Global Health Commentary Argues Fertility Awareness as a Modern Contraceptive

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At the end of January, Global Health published an article advocating for Fertility Awareness Methods (FAMs) of birth control to be considered “modern” means of family planning, citing the many advantages of FAMs for women and their communities.

But this wasn’t just any article: it was designated “the technical position of the Office of Population and Reproductive Health of the United States Agency for International Development (USAID).” USAID is the U.S. government agency that works to end extreme global poverty through the political lens of foreign policy. Their Office of Population and Reproductive Health focuses on tasks like increasing global access to family planning resources, protecting the health of mothers and children, advocating for reproductive rights, and improving women’s opportunities for education and jobs.

It’s exciting to see that they’re advocating for clarity and accuracy about the effectiveness of FAMs. In the article, they explain:

“USAID aims to help countries meet the contraceptive needs of their people. Key to achieving this aim is expanding access to a wide and diverse method mix. USAID continues to support countries and the global family planning community in their efforts to incorporate modern methods, including FAMs, into the contraceptive method mix. The more contraceptive choice we can afford to women and men, the better equipped they will be to achieve their reproductive intentions. Key to expanding contraceptive choice is overcoming misconceptions.”

Sounds like an admirable intention! And most FAM users know about those common misperceptions. As anyone who has tried to explain fertility awareness to a friend knows, falsehoods and confusions about FAMs are everywhere. Now consider that effect on a global scale: USAID critiqued a World Health Organization study for framing the practices as “traditional” rather than “modern.” This leads, they argue, to FAMs being excluded from training, funding, and educational contexts, as well as neglected in monitoring and data collection: “If users of FAMs are not counted as modern contraceptive users, we as a community are failing to recognize a valid and important choice to meet client needs—what gets counted gets supported.”

Why do they think FAMs should be considered modern? The authors list a few great reasons. FAMs, they say:

·       Are effective at pregnancy prevention,

·       Are safe,

·       Are based on a sound understanding of reproductive biology,

·       Include a defined protocol for correct use, and

·       Have been tested in appropriately designed studies to assess effectiveness under various conditions.

And they even go into listing the benefits that put FAMs a step above other methods:

·       They do not require clinical intervention, such as hormones, devices, or procedures.

·       They are controlled by a woman and her partner.

·       They increase a woman’s understanding of her fertility and biological processes.

·       [Some FAMs] provide the opportunity to facilitate pregnancy planning.

·       FAMs can be offered through a wide variety of channels, including settings completely outside the health system.

What a great sell, both on a local scale and a global scale!

That said, what could make this article even better? Well, it doesn’t talk about symptothermal method (STM) of FAM at all. It discusses Lactation Amenorrhea, which is for breastfeeding women, the Standard Days Method (SDM), and the Two Day Method (TDM). Both the Standard Days Method and the Two Day Method are fairly recently developed shortcut methods, based on huge samples of cervical fluid and cycle data, that are easy to teach to large groups. They have fairly high “perfect use” success rates (95%, SDM and 96%, TDM), and “typical use” rates (88%, SDM and 86%, TDM) in line with the “typical use” rates of condoms and other barrier methods (cited in Malarcher et al., 2016).

Symptothermal method has been shown to have slightly higher rates: a 98.2% success rate overall or with other methods used during the fertile days (Mims, 2007), and a 99.6% “perfect use” success rate when complete abstinence is observed during the fertile days (Mims, 2007; P. Frank-Herrmann et al., 2007; Planned Parenthood). STM is the most effective, but teaching charting also requires more education, bodily awareness, and time.

Hopefully the symptothermal method can make its way into global family planning, offering deeper education and accuracy, and corresponding success rates. For now, it’s great to see FAMs, in general, being advocated for by a government organization! Their desire to keep these methods on the “modern” list ensures that FAM educators and supporters will get the attention, research, and resources they need to offer its most sophisticated and empowering methods to women worldwide.

FAM on!

{Check out the whole article: http://www.ghspjournal.org/content/early/2016/01/24/GHSP-D-15-00297}

 

Citations:

Fertility Awareness-Based Methods. (2014). Planned Parenthood. Retrieved from               https://www.plannedparenthood.org/learn/birth-control/fertility-awareness

Frank-Herrmann, P., Heil, J., Gnoth, C., Toledo, E., Baur, S., Pyper, C., . . .  Freund, G. (2007, Feb 20). The effectiveness of a fertility awareness based method to avoid   pregnancy in relation to a couple's sexual behaviour during the fertile time: a prospective longitudinal study. Human Reproduction, 22 (5), 1310-1319. doi:10.1093/humrep/dem003. Retrieved from http://humrep.oxfordjournals.org/content/22/5/1310.full

Malarcher, S., Spieler, J., Short Fabic, M., Jordan, S., Starbird, E. H., Kenona, C. (2016). Fertility awareness methods: distinctive modern contraceptives. Global Health: Science and Practice. doi: 10.9745/GHSP-D-15-00297 Retrieved from http://www.ghspjournal.org/content/early/2016/01/24/GHSP-D-15-00297

Mims, C. (2007, March 26). Modified rhythm method shown to be as effective as the pill—but who has that kind of self-control? Retrieved from http://www.scientificamerican.com/article/periodic-abstinence-natural-family-planning-stm-as-effective-as-the-contraceptive-pill/

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