In the aftermath of the November election, there were several media reports that women across the country were scrambling to acquire birth control before the new administration took over. There is, of course, no looming ban on contraception in the works. But one key point seems to have been lost in the frenzy: drugs and devices that function as birth control methods and contraceptives aren’t good for women.
In an elegant pair of articles at Public Discourse, Sherif Girgis recently explained the historical and philosophical context for the Catholic Church’s stance against contraception (a stance that, as he noted, was common to all Christians for 1900 years). Beyond the philosophical and moral reasons why contraception is bad for women, though, it’s worth mentioning that scientific and medical reasoning also points away from the use of birth control. From the perspectives of women’s health and empowerment, contraceptive drugs and devices fall short of what’s advertised.
Moreover, as our medical knowledge expands, we have an improved understanding of the parameters that constitute our physical health. The realm of human fertility has seen tremendous advancements in the last several decades. We have increasing evidence that better family planning options exist for women, and these options don’t require altering the normal way a woman’s body functions.
The Beautiful Complementarity of Our Bodies
Our bodies are beautiful. Artists across the centuries have paid tribute to the beauty of our human bodies through various media. Leonardo da Vinci painted his Mona Lisa. Michelangelo sculpted David. Antonio Carlos Jobim and Vinicius de Moraes wrote “The Girl From Ipanema” as a tribute to a captivatingly beautiful girl named Helo Pinheiro. And the list goes on and on.
Importantly, there are key structural differences between the biology of a man and that of a woman, many of which relate to our procreative capacities. A woman’s body is naturally designed with a rhythm; from the onset of puberty, she has windows of time when she is fertile and the rest of the time she is infertile. Just as we recognize changing seasons in our natural environment through various cues (changing colors of leaves, for example), we can observe women’s changing fertility status. By contrast, once a man reaches puberty, his body is constantly fertile.
There’s a built-in complementarity between male and female fertility. Our bodies achieve their greatest triumph when two complementary bodies come together to produce new life. Neither the male nor female body alone is sufficient for this task.
Why, then, are women the ones bearing the brunt of the chemical and physical sterilizations of contraceptive drugs and devices? Taking birth control doesn’t free women up for a lifestyle of whimsical flings and romantic liaisons. It enslaves women to drugs and devices. It sends the message to women that their normal monthly window of fertility is a disease for which a prescription remedy is needed. It also shifts the responsibility of reproductive health away from the man and places it solely on the woman.
When “women’s issues” get brought up in debates, it’s very rare that anyone mentions the side effects and potentially adverse outcomes of taking chemical birth control, but the reality is that there’s a laundry list of possible problems in each package. Birth control advocates try to dismiss these adverse effects by calling them rare and by propagating the notion that the lower-dose hormone formulations of the last few decades are now “safe and effective.” Yet hormonal birth control remains on the WHO list of Group 1 carcinogens. Hormonal birth control’s neighbors on that list of carcinogens include tobacco, asbestos, and the active ingredient of sulfur mustard, which is used in chemical warfare. “Safe and effective,” it seems, is merely a hollow marketing slogan.
Pro-Woman Family Planning
Rejecting artificial methods of birth control is actually the most pro-woman option on the family planning menu. While the birth control industry offers chemical and physical inhibitors to turn off normal functions of otherwise healthy reproductive organs, those who embrace the historic teaching on contraception free women to live in full harmony with their natural bodies.
We should approach fertility by advocating what is morally and physically good for men and women. As it turns out, in addition to being morally good, natural methods of family planning (also known as Fertility Awareness Based Methods, or FABMs) are also healthy for the body, and they require no additives or inhibitors. FABMs come with zero side effects, and they are evidence-based: a substantial body of research on the major FABMs exists, and more research is currently underway. Published studies have found that FABM users report several advantages of these methods, including a sense of empowerment, better understanding of fertility, cost-effectiveness, eco-friendliness, and enhanced communication between couples.
Artificial contraceptives are based on the misconception that fertility is bad. The entire marketing scheme, which champions “freedom” for sexually active men and women, relies on the consumers’ belief that their reproductive capacities are unwanted, cumbersome, and potentially dangerous. While pregnancy can certainly pose risks, especially for women with preexisting health conditions, drugs and devices used as birth control also put women at risk for serious medical problems. Allowing one’s body to function in its natural state of reproductive health is healthy and normal. FABMs teach women (and couples) to understand how their bodies work and to appreciate the capacities of their reproductive systems in the holistic context of their overall state of health. Contraceptives, by contrast, send the message that our bodies are broken. They ingrain in us the message that the only way to control our fertility is by physically or chemically inhibiting it, and then enduring whatever consequences emerge as a necessary price to be paid for “sexual freedom.”
