Introduction
When used as contraception, fertility awareness-based strategies (FABMs) depend on the flexibility to trace ovulation to forestall being pregnant. FABM is an umbrella time period for a wide range of strategies used to foretell fertile and unfertile days through the menstrual cycle. Some contraceptive customers could select to make use of these strategies due to a non secular objection in direction of contraception involving medicine, gadgets, or surgical procedures, whereas others could desire hormone-free strategies of contraception. Oftentimes, customers mix FABMs or use them along side different types of contraception equivalent to condoms. These strategies are much less efficient at stopping being pregnant than different types of reversable contraception such because the oral contraceptive tablet, IUD, and implant.
Lately, FABMs have gained consideration following the elevated unfold of misinformation about hormonal contraception on social media, in addition to Challenge 2025’s name for an increased deal with FABMs within the Title X program. Moreover, the Trump administration has announced that $1.5 million of Title X funding will likely be spent on fertility coaching facilities geared toward addressing infertility by approaches equivalent to FABMs. This reality sheet offers an summary of FABMs and their efficacy charges and discusses related prices and insurance coverage protection of those strategies.
Fertility Consciousness-Primarily based Strategies
On common, every menstrual cycle has a fertile window of about six days—5 days earlier than ovulation, the day of ovulation, and as much as 24 hours after ovulation—although this will fluctuate from individual to individual. There are a number of instruments accessible to assist customers determine their fertile days by both counting days on a calendar, observing and recording indicators and signs related to ovulation, or utilizing a mixture of those approaches (Desk 1). FABM customers who wish to forestall being pregnant can stay abstinent or use a barrier technique on their fertile days.
The time period “FABM” is usually used interchangeably with the time period “pure household planning” (NFP). Whereas that is technically appropriate, NFP is a subset of FABM that particularly excludes the usage of medicine, surgical procedures, and barrier strategies like condoms. As an alternative, customers select to stay abstinent on fertile days. Some non secular establishments such because the Catholic Church encourage NFP for followers seeking to delay or forestall being pregnant.
Calendar-based strategies for monitoring ovulation and fertility are among the oldest types of FABMs and embody the Rhythm Methodology and the Commonplace Days (or Bead) Methodology. Customers report the size of their menstrual cycles to foretell their most fertile days in future cycles.
The vast majority of FABMs monitor and report indicators and signs of ovulation to foretell fertile days. These strategies could require customers to obtain coaching from well being care professionals to trace day by day adjustments to their basal physique temperature (BBT), cervical mucus, or urine hormone ranges. BBT measurements require a basal thermometer as it’s extra delicate than an everyday thermometer, and urine hormone measurements require a fertility monitor. Customers usually select to trace a number of indicators to forestall being pregnant extra successfully.
The lactational amenorrhea method (LAM), or postpartum breastfeeding, could also be used to briefly forestall being pregnant. This technique requires the postpartum mother or father to completely breastfeed their child a minimum of each 4 hours through the day and each 6 hours at night time for as much as six months (or till their menstrual cycle resumes) to delay ovulation. LAM requires strict adherence to be efficient as contraception and isn’t appropriate for postpartum mother and father who can not completely breastfeed. It’s unclear whether or not utilizing breast pumps on the identical frequency produces the identical stage of being pregnant prevention.
Along with their use as contraception, FABMs play a vital position in a rising motion amongst conservative policymakers known as “Restorative Reproductive Medicine,” a apply meant to find out the foundation causes of infertility in addition to promote fertility with out the usage of in vitro fertilization or synthetic insemination. Equally, “Natural Procreative Technology,” or NaPro, is one other instance of the position FABMs play outdoors of contraception. NaPro is a “fertility-care primarily based” well being care strategy combining FABMs with “gynecologic well being monitoring and upkeep. Although the terminology is comparatively new, these practices are already included in customary gynecological and fertility care.
Use and Efficacy
In america, individuals who use FABMs to forestall being pregnant usually pair them with one other contraceptive technique. Information from the 2024 KFF Girls’s Well being Survey show that 13% of ladies ages 18 to 49 used FABMs as contraception in some unspecified time in the future within the final yr. People in search of to forestall being pregnant could select these strategies as a result of they’re hormone-free, low price, or for non secular or well being causes.
The effectiveness of FABMs in stopping being pregnant will depend on the accuracy of the particular technique used, the flexibility of the person to accurately interpret their organic indicators of fertility, and the person and their companion’s means to keep away from unprotected intercourse through the fertile window or use a condom throughout that part (Desk 2). Failure charges fluctuate throughout strategies and range from 2 to 34 pregnancies for each 100 ladies per yr with typical use. With good use, some scientific trials suggest FABMs have low failure charges. LAM, for instance, is extremely efficient if the breastfeeding mother or father: 1) has amenorrhea, 2) completely breastfeeds a minimum of each 4 hours through the day or each six hours at night time, and three) is lower than six months postpartum. In comparison, lower than one in 100 ladies utilizing an IUD or implant, and roughly seven in 100 ladies utilizing oral contraceptive tablets, could grow to be pregnant in a single yr of typical use.
Limitations
FABMs could forestall being pregnant for some, however there may be vital room for human error which will end in unintended being pregnant, making them much less efficient than most different hormonal and non-hormonal contraceptive choices. FABMs require significant commitment from each the person and their companion. Customers are sometimes suggested to trace a minimum of six menstrual cycles to find out about their cycle size and fertility indicators earlier than counting on an FABM to forestall being pregnant, which can depart them susceptible to unintended being pregnant if no different contraceptive technique is used throughout this preliminary interval. Customers should additionally monitor indicators of fertility both day by day or a number of occasions a day, in addition to accurately interpret their observations. Lastly, each the person and their companion should be capable of stay abstinent or use a barrier technique through the fertile window.
