{"id":5673,"date":"2016-11-16T08:55:15","date_gmt":"2016-11-16T14:55:15","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/janetheactuary\/?p=5673"},"modified":"2016-11-16T09:15:27","modified_gmt":"2016-11-16T15:15:27","slug":"more-effective-than-the-pill-wait-what","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/11\/more-effective-than-the-pill-wait-what.html","title":{"rendered":"More effective than the pill.  Wait, what?"},"content":{"rendered":"<!DOCTYPE html PUBLIC \"-\/\/W3C\/\/DTD HTML 4.0 Transitional\/\/EN\" \"http:\/\/www.w3.org\/TR\/REC-html40\/loose.dtd\">\n<html><head><meta http-equiv=\"content-type\" content=\"text\/html; charset=utf-8\"><meta http-equiv=\"content-type\" content=\"text\/html; charset=utf-8\"><\/head><body><p><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-5674\" src=\"https:\/\/wp-media.patheos.com\/blogs\/sites\/533\/2016\/11\/800px-Quecksilber-Basalthermometer.jpg\" alt=\"https:\/\/commons.wikimedia.org\/wiki\/File%3AQuecksilber-Basalthermometer.jpg; By Gelegenheitsautor (Own work) [Public domain], via Wikimedia Commons\" width=\"614\" height=\"204\"><\/p>\n<p>\u201cWait, what?\u201d is my 13 year old son\u2019s favorite line when something surprises him, and this definitely qualifies.<\/p>\n<p>Let\u2019s start with this: \u00a0if you look at the <a href=\"https:\/\/www.cdc.gov\/reproductivehealth\/contraception\/\" class=\" decorated-link\" target=\"_blank\" rel=\"nofollow\">CDC resources<\/a> for information on methods of family planning, you\u2019ll see typical use effectiveness as follows (selected, expressed as failure rates):<\/p>\n<ul>\n<li>The combination pill: \u00a09%.<\/li>\n<li>The minipill: \u00a0also 9%.<\/li>\n<li>The condom: \u00a018%.<\/li>\n<li>Natural family planning or fertility awareness: \u00a024%.<\/li>\n<\/ul>\n<p>leaving NFP users stuck with explanations like, \u201cwell, that lumps in all types of NFP\u201d and \u201cwell, they didn\u2019t instruct and motivate women properly in their studies.\u201d \u00a0And, indeed, these statistics \u2014 neither for the hormonal contraceptives nor for NFP \u2014 are without any sources\/footnotes, which is understandable, perhaps, on the PDF factsheet version of this information, but should certainly be available somewhere on the site, and it\u2019s not. \u00a0You\u2019ll also notice that all methods of NFP\/FAM are lumped in together as well.<\/p>\n<p>But the WHO is a different story.<\/p>\n<p>Here\u2019s what they have to say on <a href=\"http:\/\/www.who.int\/mediacentre\/factsheets\/fs351\/en\/\" class=\" decorated-link\" target=\"_blank\" rel=\"nofollow\">their equivalent table<\/a>\u00a0of modern contraceptive methods (note that WHO shows effectiveness rates, so I\u2019m converting to failure rates here):<\/p>\n<ul>\n<li>The combination pill: \u00a08%.<\/li>\n<li>The minipill: \u00a03-10%.<\/li>\n<li>The condom: \u00a015%.<\/li>\n<li>Standard Days Method: \u00a012%<\/li>\n<li>BBT Method: \u00a025%<\/li>\n<li>Two-Day Method: \u00a014%<\/li>\n<li>Sympto-thermal Method: \u00a02%.<\/li>\n<\/ul>\n<p>And they cite references. \u00a0For the 2% rate, they cite \u201cManhart et al, 2013,\u201d which is easily found on google: \u00a0\u201c<a href=\"http:\/\/sympto.org\/data\/Fertility_awareness-based_methods_of_family_planning_2013.pdf\" class=\" decorated-link\" target=\"_blank\" rel=\"nofollow\">Fertility awareness-based methods of family planning:<\/a><br>\n<a href=\"http:\/\/sympto.org\/data\/Fertility_awareness-based_methods_of_family_planning_2013.pdf\" class=\" decorated-link\" target=\"_blank\" rel=\"nofollow\">A review of effectiveness for avoiding pregnancy\u00a0using SORT<\/a>.\u201d \u00a0Now, this isn\u2019t the study itself, but a review of mutliple studies, and the key study here is \u201c<a href=\"http:\/\/humrep.oxfordjournals.org\/content\/22\/5\/1310.long#T4\" class=\" decorated-link\" target=\"_blank\" rel=\"nofollow\">The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple\u2019s sexual behaviour during the fertile time: a prospective longitudinal study<\/a>,\u201d which is (woo-hoo!) available online for free. \u00a0And this is a major study,\u00a0with 900 couples, so the effectiveness rate is statistically credible and not just a fluke. \u00a0This study was undertaken in Germany, where I have the understanding there are more couples interested in hormone-free methods of family planning, and there was a mix of couples who abstained during the fertile period and those who sometimes used barrier methods, without any impact on effectiveness. \u00a0 But it\u2019s also noteworthy that the study occurred in Germany, where the TFR of 1.4 is itself an indicator that Germans are in general very motivated to succeed in their family planning goals.