For Women’s Health, Maybe It’s Time to Focus on Natural Pregnancy Prevention Methods

Artificial methods of contraception are considered the best tool for reducing unintended pregnancy, yet unintended pregnancy rates remain high, despite widespread acceptance and use of contraceptives. Almost half of pregnancies in the U.S. are unintended.¹

Likewise, a 2002 study assessing the reasons for pregnancy termination among teenagers in Sweden (a country where the majority of women are contracepting) found that approximately half of adolescents conceived despite using contraception.²

Additionally, abundant scholarly evidence indicates that young women are particularly susceptible to serious side effects from contraception use. Young contraceptive users have higher risks of experiencing side effects that include: VTE (Venous Thromboembolism),³ stroke,⁴ diminished bone density,⁵ depression, and suicide.⁶

Given these and other potential side effects, it seems reasonable to ask whether the effectiveness of artificial contraceptive methods outweighs the risk?

The CDC labels several side effects of contraceptive use a category 4 risk, defined as a “condition that represents an unacceptable health risk if the contraceptive method is used.”⁷ Furthermore, according to the CDC, contraceptives methods fail between .05- 28% of the time. Barrier methods (condoms, sponge, and spermicide) have the highest failure rates (the female condom is 21%). The pill, patch, ring, and diaphragm have smaller yet still considerable failure rates ranging from 9% to 12%.

Long-acting reversible contraceptive (LARC) methods and permanent methods (sterilization) have the lowest failure rates,⁸ which is one reason why they are frequently promoted as the best way for women to avoid unintended pregnancy. However, the use of LARC among young women, particularly teens, is problematic.

Young women are too young to decide if they want to be permanently infertile. For example, young women experience regret after tubal ligation at a greater rate than older women who undergo the procedure, and the degree of their regret can be substantial. Likewise, LARC Methods (IUD, IUS, and Implants) have serious medical risks and do not protect against STDs.

In 2013, the NIH issued a $3 million request to research non-hormonal contraceptive alternatives due to the many adverse effects associated with contraceptive use. Consequently, many advances have been made in natural fertility methods. Furthermore, the Trump Administration’s recently-released 2018 Funding Opportunity Announcement (FOA) for the federal Title X family planning program includes a stronger emphasis on natural family planning.

Fertility Awareness-Based Methods (FABMs) are 100% natural. They do not involve the use of hormones and are side-effect free. Couples who wish to avoid pregnancy can use information from a woman’s physical changes throughout her menstrual cycle to abstain from sex during the fertile phase of her cycle. A 2012 study published by the American Academy of Family Physicians notes that with "typical use" among committed couples, natural family planning methods are 76% effective (and 95% effective with "perfect use").⁹ The CDC reports that natural methods have a 24% pregnancy (or “failure") rate; however, FABM experts point out that the CDC rate is based on older data, where most of the women using natural methods were practicing the "rhythm" or "calendar" method, which is not the same as the newer and more effective FABM methods (such as the Billings Ovulation method).

In practice, some pregnancy prevention programs for teens that have utilized natural methods have been effective. For example, the“Not Me, Not Now” program, which featured a public education campaign,¹⁰ achieved decreases in teenage sexual activity and pregnancy.¹¹

At the very least, young women have a right to know the failure rates of popular contraceptives methods, and that hormonal contraceptives (including LARC methods) contain serious health risks, especially for younger users. Young women also deserve to hear more about the benefits of natural methods for avoiding pregnancy that can be as effective as some artificial methods of birth control without all the negative side effects.

Maria Archer (Kaufmann) is Director of Youth Ministry for St. Bartholomew Catholic Church and is an independent contractor for the Marriage and Religion Research Institute at CUA. 

Editor’s Note: The views expressed in this article are those of the author and do not necessarily reflect the official policy or views of the Institute for Family Studies. *This article was updated to include new citations on July 17, 2018.

1. Guttmacher Institute. “Induced Abortion in the United States.” Oct 2017. Citing: Finer LB and ZolnaMR, Declines in unintended pregnancy in the United States, 2008–2011, New England Journal of Medicine, 2016, 374(9):843–852.

2. M. Larsson, G. Aneblom, V. Odlind and T. Tyden, "Reasons for Pregnancy Termination, Contraceptive Habits and Contraceptive Failure among Swedish Women Requesting an Early Pregnancy Termination," Acta Obstetricia Et Gynecologica Scandinavica 81, no. 1 (2002): 68.

3. Martinelli, Ida, Alberto Maino, Maria Abbattista, Paolo Bucciarelli, Serena M. Passamonti, Andrea Artoni, Francesca Gianniello, and Flora Peyvandi. "Duration of oral contraceptive use and the risk of venous thromboembolism. A case-control study." Thrombosis Research 141 (2016): 153.

4. Bushnell, Cheryl., & McCullough, Louise. (2014). Annals of Internal Medicine: Stroke Prevention in Women: Synopsis of the 2014 American Heart Association/American Stroke Association Guideline. Annals of Internal Medicine, 160 (12), 855. See also: Bushnell, Cheryl., & McCullough, Louise. (2014). Annals of Internal Medicine: Stroke Prevention in Women: Synopsis of the 2014 American Heart Association/American Stroke Association Guideline. Annals of Internal Medicine, 160 (12), 855. 

5. Bonny, Andrea E., Michelle Secic, and Barbara A. Cromer. "Relationship between weight and bone mineral density in adolescents on hormonal contraception."Journal of Pediatric and Adolescent Gynecology 24, no. 1 (2011): 36. Busen, Nancy H., Robin B. Britt, and Nahid Rianon. "Bone mineral density in a cohort of adolescent women using depot medroxyprogesterone acetate for one to two years." Journal of Adolescent Health 32, no. 4 (2003): 257. Walsh, Jennifer S., Richard Eastell, and Nicola FA Peel. "Effects of depot medroxyprogesterone acetate on bone density and bone metabolism before and after peak bone mass: a case-control study." The Journal of Clinical Endocrinology & Metabolism 93, no. 4 (2008): 1317-1323.Kass‐Wolff, Jane H. "Bone Loss in Adolescents Using Depo‐Provera." Journal for Specialists in Pediatric Nursing 6, no. 1 (2001): 21.

6. Skovlund, Charlotte Wessel, Lina Steinrud Mørch, Lars Vedel Kessing, Theis Lange, and Øjvind Lidegaard. "Association of Hormonal Contraception With Suicide Attempts and Suicides." American Journal of Psychiatry (2017).

7. Centers for Disease Control and Prevention. “Update to CDC's U.S. medical eligibility criteria for contraceptive use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period,” MMWR Weekly, 60, no. 26 (July 2011): 878-883. 

8. CDC, “U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition,” MMWR Weekly: Recommendations and Reports, 59, No. RR-4 (2010): 64. 

9. See also: Richard J. Fehring, et al., "Randomized Comparison of Two Internet- Supported Fertility Awareness-Based Methods of Family Planning," Contraception 8, no. 1 (July 2013): pgs. 24-30.

10. Doniger, A. S., E. Adams, C. A. Utter, and J. S. Riley. "Impact evaluation of the 'not me, not now' abstinence-oriented, adolescent pregnancy prevention communications program, Monroe County, New York." Journal of Health Communication 6, no. 1 (2001): 45. See also: The work of Leslie Carol Botha for13-17 year-olds at restorative care homes for at-risk girls and the program, TeenSTAR.

11. Kim, Christine and Rector, Robert. “Evidence on the Effectiveness of Abstinence Education: An Update,” The Heritage Foundation, February 19, 2010.