Blog of the Society for Menstrual Cycle Research

Why the “pullout generation” is a sex ed fail

November 13th, 2013 by Laura Wershler

Questioning and quitting the pill are current hot topics, fueled in no small part by Holly Grigg-Spall’s recently released Sweetening the Pill Or How We Got Hooked on Hormonal Birth Control. Her book has drawn ample backlash, brilliantly addressed by re:Cycling blogger Elizabeth Kissling.

Adding to the media clamour was Ann Friedman’s New York Magazine online piece No Pill? No Prob. Meet the Pullout Generation which explores how and why women she knows are ditching hormones and depending on withdrawal and period tracking apps for birth control.

Black Iris by Georgia O’Keeffe, photographed by Laura Wershler
at The Metropolitan Museum of Art

Both writers, along with Toronto freelancer Kate Carraway, recently discussed the topic Rebelling against the pill: ‘Pulling-Out’ of conventional birth control on CBC Radio-Canada’s The Current.

Listening to Grigg-Spall, Friedman, and Carraway discuss the pill rebellion affirms that while many young women are through with hormonal birth control, their transition off the pill, etc., is not without risk-taking and pushback.

Grigg-Spall nailed the pivotal point when she said “It’s a provider issue.”

The rise of the “pullout generation” is proof that sexual health-care providers and educators, among whom I count myself, have failed on two counts:

1) We’ve failed to address a key aspect of contraceptive use: how to transition successfully between method groups, in this case from hormonal to non-hormonal methods. We’d rather present the so-called “latest and greatest” hormonal methods and say – earnestly, pleadingly – try this! The CBC panelists provided strong anecdotal evidence that more and more women are having none of it.

2) We’ve failed to adequately acknowledge and serve women who can’t, won’t or don’t want to use hormonal methods. We are NOT providing across-the-board support and programs that include easy access to diaphragms or certified training in fertility awareness based methods (FABM), either onsite or through collaborative referral strategies.

For over 25 years I’ve advocated for increased access to information, support and services for women who want to use non-hormonal methods of birth control. It’s self-evident such services must include access to qualified instruction to learn FABM that have effectiveness rates over 99%. This is not to say there isn’t a place for withdrawal as an effective back-up. Check out this confessional how-to post by fertility awareness instructor Amy Sedgewick.

As Friedman said on The Current, women are intimidated by the idea of learning fertility awareness. I believe this is mostly because mainstream sexual health-care providers have never fully educated themselves about FABM or fully committed to presenting these methods as viable options to drugs and devises. Do they think that most women can’t or don’t want to learn fertility awareness skills? That would be like thinking most girls can’t or don’t want to learn to read.

As I’ve written elsewhere: “Fertility awareness, like riding a bicycle, is a life skill.”

If you can learn to swim, ski or snowboard, knit a sweater, read a balance sheet or master Adobe InDesign, you can learn to observe, chart and interpret your menstrual cycle events. We can all acquire body literacy.

Until sexual health educators and care providers develop programs to fully serve women who won’t use or want to stop using drugs and devises for birth control, we will continue failing to meet the growing “unmet need” for effective non-hormonal contraceptive methods.

The reign of hormonal birth control as the top-of-the-contraceptive-hierarchy gold standard appears to be coming to an end. The pullout generation represents just one thread in this transition. The questions is: Are sexual health educators and care providers paying attention and, if so, what are they going to do about it?

17 responses to “Why the “pullout generation” is a sex ed fail”

  1. James says:

    My own sex ed was less inadequate than most. The separated the boys and the girls. In the boys’ class, Coach told us all that while abstinence was best, if we were going to have sex, that we needed to be using a condom. A lot of the class was about taking responsibility for our own actions instead of thinking about it as a female problem, which was surprisingly progressive considering where I grew up.

    Transition problems are huge, not only between methods, but between life stages: Between singleness and relationships. Between high school and college and beyond. Fewer high school girls are getting pregnant, which is great, but unplanned pregnancy rates for late teens and 20s remain high.

    What I have seen across the board ideologically is a lot of shaming of women, which helps no one. There is both shaming for being sexually active from conservative groups and shaming for not being on hormonal BC from mainstream SRH. Neither listens to the needs of women.

  2. Yes! I talk about “the transition” a lot. Over on the (generally positive towards FABM) Atlantic article I was in the comments with people who were hating on even teaching the methods. Why give access? Why give knowledge? I told them that the transition tends to be when A LOT of unplanned pregnancies happen. Why would you not want to be prepared with another method?

  3. Laura Wershler says:

    Wow! The idea that we should not, must not, even teach fertility awareness so obviously stems from ignorance of the method, and demonstrates unequivocally how badly sexual health educators have failed to support or advance body literacy for women. Don’t these people recognize that they are advocating for with-holding vital information from women about their bodies? Astounding. It’s like advocating not to teach girls to read because they might do something stupid with the wisdom and knowledge they gain.

    And yes, transition between method groups has been completely ignored by sexual health educators. They are big on how to transition between different drugs and devices (which I wrote about last year here: but seem to be in denial that women need information on how to transition from hormonal to non-hormonal methods. And, of course, when they fail, and experience unintended pregnancy, this just confirms that they should never have quit their hormonal method in the first place. Self-fulfilling prophecy. Then women blame themselves, instead of the care-providers who don’t acknowledge their responsibility to help women use non-hormonal methods successfully.

    I’m getting blue in the face saying the same thing over and over again!

