What is the effectiveness of natural or behavioral methods of birth control?
There are a variety of options when choosing a natural or behavioral type of birth control. These include:
Continuous abstinence: Continuous abstinence implies completely refraining from sexual intercourse.
- Effectiveness: It is 100% effective in preventing pregnancy.
- Pros: There are no hormonal side effects.
- STDs and continuous abstinence: This type of birth control prevents sexually transmitted diseases (STDs).
Withdrawal method (coitus interruptus intimate): The withdrawal method involves withdrawal of the entire penis from the vagina before ejaculation (before sperm leaves the penis). Fertilization is prevented because sperm does not contact the female partner's egg. This method remains a significant means of fertility control in less advantaged countries.
- Effectiveness: This depends largely on the man's capability to withdraw prior to ejaculation. The theoretical failure rate is estimated to be approximately 4% during the first year of proper usage of this method. The true failure rate probably approaches 19% during the first year. The failure rate implies that the method is ineffective in preventing pregnancy, and some couples using it will conceive. The higher the failure rate, the more likely a woman is to have an unintended pregnancy.
- Pros: This method can be used at any time, with no devices, cost, and no chemicals or hormones. It may also offer a lower risk for other problems.
- Cons: There is a high risk for unintended pregnancy.
- STDs and withdrawal: This method does not protect against sexually transmitted diseases (STDs).
Natural Family Planning: Natural Family Planning (NFP), endorsed by the Couple to Couple League, is one of the most widely used methods of fertility regulation, particularly for those whose religious or cultural beliefs do not permit using devices or drugs to prevent pregnancy. This method involves periodic abstinence (no sexual intercourse), with couples attempting to avoid intercourse during a woman's fertile period-around the time of ovulation. Ovulation refers to the release of an egg by one the ovaries during a woman's menstrual cycle. The current method of NFP taught by the Couple to Couple League and other organizations is called the symptothermal method. NFP has advantages and disadvantages:
- Effectiveness: The Couple to Couple League states, "the Sympto-Thermal Method of Natural Family Planning can be used at the 99% level of effectiveness in avoiding pregnancy." If a couple takes chances and has intercourse during Phase II, the fertile period, their odds of pregnancy increase dramatically. In August, 2002, the U.S. Food and Drug Administration (FDA) reported a failure rate of 20 pregnancies per 100 women per year for periodic abstinence. This figure did not differentiate for particular methods of periodic abstinence. The American College of Obstetricians and Gynecologists (ACOG) lists a higher failure rate for periodic abstinence of 25%. Again, this figure does not differentiate for the type of periodic abstinence.
- Pros: No harmful effects from hormone use occur. This may be the only method acceptable to couples for cultural or religious reasons. NFP methods can also be used to achieve pregnancy.
- Cons: This is most suitable for women with regular and predictable menstrual cycles. Complete abstinence is necessary during the fertile period. This method requires discipline and systematic charting. It is not effective with improper use. To use this method effectively, a woman or couple should be trained by a medical professional or a qualified counselor. A relatively high failure rate has been reported.
- STDs and NFP: This method does not protect against STDs.
Fertility Awareness Method: Women who use the Fertility Awareness Method (FAM) monitor body temperature and characteristics of cervical mucus similar to those who practice NFP. However, women using FAM may either avoid intercourse or use a backup non-hormonal method of birth control, such as a condom, during the fertile period. Women using the FAM monitor 3 primary fertility signs: basal body (waking) temperature, cervical mucus, and cervical position. Intercourse is not considered "safe" unless all of these conditions are satisfied. It is recommended that 2 full cycles be charted before this method can be relied upon. FAM has advantages and disadvantages.
- Effectiveness: If a couple has intercourse without using backup protection during the fertile period, the odds of pregnancy increase dramatically. In August, 2002, the FDA reported a failure rate of 20 pregnancies per 100 women per year for periodic abstinence. This figure did not differentiate for particular types
- Pros: No harmful effects from hormone use occur. FAM methods can also be used to achieve pregnancy.
- Cons: Complete abstinence without back-up protection is necessary during the fertile period. This method requires discipline and systematic charting. The method is not effective with improper use. For maximal effectiveness, a woman or couple should be trained by a medical professional or qualified counselor. A relatively high failure rate has been reported.
- STDs and FAM: This method does not protect against STDs.
Rhythm method: Couples who practice the rhythm method, also called the calendar method, decide when to abstain from intercourse based on calendar calculations of the previous 6 menstrual cycles. However, allowances are not made for the normal variations in the menstrual cycle which many women experience. This method is not as reliable as the symptothermal method of NFP or FAM.
Cervical mucus method: Also called the ovulation method, the cervical mucus method involves monitoring changes in cervical mucus, but without also recording basal body temperature and/or menstrual history. The safe period is considered to be any dry mucus days following menstruation, as well as the 10 or 11 days at the end of the cycle. Days of menstrual bleeding are deemed to be safe, but pregnancy has been reported following intercourse during menstruation. Vaginal infections, sexual excitement, lubricants, and certain medications can significantly affect the accuracy of cervical mucus assessment.
Basal body temperature method: This method involves monitoring basal body temperature only, without also observing changes in cervical mucus or other signs. Sex is avoided from the end of the menstrual period until 3 days after the increase in temperature.
Breastfeeding and birth control: After the birth of a child, certain hormones prevent a woman from ovulating if she is breastfeeding. The length of time ovulation is suppressed varies. It depends on how often the woman breastfeeds and the length of time since the baby's birth. Ovulation usually returns after 6 months despite continuous nursing.
Breastfeeding used for birth control is also called the lactational amenorrhea method (LAM). When menstrual period resume following pregnancy, another form of birth control is needed.
- Effectiveness: ACOG reports this method to be 98% effective in the first 6 months after delivery if the above criteria are met. Once menstrual bleeding resumes, the risk of pregnancy increases greatly.
- Pros: A woman has no menses during this time.
- Cons: The return of fertility cannot be accurately predicted. Frequent breastfeeding may be inconvenient. This method should not be used if the mother is HIV positive.
- STDs and breastfeeding: Breastfeeding does not protect against STDs.