Some doctors may genuinely believe that women are not smart enough to understand and assimilate the information taught in FAM classes. While I find this perspective discouraging, I understand why they believe this. It’s true that the people attracted to FAM tend to be quite educated. However, I think this is more a function of the way in which people initially learn about it, rather than of the inherent intelligence required to use it. It often takes a very motivated individual to seek out information about a subject that, until recently, has typically been reserved for the few who are resourceful enough to research the topic.
I personally have taught FAM to more than 1,500 clients and can assure you that virtually all women can internalize the method and its biological foundation within a few hours. I also suspect that few of them are particularly burdened by the couple of minutes a day it takes to apply.
In Defense of Doctors
The above is not meant to be a diatribe against the medical community. In fact, I think the majority of physicians are genuinely sensitive and caring people who truly want to empower their patients with the knowledge necessary to be healthy and strong.
Yet, in an industry that is becoming increasingly high-tech, many doctors may be skeptical of FAM, precisely because it’s so non-tech. In fact, if anything, they may believe that they are not being active enough in their patients’ care if they do not prescribe drugs or perform various procedures. And, perhaps most important, clinicians don’t realistically have the time to thoroughly explain the method in a typical office visit, and thus few women ever learn it.
Ultimately, a perpetual cycle of ignorance ensues, for even those doctors who are especially supportive of women taking control of their own reproductive health cannot be as effective as they would like to be if their patients don’t chart. Indeed, the benefits of FAM cannot become commonplace in the doctor-patient relationship until more women do their part by charting their cycles.
CHAPTER 2
Taking Control of Your Reproductive Health
During each cycle, a woman’s body prepares for a potential pregnancy, much to the chagrin of those who don’t want to become pregnant. But she is actually fertile only a few days per cycle, around ovulation (when the egg is released). The only practical, noninvasive way to reliably identify that fertile time is through observing the woman’s waking temperature and cervical fluid, as well as the optional sign of cervical position. By charting these primary fertility signs, a woman can tell on a day-to-day basis whether she is capable of getting pregnant on any given day. And because the actual day of ovulation can vary from cycle to cycle, the determination of those few days around ovulation is crucial, and therein lies the value of the Fertility Awareness Method.
THE POLITICS OF NATURAL BIRTH CONTROL
We want far better reasons for having children than not knowing how to prevent them.
—DORA RUSSELL
Why are so many women frustrated with the state of contraception today? Why is the vast majority of birth control designed for women to use, even though it’s men who are fertile every single day? Wouldn’t it make more sense for birth control to be developed for the gender that is the most fertile? Consider the following table:
METHODS OF BIRTH CONTROL AVAILABLE TODAY
(listed in approximate order from most to least invasive)
For Women For Men
Tubal Ligation Vasectomy
IUD (intrauterine device) Condom
Implanon Withdrawal
Depo-Provera Injection
The pill
Nuvaring
The Patch
Diaphragm
Female Condom
Cervical Cap
Sponge
Suppositories
Spermicides
Films, Foams, and Jellies
Natural Methods
Given that women are fertile only a few days per cycle, it’s ironic that they’re the ones who risk the vast array of side effects and physical ramifications of birth control. These include increased risk of blood clots, strokes, breast cancer, irregular spotting, severe pelvic inflammatory disease or uterine perforation, heavy, crampy periods, urinary tract infections, cervical inflammation, and allergic reactions to spermicides and latex, to name a few. And for what? To protect themselves from a man, who produces millions of sperm per hour!
Imagine the reaction of most males to the following announcement:
A NEW INTRAPENAL CONTRACEPTIVE
The newest development in male contraception was unveiled recently at the American Women’s Surgical Symposium. Dr. Sophia Merkin announced the preliminary findings of a study conducted on 763 unsuspecting male graduate students at a large midwestern university. In her report, Dr. Merkin stated that the new contraceptive—the IPD—was a breakthrough in male contraception. It will be marketed under the trade name “Umbrelly.”
The IPD (intrapenal device) resembles a tiny folded umbrella which is inserted through the head of the penis into the scrotum with a plungerlike instrument. Occasionally there is perforation of the scrotum, but this is disregarded since it’s known that the male has few nerve endings in this area of his body. The underside of the umbrella contains a spermicidal jelly, hence the name “Umbrelly.”
Experiments on a thousand white whales from the continental shelf (whose sexual apparatus is said to be closest to man’s) proved the Umbrelly 100% effective in preventing production of sperm, and eminently satisfactory to the female whale since it doesn’t interfere with her rutting pleasure.
Dr. Merkin declared the Umbrelly to be statistically safe for the human male. She reported that of the 763 grad students tested with the device, only two died of scrotal infection, three developed cancer of the testicles, and 13 were too depressed to have an erection. She stated that the common complaints ranged from cramping and bleeding to acute abdominal pain. She emphasized that these symptoms were merely indications that the man’s body had not yet adjusted to the device. Hopefully, the symptoms would disappear within a year.
