People have been paying attention to their menstrual cycles for the purposes of conception and contraception for ages, but it’s only in relatively recent years that our understandings have been paired with the likes of specific “method” names, clinical trials, efficacy rates, certified instruction, and public health education.
As these methods and the communities around them evolve, we find ourselves at a pretty unique and interesting time for the language of fertility awareness. For most of us, we learned a method of fertility awareness that we refer to as FAM (Fertility Awareness Method). However, the use of that blanket term allows some important details to get lost in translation. As you share the glorious power of fertility awareness with your friends, family, and communities, you may become aware of how frustrating these particular “mis-translation” challenges can be.
Maybe your friend’s grandmother used and conceived four times on the Calendar Rhythm Method 50 years ago, and she calls it the Fertility Awareness Method. Now your friend wants nothing to do with your insistence that Taking Charge of Your Fertility belongs on her reading list.
Maybe your mother who works in global health reads about how USAID is using the Standard Days Method to teach people in other countries about family planning without medical interventions, and they call it “FAM.”
And then, here you are, taking your temperature every morning and diligently checking the consistency of your cervical fluid in order to confirm ovulation. And you call that FAM.
The truth is, they’re all correct. They all involve being aware of the timing of fertility during the menstrual cycle, which is what it takes to be a “Fertility Awareness Method.” In fact, FAM generally exists in the plural: Fertility Awareness Methods, but this gets lost in the acronym and in common usage. This poses some obvious challenges. Your friend thinks that your FAM is the same as the one her grandmother used, and has no idea why you would trust it. Maybe your doctor thinks your FAM is the same as USAID’s Standard Days method, and so doesn’t know how to support you in your chosen method.
This is also an issue for efficacy rates. Should the SymptoThermal Method’s rate be calculated in with the Standard Days methods’? Anyone familiar with the methods would say no, but that’s not what’s happening -- they’re all being lumped in to “fertility awareness” by the Center for Disease Control’s official efficacy ratings. There’s actually a petition against the practice of lumping these methods, so that the data on each method can be more easily found and understood.
Enter, FABMs: Fertility Awareness Based Methods. FABM gives us language to refer explicitly to the category of methods, and also naturally invites and enables us to speak more particularly about the specific method we are referring to (an excellent practice to get into, as this more specific language can enable both accurate media coverage and public perception, and support new users to get better oriented in the strange new world of all that is fertility awareness).
This family of FABMs uses careful calculations around cycle length, average ovulation days, and menstruation timing to estimate the days of highest statistical probability of ovulation and the fertile window (during which time conception is possible). These are the least reliable of the FABMs because you don’t watch your own body’s signs each cycle, but we have enough data on average ovulation timing that these methods are still much more effective than a shot in the dark. These include* the Standard Days Method/Cycle Beads and the Calendar Rhythm Method.
This family of FABMs focuses specifically around cervical fluid observations for both the opening and closing of the fertile window. These include* the Billings Ovulation Method, Two-Day Method, the Creighton Model.
This family of FABMs uses only basal body temperature and menstruation/start of cycle observations, and relies on averages at the beginning of the cycle. Devices such as* the Daysy Fertility Monitor, Lady Comp Fertility Calculator utilize this method.
This family of FABMs focuses on both cervical fluid -- for the opening of the fertile window -- and basal body temperature -- for the closing of the fertile window. These include* the Justisse Method, Sensiplan, SymptoPro, and Taking Charge of Your Fertility method. Kindara was designed with these methods in mind, so it's perfectly set up to chart peak cervical mucus days, basal body temperature charges, as well as some of the STM's secondary fertility signs such as cervix position and vaginal sensation.
This family of FABMs uses tests to analyze hormonal levels that predict and/or confirm ovulation, most often in addition to cervical fluid and/or basal body temperature observations. These include* the Marquette Model and FEMM.
* Important note! These lists are only a basic guide, and some of these methods have various options where you can observe more or less about your fertility signs (and follow slightly different rules, accordingly), which would bump them to a different category. Please research each method carefully for more detailed information!
There’s one more term that often comes into the mix, which is “Natural Family Planning” or NFP. NFP is an older term than FAM or FABM, but it is also a more specific term that does not encompass all FABMs usages, so the terms cannot always be used interchangeably. Several of the above methods are considered NFP methods, which means that they have been studied and are practiced with the additional parameter of abstinence in the fertile window -- a characteristic of NFP Methods, but not inherently of FABMs. So, anyone using an NFP method is practicing a FABM, but not all FABM users are practicing NFP. NFP methods' requirement for abstinence during the fertile window makes it an acceptable birth control option under certain religious restrictions against inhibiting conception in specific ways.
In short: FABMs require identifying the fertile window or days. NFP requires identifying the fertile window or days, and abstaining during them.
Some methods listed are originally NFP (ex. Creighton) and any use of methods other than abstinence (ex. barriers, withdrawal) during the fertile window are not included in the NFP distinction nor the efficacy rates found in the studies where abstinence was observed in the fertile window.
These methods have a somewhat wide range in efficacy rates, which this table (from FACTS’ 2016 document titled “FABMs: A Medical Update”) outlines. The methods listed are the FABMs with research published in peer reviewed journals, according to FACTS, which refers to the methods having been examined in research that has been approved by a scientific community, not merely an individual. This is an important factor for scientific legitimacy.
Table 1 (via FACTS, 2016). For more information on perfect use/typical use, check out this blog post.
It becomes clear that the FABM distinction is critical when we examine the media hype around the use of “FAM” in a leaked White House memo. For starters, it wasn’t clear what methods were actually being discussed – was this is 2 Day Method, or SympoThermal? The mainstream media largely assumed that the less statistically reliable methods were what was being referred to – and no particular fault to them, methods similar to rhythm are FABMs and so the concern is valid! However, the whole group of methods was thrown under the bus in reporting, largely because the distinction wasn’t made.
This issue happens often in less dramatic ways -- back up to that scenario of your friend not wanting to use FAM because her grandmother uses the rhythm method unsuccessfully.
FABM may not have the pronunciation-ease of FAM, (fa-bam?!) but the distinction is critical for allowing these methods to gain further cultural traction, and for people exploring FABMs as a birth control option to clearly understand the nuance between them.
In what spaces do you discuss FABMs? Here’s a challenge: drop the word “FAM” or “FABM” unless you are truly and intentionally referring to every method of conception and contraception that function on an awareness of fertility. If you mean a specific method, say it! Let’s talk the way we want the media, public, and CDC to talk about FABMs.
What would it look like to truly have a shift in the language, so methods are identified by their accurate and specific names? As the language of the FABM community evolves, this clarity will be cornerstone to helping people understand their options within the spectrum of fertility awareness based methods.
Methods categorized and Table 1 via sources from FACTS: