Every birth control method has its downside, but practicing Fertility Awareness also has some unexpected perks. Birth control doula and fertility expert, Hana Askren, gives us an intimate look at the practice.
Q1: Walk us through the basis of the Fertility Awareness Method.
A: There are several different Fertility Awareness-based Methods (FABM) that all involve observing and charting signals such as basal body temperature, cervical fluid and cervical position throughout the menstrual cycle. You can interpret your charts to figure out when you ovulate and determine when you are fertile and when you are infertile.
People can use one of these FABM to achieve a goal, whether that is avoiding pregnancy, conceiving, or diagnosing hormonal or fertility issues, but I think the value of simply practicing awareness is often overlooked. You don’t have to be sexually active, partnered, or heterosexual to benefit from becoming familiar with the physical and nonphysical changes you experience throughout your cycle. Practicing that kind of mindfulness brings us into deeper relationship with ourselves and with nature.
Q2: Can you give us a brief overview of the various methods?
A: There are several methods that involve charting cervical fluid, basal body temperature, or both, in order to identify fertile and infertile days.
Some methods are based on identifying and charting cervical fluid, which can be dry, sticky, watery, slippery, stretchy, etc. The cervical fluid-only methods rely on charting these observations to identify both your fertile and your infertile patterns. One of the main rules to avoid pregnancy is to abstain or use a barrier method until the fourth dry day after the most fertile fluid is observed.
The symptothermal method involves charting cervical fluid, cervical position and texture, and basal body temperature, which is your waking temperature before you start moving around and doing daily activities. Observing these and other fertility signals can often give a more accurate picture; for example, a sustained temperature rise can confirm you have ovulated. Cervical fluid can only tell you whether your body is gearing up to ovulate but cannot confirm it has happened.
The standard days method, sometimes called the rhythm method, is often categorized as a FABM but I believe this is incorrect. The standard days method involves abstaining or using a barrier method for a fixed number of days each cycle, and does not involve observing or charting fertility signals. Therefore, while it may be a method of natural family planning, it is not a Fertility Awareness method.
Related: Benefits and Risks of IUDs
Q3: People often talk about the failure rate. What are some of the pitfalls?
Failure rates for evidence-based FABM have been reported to be between 1-5% with “perfect use.” The CDC’s reported failure rates of approximately 24% are inaccurate, as they include people who were practicing FABM as well as people who were practicing some other non-awareness-based methods such as the rhythm method.
Learning the method incompletely, using apps in lieu of true awareness practice, and being fooled by anomalous high temperatures can be some of the pitfalls. The body’s signals are rarely smooth and even a clear chart will have some noise in the form of pre-ovulatory temperatures above coverline or a “step-up” pattern indicating ovulation that takes more than three high temperatures to confirm. Illness or fever, or drinking alcohol the night before can cause temperatures to be abnormally high.
People need to be careful about confirming ovulation too quickly if there are any questions or doubts, especially before they have become intimately familiar with their own personal pattern. This is where apps can trip you up; a cautious, considered human intelligence is always going to be better than a machine intelligence. Also, people can be fooled into thinking they can easily learn the method by themselves, without instruction. Help and guidance from a FABM teacher is indispensable.
Practitioners also need to have a clear strategy for the infertile times of month. Do you use a barrier method? Do you abstain? You and your partner must be on the same page and you must be able to find sexual fulfillment in your relationship, whatever you decide.
I would also caution against being too goal-oriented or ends-oriented. FABM succeeds best when you view it as the cultivation of a state of mind and an ongoing practice that has immediate rewards by itself, rather than as a means to an end. The technocratic, ends-focused orientation can lead you to eliminate or overlook the joy and richness of learning to know and respect deep truths about human cycles and your own participation in nature’s complexity. It can lead to failures too, as lack of appreciation for the process can lead to errors in observation or interpretation.
Q4: It sounds like a lot of anxious abstinence. Is that what it’s like in practice?
Not at all! Practicing FABM — whether for birth control or for another reason — is a delightful exercise in self-awareness and appreciation of your own body. You get to know the cyclical patterns of your body and mind, and if you have a partner, they get to share in the knowledge and discovery. After you get the hang of the primary fertility signals, there is a world of secondary signals out there. You may notice that you always have six hours of intense chocolate cravings before you ovulate… Or that you have vivid dreams at a certain time of the month… Or that your partner can smell when you are fertile. (Keep charting the primary signals, though!)
Using FABM for birth control is incredibly freeing. It frees us from putting drugs in our bodies, it frees us from the health risks of the pill, it frees us to find out what our bodies are actually doing instead of trying to fit into a box, and it frees us to accept our ups and downs. It does require us to give up some of our modern cultural habits of instant gratification, but that can free us to explore other ways of being intimate, and there is so much we get in return.
Q5: How would you introduce FAM to someone new to it?
I would say, you are learning a practice that will deepen your mindfulness and your understanding of all rhythms, not just your monthly cycle. I would say, chart faithfully every day and trust that patterns will emerge.
And I would say, if you are using a FABM for birth control, please use a barrier method until you have a minimum of six to 12 months of consistent charting behind you, and some help from a teacher!
Q6: Why practice fertility awareness at all?
The main practical benefit to using FABM for birth control is that you can avoid hormonal drugs and all their side effects, some of which can be serious. Incidentally, one extremely common side effect of hormonal birth control is a low libido. Many people find their libido starts roaring when they get off the Pill — a great thing in my mind, provided you can remember to use a barrier method when you are fertile.
But I believe there is a larger reason to practice awareness, whether or not you are sexually active, a reason that everyone, including young people, old people, and people of all genders should know the basics of fertility awareness.
All of life is cyclical. When you tune in to your own rhythms you become aware of other rhythms too. You may notice how your sleep patterns change according to the season, or how your appetite changes throughout the day/night cycle. Your partner may notice changes you weren’t even aware of. You may gain more respect for and awareness of the longer rhythms of the life cycle, from menarche through menopause.
Q7: What resources do you recommend?
It can be tricky to get accurate info about FABM, particularly for use as birth control. I recommend beginning by reading at least two to three books about the method, with Toni Weschler’s, Taking Charge of Your Fertility, as the essential base resource.
I also recommend joining — or creating — a community of people around you who can support your practice and help you interpret charts. Ideally this should include a range of experience.
At least some one-on-one coaching and consultation is essential for most people to successfully learn a method.
To get started, check out Fertility Awareness in the Wild, Hana’s ebook created to walk with you as you go on your fertility awareness journey.
Hana Askren is a mother of two, a financial journalist by day and birth doula by night, a Jew who lives with Quakers, and a former Olympic hopeful in freestyle wrestling. Before she was a birth doula, she was a birth control doula, and she has practiced FAM and helped others with their birth control dilemmas for 15 years. Her highest values are self-determination and autonomy, as well as relationship, gratitude, community, and spirit. You can find her and her free fertility handbook at www.hanaaskren.com.