Opinion: Natural Family Planning Methods cannot be intrinsically contraceptive!
A self-determined effective way of natural family planning without side effects that is safe and yet simple. This is possible with smart technologies and transparent information about your own fertility.
Natural family planning in changing times?
Self-determined family planning is the basis for a stronger role for women in society. This is demonstrated by one of the most important innovations in the history of pharmacy, the introduction of the “pill” in the 1960s. Simultaneously with the introduction of the Pill, the women’s movement received a major boost in the 1960s. The possibility of contraception significantly improved educational and employment opportunities and led to a self-confident role for women in society. Nevertheless, surveys show impressively that the majority of women are no longer willing to unconditionally influence their natural cycle artificially with hormones(1). One of the main reasons for this “pill fatigue” is the fear of possible side effects(2).
What is Natural Family Planning (NFP)?
NFP is the precise determination of the fertile window in the cycle. The body sends out various signals that indicate the different stages of the monthly cycle. The fertile days can be narrowed down very precisely on this basis.
NFP enables the decision to abstain during the days of the cycle when the cycle is ready for conception or to use a contraceptive or — if you want to have a baby — to use these days for sex. There is no possibility of pregnancy during the infertile days. If the menopause is imminent, knowledge about one’s own cycle also helps these women.
What is it no?
Women seek natural alternatives
The search for reliable alternatives is increasingly arousing interest in traditional methods of Natural Family Planning. In a representative survey, 1 out of 5 women stated that they had dealt with natural alternatives of family planning at least once in their lives(3). The advantage of traditional methods is that they can cover the entire spectrum of family planning, from the desire for children to the avoidance of pregnancy. A disadvantage of these traditional methods is that they are often time-consuming, complicated to implement and prone to human error (4,5). Over the last three decades, the traditional calculation of fertile and infertile days with pen and paper has not evolved and has been increasingly replaced by digital technologies and products that recognize and evaluate the direct or indirect signs of fertility (6,7). Since 2010, a huge market of more or less trustworthy Fertility Tracking Apps (FTAs) for smartphones has also developed around the topic of fertility. Download statistics show that interest in one’s own fertility is much greater than surveys suggest.
Increased demands on digital solutions
With the rapidly growing confusing market of FTAs, the justified call for regulation, verification and evaluation of the application safety of the individual products became ever louder. The scientific literature shows that only the very few FTA algorithms are suitable for the prevention of pregnancy or have even been independently clinically tested(8,9). Another study concludes that so-called prognosis apps are completely useless for predicting ovulation and can even be counterproductive when trying to conceive. The reason: with a cycle of 28 days, ovulation is in the middle. But more than 85 percent of cycles are not 28 days long. Shift work, stress or illness are possible reasons for postponing ovulation. But even without a reason, ovulation sometimes occurs earlier, sometimes later. Therefore, the calculations of the prognosis apps can provide critical misinformation(10).
Until today there are no realizable or uniform standards
In the 1950s, Dr. Edward Keefe from the United States and Dr. Josef Roetzer from Austria developed the multiple index method, also known as the Sympto-Thermal Method (STM) in the United States. In 1971, Dr. Konald Prem worked with John and Sheila Kippley to build a network of trained couples, the Couple to Couple League, to teach the STM method. This traditional methods have been further studied and investigated at the Heinrich-Heine-University Düsseldorf since 1981. Due to the lack of alternatives, the responsible physicians at that early stage determined that the application safety of traditional methods would have to meet the same standards as pharmacologically effective drugs or invasive implants(11–13). It is obvious that a non-invasive method that neither influences nor prevents ovulation cannot fully meet this standard. A recent systematic review of studies from the last 40 years concludes, unsurprisingly, that no study has come anywhere close to meeting this standard(14).
Requirements for studies have changed fundamentally
The early NFP application safety studies, supervised each individual participant personally, with a training course lasting several days preceding participation(15). Consequently, all previous data on the safety of NFP are based on users who were introduced to the method by NFP consultants. Sales and download figures suggest that 98% of all NFP users have never attended a corresponding course, so there is no precise information about the influence of autonomous learning or use of the method on application safety. Furthermore, with the introduction of the “Emergency Pill”, the prerequisite for an unwanted pregnancy has been fundamentally changed. While in the past it was impossible to interrupt a pregnancy at an early stage, this is no longer a problem today. Since the OTC sale of the emergency contraceptive pill (2014), use has increased by 70%. It is therefore no longer possible to detect an unwanted pregnancy in prospective studies at all, so the basic requirement for statistical calculation of safety according to old standards is no longer given. Furthermore, previous studies lack any information about the relationship status or fertility/infertility of the participants.
In the past, the Pearl Index (named after the American scientist Raymond Pearl; 1933) has been the measure for assessing the safety of contraceptives: the smaller the Pearl Index, the safer the contraceptive method. If 100 women use the same contraceptive method for one year and three pregnancies occur during this period, the Pearl index is 3. A Pearl index of 0.1 means that one in every 1000 women who use the same contraceptive method for one year becomes pregnant(16).
Although it was known early on that the Pearl index has enormous weaknesses(16), it is still used today in all common doctor brochures, magazines, internet portals etc. This ignores the fact that the method used to calculate the Pearl Index did not/does not take into account some things: neither the size of the sample, i.e. the group of women observed, nor their age or the frequency of their sexual intercourse. Not to mention the correct application of the respective method or agent, which can vary greatly from woman to woman or from man to man.
The index can be calculated from many different sources and studies where the conditions are not always the same(17). But this is exactly what a correct scientific approach actually requires: comparability.
A method cannot be a contraceptive
The past has shown that it is impossible to meet the standards for pharmacologically effective drugs or invasive implants as a method that makes a statement whether a woman is fertile or not. The solution can only be a standard adapted to the respective method. Smart solutions such as Fertility Tracker calculate a woman’s individual fertile and infertile days based on the daily measurement of basal body temperature and the resulting cyclically recurring fertile window. A logical, transparent and comparable statement in this regard can only be how EXACTLY Fertility Tracker performs the task for which it was developed. With a scientifically proven statement about the accuracy of a method, women are given information in which they can make a self-determined decision whether or not to use a barrier method as a contraceptive based on their fertility.
The statement how EXACTLY a Fertility Tracker detects infertile days in the cycle is completely independent of age, relationship status, frequency of intercourse, use of additional contraception or male fertility. The statement about the accuracy is extremely specific, transparent, not a “general guideline” like the Pearl Index and most importantly, the statement is repeatable or directly comparable!
Against the background of the ever faster digitalization of traditional methods of family planning, it is urgently necessary to question outdated standards and to offer women a transparent and accurate solution.
Literature
1. Verhütungsverhalten Erwachsener 2018. https://publikationen.sexualaufklaerung.de/themen/verhuetung/verhuetungsverhalten-erwachsener-2018/.
17.Turner, J. Misrepresentation of contraceptive effectiveness rates for fertility awareness methods of family planning J. Obstet. Gynaecol. Res. 2020
18.Frank-Herrmann P, Gnoth C, Baur S, 17. et al. Determination of the fertile window: Reproductive competence of women — European cycle databases. Gynecol Endocrinol 2005;20:305–12.
