If you’re trying to prevent pregnancy without turning to hormonal contraception, like the pill, or barrier methods, like condoms, you may be considering natural birth control. Fertility awareness, natural family planning and the calendar or rhythm method all refer to someone keeping track of their ovulation, instead of using artificial means, to prevent pregnancy.
For couples who are attracted to natural birth control, it does have drawbacks — with lower effectiveness compared to artificial methods topping the list. Natural birth Control Methods should only be used by someone if an unintended pregnancy would not be catastrophic and they would be comfortable either continuing the pregnancy or terminating the pregnancy. Below, experts in reproductive health describe natural birth control techniques, clarify the pros and cons and explain what makes it most likely to succeed.
Natural vs. Artificial Birth Control
What is ‘natural’ in contrast to artificial birth control?
“Many people use the term ‘natural birth control’ to refer to ways of preventing pregnancy without using medications, like hormones or spermicides, or a physical device,” says June Gupta, a women’s health nurse practitioner and director of medical standards at the Planned Parenthood Federation of America. “Fertility awareness methods, the pull-out method, breastfeeding, abstinence and outercourse are all versions of these methods — as opposed to medication or barrier methods like the pill or condom.”
Fertility awareness is a special birth control category. “When someone thinks about natural family planning or natural forms of birth control, it involves knowing how your body functions, knowing when you are and aren’t fertile and using that knowledge for whatever goal you have,” says Dr. Sharon Sung, an OB-GYN with Sparrow Hospital in Lansing, Michigan, and a faculty member with the department of obstetrics, gynecology and reproductive biology at Michigan State University.
Natural family planning is a dual concept with contrasting goals. “An interesting thing about natural family planning is it can be used to conceive or for contraceptive purposes,” Sung points out. Some people may use the concept to prevent pregnancy at one point in their lives, but eventually at a different stage of their lives, to become pregnant.
These are common forms of natural birth control:
— Fertility awareness methods. Calendar tracking, basal body temperature and cervical mucus monitoring are among FAM methods.
— Breastfeeding (lactation amenorrhea). For those who are breastfeeding — and within six months of giving birth — ovulation and menstruation don’t occur, making pregnancy unlikely during that time frame.
— Withdrawal. Also known as “pulling out,” a sexual partner pulls their penis out of their partner’s vagina before ejaculation.
— Outercourse. Having any type of sexual activity — but avoiding vaginal sex with the penis or semen entering the vagina — is outercourse. Masturbation, oral sex and anal sex are examples.
— Abstinence. Although there are different shades of meaning, abstinence is based on not having sex with anyone. For birth control purposes, abstinence may involve not having vaginal sex during fertile periods.
It’s not possible to get pregnant when you’re not ovulating. With fertility awareness, “a patient is able to track their periods and reliably predict when they’re ovulating,” says Dr. Jennifer Chin, an OB-GYN, a complex family planning fellow at the University of Washington in Seattle and a spokesperson for the American College of Obstetricians and Gynecologists. “In order to prevent pregnancy, they simply avoid intercourse (when) they know they’re ovulating.”
Any type of birth control — including natural methods — must be done correctly to prevent pregnancy. The more painstaking and challenging the method, the easier it can be to make a misstep. And with fertility awareness methods, normal bodily fluctuations or disruptions could potentially throw off your tracking.
In addition to measuring the cervical mucus and looking at its consistency, feeling the consistency and position of the cervix itself for changes in height and firmness, can be another aspect of fertility awareness. “The position and consistency could be difficult to exactly determine in someone who hasn’t done that regularly, and it may be a more difficult way of tracking,” Chin says. “But some people prefer to do it that way and feel comfortable doing that.”
Breastfeeding in itself is not enough to prevent pregnancy. “Lactation amenorrhea is a potential option, but it’s very specific,” Sung says. “It has to be within the first six months of delivery. You have to be breastfeeding exclusively — so no bottle supplementing, nothing like that. And it has to be every four hours during the day, every six hours in the night. You can’t skip a feeding. It’s very rigorous. But if you do that, then it can be effective.”