Fear of pregnancy is a major motivator for women who seek out birth control. Many women mistakenly think they only have two choices: use contraceptives or resign yourself to a lifetime of surprise pregnancies. But there is no numerical pregnancy moral requirement for married couples, nor is each marital embrace morally worthy only if it results in pregnancy. There are times when, for various reasons, couples should avoid trying to achieve pregnancy. The beauty is that women’s bodies are naturally designed with spacing capacities, so it is quite possible to avoid pregnancy without subjecting either partner to any sort of drug or device.
A 99-percent FABM effectiveness rate with correct use is comparable to the most effective contraceptive options, including implants and intrauterine devices. But what about typical use? The Centers for Disease Control and Prevention (CDC) still lists FABMs at the bottom of the effectiveness list for preventing pregnancy, citing a 24-percent incidence in unintended pregnancies with typical FABM use. This 24-percent figure is outdated, as explained in depth here and here. Briefly, it is based on data collected from the 1995 and 2002 National Surveys on Family Growth. These two surveys, though offering large sample sizes, were retrospective studies based on patient recall, and were conducted via phone calls asking women about family planning methods used and pregnancy status. Among several limitations to these surveys, the majority of the women sampled who identified as using a “natural” method of family planning had reported using some form of calendar rhythm method, an older and less-effective method. Researchers who later sought to generate an overall effectiveness rate for FABMs then pooled all of the pregnancy rates from all natural methods together. This blurred the distinctions between the modern methods and also masked the individual method effectiveness rates. So while the calendar rhythm method may be less effective with typical use, there are several other FABMs available with very different typical use profiles. For example, users of the SymptoThermal Method, one example of a very effective modern FABM, on average experienced a less-than-one-percent pregnancy rate with correct use, and between one- and just-over-two-percent pregnancy rate with typical use. By comparison, the birth control pill has a typical-use pregnancy rate of about nine percent. We can thus conclude that, with typical use, some modern FABMs can have unintended pregnancy rates that are comparable to those of commonly used contraceptives.
Aside from efficacy and safety, another clear advantage FABMs have over any kind of birth control method is that FABMs can help physicians trained in these methods to identify and diagnose underlying reproductive health issues. By learning to appreciate natural biomarkers and indicators of fertility, women (and their physicians) can use charted information to identify a range of medical problems including polycystic ovarian disease, ovarian cysts, abnormal bleeding, and hormonal abnormalities. No contraceptives can provide this information. In addition, FABMs are true methods of family planning because women can use the same FABM to either avoid or achieve pregnancy. There’s no drug washout phase, and the transition from avoiding to achieving pregnancy can be made as soon as the couple discerns a change in pregnancy intentions.
Contraception and Public Policy
Philosophical and moral objections to providing contraception formed the crux of the Little Sisters of the Poor’s opposition to the HHS Mandate. The Little Sisters challenged the mandate because it would have forced them to choose between the laws of their country and their beliefs.
In the aftermath of the Supreme Court ruling, the HHS accepted public comments about how best to accommodate employers and health care insurance providers who have religious objections to contraceptives. Offering alternative insurance coverage for instruction in the major FABMs would be an excellent way to promote evidence-based family planning methods that are pro-woman, pro-family, and in accordance with teachings of every major religious group.
FABMs are natural methods of family planning that demystify our bodies without destroying their natural beauty. These methods are safe and effective. In addition, once you learn how to use them, most of these methods are essentially free of cost. FABMs empower women and couples and help them understand and work with their fertility, which is central to what it means to be male or female.
As Fulton Sheen pointed out, “the history of civilization could actually be written in terms of the level of its women.” So let’s invest in our women, empower them, and raise them up to true freedom.
Ana Maria Dumitru is a sixth-year MD-PhD candidate at Dartmouth’s Geisel School of Medicine. She is a trained FABM instructor and a student ambassador of the Fertility Appreciation Collaborative to Teach the Science (FACTS). She thanks Dr. Marguerite Duane, co-founder and Executive Director of FACTS, for FABM research and resources that contributed to this article. Dr. Duane is a board-certified family physician and adjunct associate professor at Georgetown University.