One complication caused by the IPD was the incidence of massive scrotal infection necessitating the surgical removal of the testicles. “But this is a rare occurrence,” said Merkin, “too rare to be statistically important.” She and the other distinguished members of the Women’s College of Surgeons agreed that the benefits far outweighed the risk to any individual man.
—©1974 Written by Belita H. Cowan. Reprinted with permission.
Illustration by Frankie Collins.
Although the above is only a parody, in reality the notorious Dalkon Shield IUD rendered many women infertile by causing severe pelvic inflammatory disease. And it’s but one example of the medical nightmares to which many women have been subjected; recent history reveals countless ways in which women’s bodies and those of their potential offspring have been exposed to dangerous drugs and procedures.
From the tragedies caused by thalidomide and DES in the 1950s to the later controversies over the side effects of Norplant and Depo-Provera, we’ve seen an endless stream of revelations that call into question the level of safety that female patients are assured. Beyond the often dubious nature of the drugs we’ve been prescribed, both contraceptive and otherwise, we’ve witnessed the anguish surrounding the use of breast implants. In addition, we eventually became aware of the wide overuse of such medical procedures as C-sections and hysterectomies, which simply added to the average woman’s confusion (thankfully, recent studies show that the number of hysterectomies has dropped significantly in the last 10 to 15 years, but the total number of C-sections still remains suspiciously high).
Whether men would submit to all the “inconveniences” is not really the issue. Given all that women have been through, it’s only natural that they would want to take control of their own medical and reproductive needs with the most effective, least intrusive means possible.
Why Unplanned Pregnancies Occur
I remember . . . a friend described her first experience with a contraceptive device
, which shot out a bathroom window into the college quadrangle. She never retrieved it. I wouldn’t have, either.
—ANNA QUINDLEN
To understand the politics of natural birth control, we must examine the concept of unplanned pregnancies. Why do unplanned pregnancies occur? There are four primary reasons:*
1.People do not use birth control because they are “swept away in the moment.”
2.People do not use birth control because of ignorance.
3.People do not use birth control because they feel no method is acceptable.
4.People use birth control, but the method fails.
How does the Fertility Awareness Method fit into the above scheme? Let’s examine each situation individually:
People Do Not Use Birth Control Because They Are Swept Away in the Moment
All barrier methods leave people vulnerable to the type of passion that reduces them to a momentary lapse in judgment. Who among us hasn’t thought at one time or another, “Oh, I’m sure I’m not fertile right now”? However, when a woman knows whether she is fertile, it eliminates guessing. Being unlucky is no longer an excuse.
People Do Not Use Birth Control Because of Ignorance
Many people would be more inclined to use birth control if they understood the likelihood of pregnancy occurring at specific times in the cycle. There are so many myths perpetuated about human fertility that it’s no wonder there are so many unplanned pregnancies. The classic one responsible for probably the most unplanned pregnancies is that ovulation occurs on Day 14. In fact, ovulation may occur on Day 14; or it may occur on Day 10, Day 18, or Day 21. In other words, ovulation is not the consistent event it’s presumed to be. But the fallacy of Day 14 is so prevalent that even clinicians inadvertently perpetuate it.
If a couple thinks a woman can get pregnant only on Day 14, they may feel safe having unprotected intercourse up to Day 13 and again from Day 15 on. Some couples may even feel that they are being conservative if they put a buffer zone of several days on either side of Day 14. But if the woman ovulates on Day 20, for example, even complete abstinence between Days 11 and 17 will not prevent an unplanned pregnancy! The dangerous fiction of Day 14 is but one example in which people are not accurately taught about human reproduction.
What about the faulty assumption that women cannot get pregnant when they have intercourse during their period? Another common belief is that sperm can live up to only three days. In reality, sperm can survive up to five days if fertile-quality cervical fluid is present. Combine this belief with that of ovulation’s always occurring on Day 14, and unintended results are almost inevitable.
These are just some of the more common misperceptions that people have about basic human biology. Suffice it to say, many unplanned pregnancies occur because people believe such fallacies. Obviously, education is key to dealing with this problem.
People Do Not Use Birth Control Because They Feel No Method Is Acceptable
It’s hardly surprising that most people find today’s contraceptive choices far from ideal. Aside from sterilization, our options include such alternatives as a method that infuses the woman’s body with unnatural hormones (the pill and other artificial hormonal methods), may increase a woman’s risk of breast cancer or osteoporosis (Depo-Provera), involves inserting a matchstick-size silicone tube under the skin of the arm (Implanon), maintains the uterus in a constant state of inflammation, sometimes causing painful periods (the IUD), fills the woman’s vagina with a latex dome that leaks gooey spermicide for at least 24 hours after intercourse (the diaphragm), can be uncomfortable and cause cervical anomalies (the cervical cap), is notorious for causing vaginal infections (the sponge), completely covers the woman’s clitoris (the female condom), or places a rubber sheath between the two individuals (the male condom).