  4. My “sex ed” experience was similar to the experience James had in that we, too, were separated by gender. I’m not sure what “talk” they gave to the boys, but the only subjects they touched on with the girls was feminine hygiene products and keeping your face acne-free by washing it regularly…seriously?!

    Now, as an adult who uses FABM, it is so glaringly obvious that a very large part of the problem is an extreme lack of education, both from a sex ed perspective and in terms of information distributed about birth control options. I do not believe that this problem will be solved by placing this burden solely on the shoulders of educators and providers…we, as advocates, must also take matters into our own hands by spreading knowledge in innovative ways and refusing to accept things as they are.

  5. Yes, very frustrating. If 50% or so who initiate hormonal methods don’t stay on them, yet they are only taught that hormonal methods are the responsible choice and everything else is too difficult. Then what?

    I truly believe that a large problem we have is TEACHING people that they are irresponsible with birth control. Self-fulfilling prophecy?

  6. Laura Wershler says:

    Good point, James, about transitioning between method groups at various life stages, which is really what this pullout trend seems to be for women in their late 20s, early 30s in stable relationships. What’s different is that these women a decade ago would more likely have used hormonal birth control right up until they wanted to get pregnant. Now they are done, done and done with the ill effects of hormonal contraceptive drugs.

    I believe it’s time to start teaching about contraception from a non-hierarchical framework: method groups presented side by side, rather than top to bottom, and how to transition successfully between groups must be fully integrated into sexual health education. This will require sexual health educators committing to the idea, finally and completely, that there will always be women who don’t want to use drugs or devises and that it is their job and responsibility to serve these women without judging or trying to dissuade their choices.

  7. I think one of the big problems is that FABMs don’t make money for the providers in the same way that drugs and devices do…so in their minds, why bother taking the time to distribute information about them? It’s absolutely infuriating that women are denied this much-needed care, especially during a time of transition when they are most vulnerable.

  8. But they could. There is no reason why not. They just don’t happen to employ anyone to teach the methods now (in general) because they don’t believe in them (again, overall).

  9. Laura Wershler says:

    Jennifer, I agree that advocates and women themselves are taking matters into our own hands and by so doing creating real change, along with alternative services that are meeting many women’s needs. We are leading the way for educators and care providers.

    The question I keep asking is: Are they going to follow or be left in the dust? It’s really up to them. But I will not cut them any slack: It is the mainstream sexual health community’s responsibility, if it is truly committed to reproductive justice, to sit up, take notice and start better serving women who don’t want to use hormonal birth control.

  10. I wholeheartedly agree that it is the primary responsibility of the sexual health community. Until they adopt a more comprehensive program, this information will never be widely accepted. But we can certainly shift things enough to force them into the realization that they cannot continue down the current path. I love being part of the community that is leading the charge and cannot wait to see the day that this work pays off on a large scale.

  11. Totally agree, Hannah. They absolutely could and there’s really no reason for them not to provide these services. But I do think part of it (aside from their not believing in the methods) is their financial incentives: the cost of training people to teach FABMs + the cost/time associated with teaching patients is very high compared to their typical “here’s a piece of paper with a prescription”. Not a valid reason not to provided needed services, but, unfortunately, many things in our society come down to money and being as financially effective as possible. It’s completely unethical, but, sadly, a current reality.

  12. As an educator, activist and advocate for menstrual health and body literacy, I find myself asking the very same questions. I believe one of the answers is that we need a great many more practitioners who are educated on non-hormonal methods and who can support women to transition (from hormonal methods). And we need to do a better job of marketing our services and fertility awareness generally, we need to make the practice more appealing to modern women and their partners. For better or worse, packaging matters, and women need to feel that it’s a progressive, body-positive option for intelligent, independent women, like themselves.

  13. This is a really great point, Giuliana! I find that many of the women I talk to simply feel they can’t relate to fertility awareness due to stereotypes, myths, etc. Hormonal methods have been around for over 50 years, yet many still see them as “modern”, and I think much of the reason for that is the way they are advertised. Women use hormones because they can relate to the messages and feel it’s the “modern” option.

    If we can continue to change the “packaging” of fertility awareness, I think the barrier to entry will be lowered for many, many women.

  14. Yep, I’ve been working on packaging FAM differently like a mad woman.

  15. Jay says:

    I’ve recently been ‘told off’ for posting a link discussing non-hormonal birth control methods, their argument seemed to be that young women are ignorant so we must put them onto hormonal methods (regardless of the fact they’d be just as ignorant of how this method works) rather than educate them.

  16. James says:

    As the Atlantic article pointed out, fertility awareness “is the secular branch of a much older—and thoroughly Catholic—tree called Natural Family Planning (NFP).”

    While the science is the same, the culture and even the language is very different between many religious groups and many secular groups. People often associate the method with the religion or the very traditional culture around it. It doesn’t help that some religious advocates see their primary job as promoting this culture, and really don’t give the health component the attention it deserves. This can leave couples unable to effectively use the method. Some mix solid science with outright myths, which discredits the whole package.

    This is not to say that all religious advocates are bad with the science—many do an excellent and amazing work—but that this can be a problem.

    If FABMs are to go mainstream, which would help everyone, advocates do need to draw the distinction between what are health issues and what may be a cultural/religious issue. Not in a judgmental way, but simply as a way of clearing up misunderstandings.

  17. […] and more secular feminists are sounding the alarm on hormonal contraception today, and Christians ought to […]

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