Fertility- Tracking Tools
Fertility awareness/natural family planning variations include:
With the calendar or rhythm method, you chart your menstrual cycle on a calendar or another tool like a period tracking app. By using simple arithmetic, you determine your first fertile day and mark the calendar accordingly.
This allows you to predict and map out unsafe days for practicing unprotected sex if you’re trying to avoid pregnancy. Mobile apps like Kindara, Natural Cycles or CycleBeads are designed to aid in the process.
Standard Days Method
This is a type of calendar method for people who have menstrual cycles that consistently last between 26 and 32 days, Standard days recognizes days 8 to 19 as the most fertile days. Avoid having intercourse, or use a barrier birth control method, during those days to prevent pregnancy.
Basal Body Temperature Method
Typically, a person’s normal body temperature rises slightly during ovulation, about 0.5 to 1 degree Fahrenheit. With BBT, you take your basal body temperature — when someone is fully at rest — every morning upon waking, before any activity whatsoever, and record it daily. BBT is often done in conjunction with other fertility awareness methods to increase effectiveness.
Cervical Mucus Method
The cervix — located at the lower end of the the top of the vagina — produces mucus, which changes right before ovulation. Cervical mucus — or vaginal discharge — increases in amount, and also becomes thinner, clearer and slippery.
Following ovulation, cervical mucus decreases in amount and becomes thicker and less obvious. Closely monitoring these indications is a form of natural birth control.
Combining two fertility awareness methods, such as the BBT (thermal) and cervical mucus (symptom), provides extra information to help predict fertile days.
During ovulation, the cervix may have changes in texture, position and size of the opening, which those who follow this method can learn to check. It’s typically combined with other FAMs.
[READ: Tips for Better Vaginal Health.]
People have a variety of reasons for choosing fertility awareness for their method of birth control. Chin shares feedback from patients who are interested: “They like this method because it does not require input from a clinician, it does not require any visits to a health care facility and it really puts the decision and the ability to control their desires for pregnancy — which is something that some patients feel they want.”
Another advantage is not having to deal with side effects from different birth control methods, Chin notes. “And for a lot of people, they feel like it helps them be really in tune with their bodies and know their bodies better.”
If your body consistently runs like clockwork, that makes success with natural birth control more likely.
“In theory, if you do it perfectly and you don’t have sex while you’re fertile, you should never be able to get pregnant,” Sung says. “So it has this theoretical potential for being very effective. But when it comes to real life and real people, it doesn’t tend to work as well.”
For instance, if, like many people, you have irregular menstrual periods or spotting, that could make it harder to track your ovulation, Sung notes. Getting sick can also disrupt your calculations.
“If you have to check your temperature and know when you’re ovulating based on your temperature, if you have a cold or the flu and you have a fever, then that kind of throws that out the window,” Sung says. “So there are a lot of barriers that can make natural family planning difficult for certain people, and it is a lot of work and commitment.”
In advance of starting natural birth control, awareness of your body’s individual patterns is essential. “In patients who are interested in this method, I typically counsel that they should track their periods for at least three cycles to make sure they have regular, predictable cycles before using this other, less-reliable method of preventing pregnancy,” Chin says.
In addition, having recently given birth makes menstrual periods unpredictable, she notes. “And those are not ideal candidates for using this method, just because it’s so hard to know exactly when they’re ovulating.”
Who might make a better candidate?
“I would say that for someone who’s been tracking their cycles for at least three months, and who has predictable, regular cycles, it’s a pretty good method,” Chin says. “But for someone who does not meet those criteria, then it can definitely have a pretty high failure rate.”
The type of natural birth control makes a difference, too. “Some of these methods are more effective than others,” Gupta says. “Abstinence and outercourse are the most effective at preventing pregnancy — but only if you don’t have unprotected vaginal sex, or get any semen in the vagina.”