Is it any wonder that unplanned pregnancies occur, given the choice of methods people perceive as their only options? With FAM, couples can experience the freedom of effective contraception without devices, chemicals, or side effects for most of the cycle.
People Use Birth Control, but the Method Fails
One of the most inflammatory opinions some people hold is that if a couple has an unplanned pregnancy, it’s their fault because they were being careless by not using birth control. Often this is simply not the case. According to the Alan Guttmacher Institute, a leading think tank for population research, about half of all American women who experience unplanned pregnancies are, in fact, using contraception at the time they conceive. Many of those failures could have been avoided if couples better understood the woman’s menstrual cycle.
This fact is particularly interesting given that so many of the barrier methods advertise such impressive “effectiveness rates,” often around 95% or higher. These statistics are inherently misleading, primarily because they are based on the faulty assumption that women can get pregnant throughout the menstrual cycle, when in fact a woman can get pregnant for only about one-fourth of a typical cycle. If a method is going to fail, it’s only going to fail during the short fertile phase when her body is even capable of conception.
Given this information, people should know when in the cycle a contraceptive has the potential to fail. They can then make an educated decision as to whether they want to abstain or double up on methods of birth control during that very risky phase to reinforce effectiveness of the methods. For example, if a couple normally uses the diaphragm and knows that the woman will be especially fertile on a particular day, they would be able to increase its effectiveness by using a condom as well.
Women, Men, and Contraceptive Responsibility
A common theme in women’s conversations is the frustration they often feel when saddled with the full burden of birth control. Once people understand that women are fertile for only a fraction of the time men are, they are especially struck with the inequity of it all. So it’s particularly interesting to examine the ways in which women have been disproportionately exposed to side effects throughout their cycle. For example, there are many who will concede that while the pill was originally designed to sexually emancipate women, it has also had the effect of burdening the woman with the sole responsibility of birth control.
Printed with special permission from John Callahan/Levin Represents.
Susan and Joe were a very affectionate couple who grappled with the issue of inequality. Susan had been on the pill for years even though she often suffered nausea and migraine headaches. So when she suggested they take a class in the Fertility Awareness Method, Joe was more than willing. Three years later, they joke about the fact that, even today, every time the alarm rings, he gets up, puts the thermometer in her mouth, brushes his teeth, comes back and removes the thermometer, and records it on her chart. Susan, for her part, remains half asleep, snuggled in bed. No more nausea. No more headaches.
Unlike most other methods, FAM affords men the opportunity to lovingly and actively share in the responsibility of contraception. In fact, the method is so conducive to male involvement that many couples claim that FAM has strengthened their relationship.
THE POLITICS OF PREGNANCY ACHIEVEMENT
I’ll never forget that day my client Terry called. She had been trying to get pregnant for over a year before taking my seminar. It was two weeks following the class, and there was a slight hint of anxiety in her voice as she asked me whether she and her husband should make love that night. They were worried because she thought she had a serious vaginal infection that might affect their chances of conceiving. Just as she began describing what was “coming out of her,” I heard someone pick up the other extension. It was her husband, James. “You cannot believe what is leaking out of Terry right now.”
“Wait a second, you guys. Let me ask you a few questions. Is it clear?”
“Yes.”
“Is it slippery?”
“Definitely.”
“Is it stretchy?”
“Toni, it’s 10 inches!”
“Well then, what the hell are you d
oing talking to me?” I joked. “Get off the phone and take advantage of it!”
Before making love that night, Terry and James took a dozen photos of her fertile cervical fluid. Thirteen years later, I had the privilege of attending their son’s bar mitzvah.
It’s unclear whether the incidence of infertility has actually been increasing over the last several decades or if people are simply seeking treatment in higher numbers. Most likely it’s a combination of both, in large part because more women today delay having children until at least their mid-30s. Of course, as you have no doubt heard many times before, the unfortunate reality is that a woman’s fertility diminishes as she grows older. Regardless of what the reason is, infertility touches about 1 in 6 couples; however, what is often perceived as or referred to as infertility may not necessarily be infertility at all.
The standard definition of infertility is not becoming pregnant after one year of unprotected intercourse. However, there are many couples whose problem is so minor that Fertility Awareness alone would facilitate pregnancy. This is not to imply that fertility issues can always be treated through education. And I am certainly not suggesting that those who are having difficulties getting pregnant are uneducated or ignorant. But clinicians themselves often inadvertently perpetuate myths that prevent couples from attaining pregnancy.
The classic myth, already discussed in Chapter 1, is that ovulation occurs on Day 14. To use this as an example, a couple may spend one year trying to time intercourse around Day 14, only to discover that in their particular case, the woman doesn’t usually ovulate until about Day 20. If the couple gets pregnant after learning this information about her particular cycle, would you say that they were infertile before that? Clearly not. But the emotional and financial consequences are often so great that it’s as if they really were.
Taking Charge of Your Fertility Page 3
