This article is part III of a series on “Contraceptives” by POKA app.
“I only have two children, because I was told that pregnancy during lactation and breastfeeding – before my period returned, could not get me pregnant. Here we are.” - N.T.
There are many reasons why people use natural or traditional methods of contraception. There are also many reasons why people do not. What are natural methods of contraception? They are the ways that women avoid pregnancy without using artificial or chemical interventions. These methods are sometimes called traditional or behavioural methods, as they require behaviour change based around a woman’s knowledge of her menstrual cycle, e.g., abstinence during the most fertile periods of a woman’s cycle1.
Natural methods of contraception have been known to have high failure rates2, especially when compared to other more modern methods of contraception. Counselling and thorough education from trained healthcare workers is very important for women who consider these natural methods. They can be effective when used consistently and correctly, but this is largely dependent on individual behaviour and a high motivation to monitor and track fertility closely, while modifying behaviour.
There are two main categories of natural contraception: the withdrawal method, also known as coitus interruptus and the many Fertility Awareness-Based Methods (FABMs) which require an intimate understanding of a woman's menstrual cycle and the timing of ovulation and fertility.
Let’s delve into them!
1. Withdrawal Method a.k.a. Coitus Interruptus: This method involves the removal of the penis from the vagina prior to ejaculation, to prevent the introduction of sperm into the vagina, and thus prevent fertilization and pregnancy. Withdrawak method relies on the skill of the male partner, and effective communication prior to ejaculation. For a more detailed analysis of the withdrawal method of contraception, see the POKA article “To Pull-Out or Not to Pull-Out” .
2. Fertility Awareness-Based Methods (FABMs): There are different ways women use FABMs as a method of contraception:
a. Calendar Method, a.k.a. the Rhythm Method: This method involves using a calendar or a menstrual cycle tracking app like Poka app to track the menstrual cycle in order to predict fertile and non-fertile days. Most women that use this method have regular cycles and can therefore estimate their exact ovulation dates, which typically occurs mid-cycle. They avoid sexual intercourse around their predicted ovulation days.
b. Standard Days Method: This method also uses a calendar, a cycle tracker app like Poka app or cycle beads, and assumes a fixed fertile window during which a woman will abstain from sexual intercourse. This fixed period revolves around ovulation. Typically the fertile window falls between days 8 and 19 of the woman’s cycle hence this method also requires a woman to have a very regular menstrual cycle, lasting between 26 and 32 days.
c. Basal Body Temperature (BBT) Method: This method tracks ovulation, using the Basal body temperature, which can often be measured using a standard thermometer. During ovulation, BBT is known to slightly increase, from the usual 35.5C - 36.6C, to about 36.1C-37.2C, hence tracking it allows women to know the potentially fertile days in their cycle, based on when they may be ovulating, and hence avoid intercourse to prevent pregnancy.
d. Cervical Mucus Method (Billings Ovulation Method): This method also tracks ovulation, however, it does so by paying close attention to the consistency and texture of cervical mucus/discharge throughout their menstrual cycle. Cervical mucus changes in response to hormonal fluctuations, getting more slimy and stretchy during ovulation. This can help women to predict ovulation and thus their potentially fertile days.
e. Sympto-thermal Method: This method combines some of the other FABMs, e.g., BBT, Billings method and calendar methods, with the aim of increasing the accuracy of predicting fertile and non-fertile days.
f. Lactational Amenorrhea Method (LAM): This method relies on a brief period of temporary infertility that has been thought to be associated with exclusive breastfeeding after having a baby. For many years breastfeeding was known to suppress ovulation, especially in the first 3-6 months postpartum.
Summary of Mechanisms of Action and Effectiveness of Natural Methods Of Contraception3
| Method | How it works | Effectiveness: pregnancies per 100 women per year with consistent and correct use | Effectiveness: pregnancies per 100 women per year as commonly used |
| Fertility Awareness Based Methods | |||
| Calendar method or rhythm method | The couple prevents pregnancy by avoiding unprotected vaginal sex during the 1st and last estimated fertile days, by abstaining or using a condom. | Reliable effectiveness rates are not available | 15 |
| Standard Days Method or SDM | Prevents pregnancy by avoiding unprotected vaginal sex during most fertile days. | 5 | 12 |
| Basal Body Temperature (BBT) Method | Prevents pregnancy by avoiding unprotected vaginal sex during fertile days | Reliable effectiveness rates are not available | |
| Sympto-thermal Method | Prevents pregnancy by avoiding unprotected vaginal sex during most fertile | <1 | 2 |
| Lactational amenorrhea method (LAM) | Prevents the release of eggs from the ovaries (ovulation) | 0.9 (in six months) | 2 (in six months) |
| Withdrawal Method | |||
| Withdrawal (coitus interruptus) | Tries to keep sperm out of the woman's body, preventing fertilization | 4 | 20 |
Natural methods provide a hormone-free approach to contraception, allowing women to opt out of hormonal or invasive methods of contraception. Some women prefer these methods for religious reasons, cultural reasons and sometimes health reasons. As with any other contraceptive choice, consultation with a healthcare provider can help women make informed decisions based on their individual circumstances and medical backgrounds.
Natural methods rely on a regular menstrual cycle, motivation and discipline, consistency and correctness of use, as well as experience and communication to be effective. Women who choose these methods must understand that they do not prevent sexually transmitted infections. Regularity of menstrual cycles can also be affected by a myriad of factors, such as lifestyle changes, travel, stress, and illness, which can impact the accuracy of predictions, and therefore increase the risk of unintended pregnancies.
Have any of these methods worked for you? Have any failed you? Join the PokaDolls community to share your experience!
References
1. Altshuler AL, Blumenthal PD. Behavioral Methods of Contraception. The Handbook of Contraception. Published online 2020:239-254. doi:10.1007/978-3-030-46391-5_12
2. Teal S, Edelman A. Contraception Selection, Effectiveness, and Adverse Effects: A Review. JAMA. 2021;326(24):2507-2518. doi:10.1001/JAMA.2021.21392
3. WHO. Family Planning - A Global Handbook for Providers. 2022nd ed.; 2022. Accessed April 9, 2024. https://www.who.int/publications/i/item/9780999203705