Fertility awareness methods are generally about 76% to 88% effective, says Gupta, citing statistics from the Planned Parenthood website. “That means 12 to 24 out of 100 people who use FAM will get pregnant each year, depending on the methods used,” she explains.
Among people who use the pull-out method, about 22 out of 1000 get pregnant each year, or about one in every five, Gupta says. “About two out of 100 people who use breastfeeding as control get pregnant in the six months it can be used after the baby is born,” she adds.
Advantages and Challenges
Consider the following factors when weighing the possibility of using natural birth control.
Natural birth control pros:
— Avoids the side effects of certain medications or devices.
— Free or low-cost, such as the cost for a thermometer or tracking apps.
— Independence and control of contraception.
— Makes you more in tune with your body.
— May align with religious or personal stances.
Natural birth control cons:
— Less effective at preventing pregnancy.
— Reduced spontaneity.
— Tracking, which can be cumbersome, requires dedication and commitment.
— Irregular periods or health problems may interfere with accurate tracking.
Person-Centered Birth Control
“I would always recommend talking with your doctor and getting that understanding between the two of you whether natural family planning is right for you,” Sung says. “Where are you as far as your cycles? How regular are your cycles? How do you and your partner feel about different methods? What have you tried before? What’s your motivation?”
With so many available birth control options, Sung says, “Having an open and honest conversation with your doctor, about what your goals are, what you want out of a birth control method, the two of you can hopefully figure out what the best method is — whether that’s natural family planning or not.”
Birth control methods are not one-size-fits all, says Gupta at Planned Parenthood. “A method that’s perfect for one person may not be right for another,” she says. “That’s why we offer the full range of contraceptive options — including fertility awareness — as well as information to help people make informed decisions about which method is best for them.”
Health care provider-patient discussions should be a bias-free zone. “Whenever I see someone for a birth control visit, I make sure the very first thing I ask my patient is what their preference is in choosing a method for birth control.” Chin says. “And I make sure my entire visit is centered around that priority. I do not go into a birth control visit with a specific agenda.”
She encourages anyone with birth control-related questions to visit an OB-GYN, who will work with individual patients to find the best method to meet their needs.
Back-Up Plans and Alternative Birth Control
“If efficacy is important to a person, there are other, more effective methods of birth control methods to consider, including IUDs, the implant or permanent control birth control — all more than 99% effective,” Gupta says. Then, there’s the birth control shot (94% effective), and the pill, patch or ring (all 91% effective), she says.
Condoms, which also can be part of a back-up plan for natural birth control methods, have certain advantages, including preventing sexually transmitted diseases.
“Condoms are the only way to get protection from (both) pregnancy and STDs during vaginal sex, and they can be found low-cost or free in many places,” Gupta points out. “Condoms can be even thought of as, well, sexy. They come in lots of different styles, shapes and textures that can increase pleasure for both partners.”
If you’re not sure about using natural birth control, or realize you’re not a good candidate, effective contraceptive options include:
— Birth control pills, or a birth control patch or ring.
— The birth control injection.
— A birth control implant such as Nexplanon.
A beginning step to undertaking natural birth control is learning about your reproductive anatomy, hormonal activity and menstrual/fertility cycles, and understanding details like sperm and egg survival time in the reproductive tract. Check these resources for in-depth, accurate information on reproductive health and natural birth control methods:
— ACOG provides answers about fertility awareness-based methods of family planning and other birth control options on its website.
— “Taking Charge of Your Fertility: The definitive guide to natural birth control, pregnancy achievement, and reproductive health” by Toni Weschler is a go-to reference for Chin and one she also recommends for those interested in learning about these methods.
— Visit PlannedParenthood.org for facts on contraceptive options including fertility awareness methods.
— Fertility awareness educators can provide one-on-one instruction in fertility awareness methods. The Association of Fertility Awareness Professionals can help you locate a fertility awareness educator.
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Update 03/29/22: This story was published at an earlier date and has been updated with new information.