Why Fertility Awareness Methods (FAMs) Based on Periodic Abstinence (PA) Only Cannot Be the Solution to the Need for Contraceptives Worldwide

WICR is the only Catholic institution in the world to have put together the most comprehensive explanation, based on the scientific evidence, of why “natural” methods based on periodic abstinence cannot work on a global level.

What follows is a summary of section 2 “Fidelity to the Good – Real Life Impact of Revising HV” of the interim report WICR sent in August 2017 to the Pontifical Academy for Life. The conclusions below are based on evidence which has been fully referenced in the interim report.

– FAMs are largely marketed and used simply as fertility trackers to more accurately target the use of barrier methods (generally condoms), rather than to abstain during the fertile window.

– FAMs based on “periodic abstinence” (PA) alone (i.e. without complementary use of condoms during the fertile period) have a relatively low population-level typical-use effectiveness, that is, they display a relatively high population level typical-use failure rate, approximately 25%. In other words, one in four women using them who is trying to avoid a pregnancy will become pregnant within one year.

– Worldwide, the vast majority of women (and men) in reproductive age cannot identify when a woman’s fertile period is, and that includes users of periodic abstinence methods who necessarily rely on identifying ovulation. This is likely to be one of the reasons why PA users have such a relatively high failure rate.

– Almost 50% of all unintended pregnancies worldwide ends up in abortion, and this percentage does not vary significantly between developing and developed countries. For this reason, it has been found that PA users, despite being just less than 3% worldwide, are in fact directly responsible for about 16% of all abortions due to contraceptive failure.

– Generally speaking, FAMs are not suitable for women who have an irregular monthly cycle. To help you put this into perspective, and show how huge a drawback this is, even the relatively recent Standard Days Method/CycleBeads™, strongly pushed by the Holy See, is unsuitable to close to 50% of women due to their cycle not being “regular” enough for that method!

– All FAMs (including one as relatively recent as the Standard Days Method/CycleBeads™) require a relatively long period of abstinence, i.e. almost half (!) the monthly cycle (i.e. a minimum of 12 days, and more often about 14-15 days).

– Linked to the above is the not surprising conclusion, again substantiated by recent evidence, that PA users have much less sex than users of modern contraceptives. Use of FAMs decreases coital frequency, while use of modern contraceptives is associated with higher coital frequency.  In not a single country out of the 55 surveyed [in a recent global study] women who did not use contraception [i.e. PA users] were having more sex than those who did.

This is why it is likely that the very tiny minority using PA methods (less than 3% worldwide) only uses them because they are older couples who for one reason or another do not have sex that often, and so can cope well with the long periods of abstinence required (approximately half the time every month, as noted).

The fact that PA requires such long periods of abstinence is the reason why most FAMs are generally used to as fertility trackers to know when to use condoms, rather than when to abstain.

– Even newer FAMs are still relatively inaccurate in tracking the fertile window even of women who have a regular cycle. This is because, for FAMs to work, they need to be able to predict the time of ovulation approximately a week before it occurs (the ovum only survives 24h at most, but the sperm can survive for up to six days – hence the “fertile window” is considered to be up to a week at most). Clearly, predicting ovulation a week in advance has an inherent and significant margin of error. In order to be on the safe side, all FAMs tend to overestimate the duration of the biological fertile window. As a consequence, they require sexual abstinence for a longer period – almost half the time each cycle – than what would be required by the biological fertile window.

– Acceptability and continuation rates are very low. “NFP methods are not all that easy to provide or to use,” as Dr Richard Fehring, a Catholic and long-time researcher of NFP and the developer of the Marquette Method, recently observed.

Of the above findings, the two that should carry most weight with the Vatican should be the one showing that PA users, despite being just less than 3% worldwide, are in fact directly responsible for about 16% of all abortions due to contraceptive failure, and the one that access to free and effective contraceptives significantly reduces abortion rates.

Conservative Catholic news outlets and think tanks as well as official Catholic officials and institutions (e.g. the Pope, the Permanent Observer Mission of the Holy See to the United Nations) consistently ignore those findings, indeed even argue the opposite – namely that contraception increases abortions – and continue pushing for PA methods.

For instance this recent speech by the Permanent Observer of the Holy See to the United Nations pushes for the adoption of FEMM, i.e. the training program on FAMs which takes its name by the small conservative Catholic think tank FEMM. No mention is made of the fact that PA users are responsible for a disproportionate percentage of all abortions due to contraceptive failure.

From that viewpoint, it is important to point out to them that “A culture of life requires an ethics of contraception.”