<\/p>\n<p>That the Standard Days Method and the Two-Day Method have lower effectiveness rates is not a surprise, because they are less effective methods.<\/p>\n<p>But\u00a0what about that 25% for the BBT method? \u00a0That\u2019s generally a more conservative method so it\u2019s surprising to have such a high reported failure rate.<\/p>\n<p>The reference WHO gives here is \u201cTrussell, 2009\u201d which produces one result, \u201c<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3638200\/\" class=\" decorated-link\" target=\"_blank\" rel=\"nofollow\">Cost Effectiveness of Contraceptives in the United States<\/a>.\u201d \u00a0And this article is actually focused on the math of the \u201ccost effectiveness\u201d of preventing pregnancies by looking at\u00a0the cost of the methods themselves, their effectiveness, and the cost of the abortions or births due to pregnancies that occur. \u00a0Now, this is a mindset that assumes that every unintended birth is a net \u201cextra\u201d birth in this country, and that, without those unintended prengnacies, we\u2019d never have those births \u2014 rather than what I\u2019ve read as an operating assumption in other literature, that unplanned pregnancies are \u201cmistimed\u201d and without them, most women would still go on to have those children, just at a different time in her life. \u00a0But in any case, there is a table of effectiveness, and the 25% that the WHO references comes from this table, and is actually, again, as with the CDC, the lumping-together of all NFP\/FA methods. \u00a0Perhaps it\u2019s even the same source, and the 25% is just rounding. \u00a0What\u2019s more, the reference for all these failure rates is a text, \u201cHatcher RA, Trussell J, Nelson AL, Cates W, Stewart FH, Kowal D. Contraceptive Technology, nineteenth revised edition. New York NY: Ardent Media; 2007,\u201d which is not viewable online. \u00a0So the 25% failure rate is a dead-end; I\u2019m simply not finding any references to any studies that establish this rate. \u00a0(Perhaps a reader will have more success?) \u00a0My guess is that this was some kind of retrospective study asking women, \u201cwhat method did you use?\u201d and labelling as NFP\/FAM any response about \u201cI just don\u2019t have sex when I think I\u2019m fertile,\u201d rather than a controlled study of any kind based on a specific method and genuine instruction. \u00a0Bottom line: \u00a0I would discard the 25% as not credible.<\/p>\n<p>So that\u2019s what I\u2019ve got for you for discussion today, for those of you who are exhausted by the protests and the cabinet pick rumors and all the other nonsense. \u00a0And, yes, I am aware that it sidesteps entirely the attempts among contraception advocates and policy-makers to move as many women as possible onto IUDs, which is a whole \u2018nother story.<\/p>\n<p>\u00a0<\/p>\n<p>image: \u00a0https:\/\/commons.wikimedia.org\/wiki\/File%3AQuecksilber-Basalthermometer.jpg; By Gelegenheitsautor (Own work) [Public domain], via Wikimedia Commons<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"<p>\u201cWait, what?\u201d is my 13 year old son\u2019s favorite line when something surprises him, and this definitely qualifies. Let\u2019s start with this: \u00a0if you look at the CDC resources for information on methods of family planning, you\u2019ll see typical use effectiveness as follows (selected, expressed as failure rates): The combination pill: \u00a09%. The minipill: \u00a0also [&hellip;]<\/p>\n","protected":false},"author":2209,"featured_media":5674,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[269,501,489],"class_list":["post-5673","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-contraception","tag-natural-family-planning","tag-nfp"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>More effective than the pill. 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