Last night in our church small group, somehow (don’t ask) the topic of family planning came up. One of the couples said, “our friends got pregnant using “natural family planning” and the doctor said, “do you know what we call couples who use that method? PARENTS.”

Everyone laughed.

But it bugged me.

I feel fairly strongly about the following:

a) Everyone should be able to do their own research about how to have safe sex and/or avoid/plan to get pregnant.

b) Women who want to take the Pill should be able to take the Pill. Those who do not want to take the Pill SHOULD NOT HAVE TO TAKE THE PILL.

c) Aside from the Pill – taken here to mean an estrogen-containing oral contraceptive – there are other family planning methods available that are effective (or not effective) for family planning. These include the following:

1) Progesterone-only Pill – aka the “minipill”, or “POP”. Does not contain estrogen. Very prone to failure, as it is a tiny dose of progesterone that must be taken at the *exact* time every day. (Estrogen pills should be taken at the exact time every day, but they are *slightly* more forgiving of slight discrepancies in the time one takes them.)

2) IUDs. There is the copper IUD and the Mirena IUD. The copper IUD has no hormones. The Mirena IUD has progesterone which is released “locally” (although really, everything *does* circulate, but it is said to release a very very low concentration of progesterone). Both are extremely effective. The copper IUD tends not to affect periods/blood flow and the Mirena IUD tends to lighten or eliminate periods.

Once they are removed, they convey no protection against pregnancy.

I had a Mirena for almost 2 years. It was good. It stopped my periods, which was the goal. Unlike a lot of women who have it, I really had no other side effects and I thought it was fine.

3) Barrier methods: condoms, female condoms, diaphragms, cervical caps. All of which have varying rates of efficacy (the diaphragm and cervical cap being among the worst because they can slip, and the woman has no idea that it has slipped, followed closely by the female condom). (I don’t know why the female condom sucks. I’ve never used one, and they are very expensive compared to male condoms. According to this article, they are difficult to place, which probably means they aren’t used properly in practice.)

The male and female condoms are the only birth control methods that can protect against sexually transmitted diseases.

4) Abstinence. I love how this is mentioned in every birth control efficacy chart. Of COURSE this is 100% effective…until it is no longer the game plan. Remember that line from Anchorman? “They’ve done studies, you know. 60% of the time, it works all the time.”

Ha. I crack myself up.

5) Other hormone-containing things, like the Patch or the Ring.

I tried the Ring. I hated it. It fell out constantly. But it has its enthusiastic fans, too.

6) More hormone-containing things, like the Shot (Depo-Provera). Has only progesterone, given by injection every three months.

This freaks me out because it is something circulating in the body for 3 months. What if you hate it? You can’t clear it out of your system, and you have to wait for 3 months! However, it is a good option for people who can’t remember to take the Pill, or people who can’t take estrogen.

7) Natural family planning methods. AKA: Non-hormonal, non-invasive methods.

And here we get on a soap box.

The options:

1. The pull-out-and-pray method (aka coitus interruptus). Does this require further explanation? Issue: Sometimes there are spermies in the pre-ejaculate. The part that escapes prior to the guy knowing to pull out.

2. Rhythm/calendar method: Where a woman starts counting her cycle days from the first day of menstruation, to day 14, when she assumes she ovulates, avoids around that time, and assumes she is safe the rest of the month.

This just doesn’t make sense.  All women are different.  Their cycle lengths are different, their bodies are different, and very few women actually ovulate on the 14th day of their not-likely-to-be-28-day cycle.

3. Natural family planning (NFP)/Fertility Awareness Method (FAM). (Yes, I am lumping the two together for purposes of this post. I’m sorry to anyone I offend.) Differentiated by the fact that FAM users employ backup methods, like condoms, during fertile phases of the woman’s cycle. NFP traditionally employs abstinence during these times.

Birth control method charts make this method of family planning look foolish, which only contributes to the types of jokes circulating in doctor’s offices. The number of health-care professionals I have had to explain this method to is appalling…friends of mine who use the calendar method, the pull-and-pray method, who think that we are insane for planning the way we did for the time that we did it. So here I go: my plug.

It is my opinion that every woman on this planet should have access to this information.

It is NOT my opinion that every woman/couple on this planet should employ this method of birth control for a billion reasons:

1) It takes planning, awareness, preparation, and, at times, restraint. The fertile phases of a women’s cycle also tend to be the most sexually arousing. Couples prone to spontaneous unprotected sex would be very, very poor matches for this method of birth control.

