Recently, there have been rumblings in several cultural magazines of female dissatisfaction with available birth control methods. This sentiment is not all that surprising to me. During my years in medical school, patient clinic appointments were commonly devoted to women’s concerns about their contraceptive method and their desires to try something different. But despite all the complaints I heard about condoms and contraceptives behind closed clinic doors, many colleagues and friends (and perhaps even some family members?) looked at me in shocked disbelief when I admitted that my husband and I don’t use hormonal contraceptives or condoms. So, I was amazed to read Ann Friedman’s piece in the New York Magazine (note: the headlining picture and article may be explicit for some readers) last month. Friedman openly acknowledged complaints and frustrations that I have heard so many times with patients. She also offered a no doubt inflammatory admonition: “Though we all want safe, accessible, reliable contraceptive options, the pill is no longer synonymous with sexual liberation.” (NYMag 9/5/13, Ann Friedman)
I read with even greater interest Katie Gilbert’s piece in The Atlantic a few weeks ago, proposing Fertility Awareness Methods (FAMs) as a solution to the plaguing hormonal milieu. She acknowledges that a rare 1 to 3 percent of U.S women use FAMs as their family planning method of choice (which includes all nine of the Builders here). But, she sites Journal of Family Practice survey suggesting that far more women consider FAM when the methods are fully described. Ms. Gilbert concludes that FAMs are effective, based on several recent scientific reviews, while acknowledging that they require more detailed training than hormonal contraceptive methods.
What I found most interesting were Ms. Gilbert’s assessments regarding the reasons why FAMs have failed to gain wider acceptance. She cites as a limiting factor the religious, specifically Catholic, ties that people assume about FAMs (given that NFP methods and instructors have been lead the field for so long) and seems to bemoan that secular versions of NFP teaching and support groups don’t really exist. She also notes that there is a lack of knowledge and information about FAMs among our country’s physicians, as well as a lack of economic motivation for companies to promote it. Gilbert quotes Mihira Karra, an official with USAID’s office of population and reproductive health: “With the natural methods, we have clients eager to use them, but our big barriers are sitting at the higher medical levels.”
During medical school, I was discouraged that fertility awareness methods weren’t taught in any meaningful way. This felt especially affronting during my family practice and OB/gyn rotations, when NFP and other FAMs were dismissed as ineffective rhythm methods without any serious explanation. Within the fields of OB/gyn and Family Practice, providing and promoting contraceptives among women of childbearing age is considered a cornerstone clinician obligation. Yet, most physicians don’t realize that without a knowledge base rounded out by fertility awareness techniques, the promotion is terribly one-sided and does a disservice to many women.
In my opinion, most of the medical community is totally unconvinced that any reasonable, rational, educated women desire natural forms of family planning. As a training clinician, I never had a patient tell me that she would prefer a non-hormonal method of birth control. As patient myself, I had to weather the uncomfortable, amazed expression on the face of my OB when I turned down her offer of post-partum contraception. “No thanks, we’ll use NFP,” I said, shyly. “So, how about spermicide and condoms?” was her confused reply. Discussing dissatisfactions or oppositions to hormonal or barrier contraceptives with your physician can be uncomfortable and discouraging. But in my experience, the vast majority of physicians want to find ways to respond to the preferences and desires of their patients. So, such discussions are a valuable opportunity to encourage some change or broaden the scope of care that is offered. We all can play a role in improving this area of health care. Any other ideas?