FABMs may not be appropriate for everybody, particularly for individuals who have irregular menstrual cycles. Calendar-based strategies, for instance, depend on the size of menstrual cycles recurrently being between 26 and 32 days every month. Well being situations, stress, alcohol, drugs, or life occasions have an effect on the predictability of menstrual cycles, making FABMs less reliable. Some preliminary analysis means that clinician data and perceptions of FABMs could play a job in sufferers’ success in utilizing FABMs as contraception. In a survey of clinicians working in Title X clinics, suppliers recognized a number of limitations to providing FABMs, together with an absence of coaching on these strategies, lack of time for counseling, low demand from sufferers, decrease success charges, and desire for extra dependable strategies of contraception. Although some respondents reported offering training supplies to sufferers upon request, they might not have had info on all FABMs. As well as, respondents perceived FABMs to be inappropriate for his or her sufferers’ wants.
Know-how and Entry
The right use of FABMs requires consistency and customers to have various ranges of coaching and expertise. For calendar-based strategies, customers could use a bodily calendar, CycleBeads, or cell apps to trace the times of their menstrual cycle. Some fertility monitoring apps, equivalent to Daysy, have instruments particularly designed to sync person info to their related app. Daysy syncs with its personal BBT thermometer to digitally report the person’s temperature all through their cycle. Different apps use algorithms to interpret person information to foretell a person’s day by day danger of being pregnant. FABMs that observe a number of indicators of fertility generally require coaching with a licensed teacher to make sure correct use, notably if the tactic has a novel system for recording these indicators equivalent to symbols or colours.
In 2018, the Natural Cycles app grew to become the primary FDA cleared cell medical app that can be utilized as contraception. The app operates by monitoring the person’s day by day BBT and makes use of an algorithm to determine fertile days and “not fertile” days. Not like different fertility-tracking apps, Pure Cycles states that the app makes use of an algorithm that’s personalised to the person primarily based on their distinctive temperature and cycle information. Typically, cell well being apps that meet the FDA’s definition of a cell medical app or machine have to be permitted and controlled by the FDA. Whereas apps that don’t meet this definition are exempt from FDA evaluate, they have to register with the FDA and adjust to basic laws.
Through the years, well being apps have come underneath scrutiny as a consequence of privateness considerations. In a post-Roe reproductive well being panorama, customers of period-tracking and fertility apps have taken to social media to caution different customers about information privateness and safety, notably for private and identifiable info. In response, apps equivalent to Flo have up to date their privateness insurance policies to incorporate choices equivalent to “Nameless Mode,” although research means that well being apps can do extra to enhance person privateness.
Protection and Price
Federal tips such because the CDC’s and the Workplace of Inhabitants Affairs’ Providing Quality Family Planning Services (QFP) and HRSA’s suggestions for preventive providers for girls state that providing ladies the total vary of FDA-approved contraceptive methods, together with FABMs, is a crucial component of high quality household planning care. From 2022-2023, 60% of all household planning clinics and 81% of Deliberate Parenthood clinics provided FABM directions or provides.
The price of provides varies by technique. Instruments equivalent to basal physique thermometers typically price between $10 and $20, and plenty of fertility consciousness apps within the U.S. are free to make use of, although some apps require subscriptions. For instance, the Kindara app affords a $5 month-to-month subscription and a $50 annual subscription, in addition to the non-compulsory Kindara Wink oral thermometer for $129. With out insurance coverage, Pure Cycles has a $150 annual subscription that features the Pure Cycles Thermometer, in addition to a $22 month-to-month subscription with the choice to buy the thermometer for a further $40. The app additionally syncs with the Oura Ring and sure Apple Watch fashions, however these gadgets are offered individually and never coated by insurance coverage.
As an FDA cleared contraception technique, Pure Cycles is included within the ACA’s contraceptive protection coverage, which requires most non-public plans and Medicaid growth packages to cowl contraceptives for girls which are prescribed by a clinician. Pure Cycles is covered by most main medical health insurance plans, although protection is restricted to the annual subscription with a prescription from a healthcare supplier. As an over-the-counter product, protection shouldn’t be essentially required underneath Medicaid. In a 2021 KFF state survey of Medicaid household planning providers, few states reported overlaying Pure Cycles of their packages.
Some strategies, such because the Creighton Model Fertilitycare System (CrMS), require courses from educated instructors. CrMS prices for the primary yr of use fluctuate by teacher or program, however typically embody an introductory session, an tutorial equipment, and a minimum of eight follow-up periods with an teacher, all of which might simply exceed $200. Medical health insurance protection of those tutorial courses varies by insurance coverage supplier and state insurance policies.
Contraceptive info is pervasive on social media, with almost 4 in ten (39%) ladies of reproductive age saying they’ve seen or heard one thing on social media about contraception up to now 12 months. Some outstanding social media influencers have utilized their social networks to share their destructive experiences with and rationale for discontinuation of hormonal birth control strategies equivalent to oral contraceptive tablets or intrauterine gadgets (IUDs), generally making false claims concerning the harms and efficacy of hormonal contraception. A content material evaluation of Pinterest in 2021 and TikTok in 2023 discovered that FABM-related pins conveyed extra advantages than limitations, whereas pins about oral contraceptive tablets conveyed extra limitations than advantages.