2) It requires that the woman read a lengthy book and understand what is going on in her body.

3) It requires that the woman consistently check her temperature and interact with her body in ways that may be uncomfortable for her.

4) It requires that the couple be on the same page in terms of protecting/avoiding during fertile periods (if avoiding). This is *not* always the case in many relationships. It is the sad reality that many sexual relationships are not characterized by negotiation, understanding, and love, and in those relationships, where the woman cannot guarantee that she will always be able to avoid/protect during fertile periods, this method is not appropriate.

That being said, this method is extremely effective when used appropriately and correctly.

It takes into account temperature charting (basal body temperature – temperature first thing in the morning), cervical mucus, and cervical position. Those three signs, combined with a commitment to using condoms or abstaining during the fertile period, constitute a form of birth control that is more effective than almost any other method (other than abstinence entirely, IUDs, or permanent sterilization).

We used this method exclusively for two years of avoiding. We didn’t get pregnant during those two years, but I wasn’t sure if it was because I was infertile or because the method was effective. (Then I had the Mirena IUD placed to reduce my menstrual flow because I was getting too anemic.) When we started trying, we achieved pregnancy on the first full cycle of trying.

That is not to say that everyone using this method will find that it works well when TTC. But it *will* help a woman determine the length of her luteal phase (a critical factor in a successful pregnancy), whether she is ovulating, or whether there might be some other underlying factor in the inability to conceive. It will help a fertility specialist in trying to help a couple who seek to become pregnant.

I will also say that DB and I practice this method in the *most* conservative way: we use a condom/avoid on the days that I know I am fertile and/or THINK that I MIGHT be fertile. I think this has contributed to our success for those two years and again in the last 4 months, when avoiding pregnancy has been critical (due to the type of pregnancy loss we had).

This book changed our (my husband and I) lives for the better:

And apparently, 1000 women agree with me (see reviews for the book on Amazon!).

It is long, and it is comprehensive, but it is absolutely the best book on women’s bodies, fertility, and practicing reliable birth control without pills or implants or medical intervention. It is also a great book for learning about conception. I cannot recommend this book highly enough. I believe that *everyone* should have a copy, even if the Pill is the best option for them.

So here is my point:

If you look at that article I linked to, above, and look at the efficacy rates of any of these methods, they all seem scary, with the exception of the permanent/fixture-type (IUD) methods.

However, this method is different in that its efficacy rate is based upon reading natural signs/symptoms of the body, understanding them, and acting accordingly. Which means that efficacy rates will take into account all of the issues noted above (women unable/unwilling to chart effectively, unable to negotiate terms with partner, unable to abstain/protect at fertile times).

Which means that the data – as is the data with almost any BC method (ie, the columns for “perfect” versus “typical” use) is skewed. Couples using a condom every time but the one time she is fertile screw up the statistics. Couples who are on the Pill except for the two days she forgets it screw up the statistics.

In short, they are all prone to failure. And they are all prone to not-failure. It depends on the user’s level of commitment to the method.

And, a word on God and His will for people getting pregnant:

We all know of the couple that got pregnant using this method. Our friends did. Our friends friends did. No question, it happens.

But if you ask them, honestly, if they knew the possibility existed when they conceived that child? I would guess that the vast majority would say yes (although you’d have to be a close friend to ask!!) Our friends said that they were pretty sure they wanted a child, and they just “kind of stopped paying attention”.

OF COURSE one runs the risk of getting pregnant with this method if they “stop paying attention”!

And this also means – if you get pregnant, it is not because “God wanted you to have a baby!” No. With the number of infertile couples out there, I do not believe that God has any personal desire for one couple to easily get pregnant and another couple to struggle for years. I’ve talked about this (probably ad nauseum) before.

No, God created women’s bodies to be able to carry a child and God created men’s bodies to be able to father a child. But God wants us to be smart about what we know, too. Getting pregnant because the couple was not paying attention is not necessarily God’s will for their family’s growth. That is people having sex at the appropriate point in the woman’s cycle, resulting in a fertilization event that will ultimately become a baby.

But can we say that it is God’s will that adoptive mothers relinquish their child? That it is God’s will that a child suffer abuse, or trauma, the family they were born into? That it is God’s will that a pregnancy ends tragically in a loss?

NO.

Stepping off of soapbox now…

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