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.