that couples had intercourse during the fertile window. As for perfect users, only .6/100 had unintended pregnancies.
Since this study had such a large sample size and followed women over a period of time, this seems like a reliable study, and the results showed that the sympto-thermal method is effective at preventing unintended pregnancy, even when compared to other forms of birth control. For example, oral contraceptives result in unintended pregnancies 9/100 times for imperfect use and 1/100 times with perfect use. Furthermore, oral birth control can have many side effects like weight gain, mood fluctuation, a decrease in libido etc. Therefore, if the sympto-thermal method really is so effective and symptom free, why haven’t I heard about it before?
As I continued my basic Google search, I started seeing the statistic of 25% failure rate from FAM method. After finding some more research, I found a study that randomly assigned over 1,000 women to use either the ovulation method or the sympto-thermal method, both are consider fertility awareness methods. I already have described the sympto-thermal method above, but the ovulation method is when the discharge around the vaginal opening is monitored. The last day the discharge is slippery marks when ovulation should be occurring. After 12 months, the failure rate was 16.6/100 for those who used the sympto-thermal method and 34.9/100 for those who used the ovulation method.
Wow! These results were a lot worse than from the previously mentioned study. This study also noted that many of the pregnancies were due to confusion about the method or not strictly following the rules. The study went on to note that failure rates for perfect use should have been 0 for sympto-thermal method and 6/100 for ovulation method. Even though the perfect-use numbers deem the sympto-thermal and ovulation method effective, I do not understand how the researchers calculated these number. Also, the ovulation method seems to be not effective because it relies on the variability of perception and biology between each woman.
Even though this study found many different rate, I now have a better understand of why I see failure rates with such variability between different websites. There could be potential confirmation bias for different results and statistics. For example, many Catholic groups, whom do not agree with certain forms of birth control, might cite studies that promote FAM. On the other hand, gynecologists and people who want to distribute other forms of birth control might cite other articles or find results against FAM.
Despite the differences between the studies, both mentioned that some participants dropped out of the study because they did not like the method. There seems to be a lot of confusion on the internet about what exactly FAM is and the actual effectiveness of it. The FAM method, specifically the sympto-thermal method, seems to take a lot of personal awareness, self-discipline, and a consistent lifestyle routine to be successful. Those who would benefit from FAM are women who react poorly to other forms of birth control, do not have access to any other options, or want to have a deeper connection/understanding with their own bodies and fertility.
In class, we discussed risk. In the case of contraceptive use, the risk is pregnancy. The exposure is frequent, usually a few days each month (fertility window), and the hazard or consequences of being pregnant are life changing. So, until more research is done, and more precise ways of using FAM and the sympto-thermal method is taught, then it seems less risky to stick with a form of birth control that has been tested more and is less complicated. Overall, if someone is not experiencing any problems with their normal form of birth control, I would not recommend switching to FAM.