Blog of the Society for Menstrual Cycle Research

Contraceptive Care Must Include Fertility Awareness Methods

September 21st, 2012 by Laura Wershler

I was fuming. My Twitter feed had alerted me to a free online course called Contraception: Choices, Culture and Consequences. I opened the link to find this course syllabus:

  • Week One: Introduction to Contraceptive Care         
  • Week Two: The Menstrual Cycle
  • Week Three: Long Acting Reversible Methods
  • Week Four: Hormonal Methods
  • Week Five: Barrier Methods

Regular readers will know what I think is missing from the syllabus: Fertility Awareness Methods. I emailed course instructor Jerusalem Makonnen from University of California–San Francisco to ask about this omission. I was delighted by her response. She will be including information on Fertility Awareness Methods in Week 5, with Barrier Methods. It was an oversight. Makonnen wrote, “I have been teaching a Contraception course at UCSF School of Nursing for the past five years and it has been a topic that is fully integrated and taught to nurse practitioners and midwives.”

I wish I could say that Fertility Awareness Methods of birth control are “fully integrated” in all sexual and reproductive health clinics and organizations across North America. I have advocated for their inclusion throughout my volunteer and work career in this field, including 19 years on the boards of Planned Parenthood affiliated organizations in Canada, and as a writer on women’s health issues. I believe that full contraceptive choice must include information, support, and training to use Fertility Awareness Methods effectively and confidently.

For more than 25 years I’ve been urging the mainstream sexual and reproductive health community to include FAM in their service delivery. While it might be discussed as an option, with some helpful information provided, the means to learn and use the method is rarely made available to clients. I consider this to be a serious error of omission, an unacceptable failure to provide access to an effective birth control method.

The facts are these: FAM works and many women want to learn how to use it. They buy books and seek out skilled instructors to learn from. They share information online. Thousands are downloading apps to their smartphones to track their menstrual cycles. You could almost say FAM is trending. So why are women who don’t want to take drugs or insert devices to prevent pregnancy receiving such little support and service from established providers of contraceptive care?

There are no valid excuses for sexual and reproductive health clinics and educational organizations NOT to offer FAM instruction to clients, either through trained in-house staff  or in collaboration with certified FAM instructors. At the very least, they should have referral programs – regularly evaluated – for women seeking instruction in the method.

To return to the course syllabus above, I can’t help but suggest that Fertility Awareness Methods should follow Week 2: The Menstrual Cycle, since FAM is all about learning how to observe, chart, and interpret menstrual cycle events. This would be the logical progression. But for now, I’ve stopped fuming and am just relieved to know that the free online course Contraception: Choices, Culture and Consequences is going to include instruction on FAM. This means more women will have access to accurate information about these methods.

In the video explaining the course, instructor Makonnen notes that half of all pregnancies in the United States are unplanned. It’s quite likely this percentage could be lowered just by teaching girls and women the key principles of fertility awareness. When it comes to women’s sexual and reproductive health, body literacy is a good place to start.

6 responses to “Contraceptive Care Must Include Fertility Awareness Methods”

  1. I agree on the menstruation-specific education. So many women – even, or especially, the most feminist-bent educated ones – have swallowed the logic of hormonal contraceptives produce a “fake period” –> that “fake period” is useless medically and you don’t need it –> in fact it is just a ruse created for the Pope –> so let’s get rid of this bleeding and take birth control pills continuously or get a LARC. OR for those woman not on hbc and menstruating then it goes –> we have more periods than cave women –> too many periods is dangerous for your health –> periods are also inconvenient and most modern women don’t want to have them –> take the pill or get a LARC. I hear these lines of thought so often.

  2. I am absolutely thrilled to have stumbled upon your article via Twitter. Though I use fertility awareness for many reasons, one of its greatest benefits has been health-related. FAM is the reason I finally discovered my that my “dysmenorrhea” was actually endometriosis, but my diagnosis took over almost 10 years because my doctors were too busy touting the wonders of hormonal BC as a cure-all and dismissing the importance of FAM or the need to address the underlying cause for my symptoms. I’ve used three different FAMs successfully for 7 years now and couldn’t be happier. It’s a shame many think we are too unintelligent or lazy to understand our bodies or choose a true ‘organic’ option that really does benefit overall health. And it incenses me that one of the strongest arguments re: the national debate on contraceptives is that women like must have contraceptives to treat our condition. This is the very mentality that PROLONGED my suffering and delayed my ability to find actual. So THANK YOU for understanding the importance of this, taking a genuinely comprehensive approach, and being an advocate for us in this area!
    (My story –

  3. Whoops, should say “women like me” and “find actual treatment.” Fast fingers, sorry!

  4. Megan, you make a great point about the strong argument being made that women with menstrual-related health problems require HBC for “treatment.” Many women are not aware that these medications do not “treat” their conditions, but rather impact symptoms only. At some point, women with underlying menstrual problems will need assistance to resolve them, and often to achieve fertility, without these drugs. Understanding fertility awareness is helpful during such a process.

    You might want to check out the Centre for Menstrual Cycle and Ovulation Research, Here you will find treatment protocols that don’t involve hormonal BC for endometriosis, PCOS, and heavy bleeding. The site offers information about menstruation from menarche to menopause.

    Thanks for your comment, and for letting me know you found this article via Twitter!

  5. […] Furthermore, manipulative language polarizes the discussion. It makes others closed to your ideas, even if your arguments are sound and beneficial to them. […]

  6. […] benefits of ovulatory menstruation or acknowledge the need – let alone act – to better serve women who want to use non-hormonal contraception. It’s frustrating to be a lone voice, but I keep […]

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