For birth control, what’s old is new again

“I can’t afford to get pregnant,” says 25-year-old Aisha Mukooza.

So every morning, for the past two and a half years, Aisha’s been strict about taking her temperature as soon as her alarm goes off at 6 a.m.

“I have my thermometer under my pillow. I take it, and then take the reading and put it in Kindara,” Mukooza says.

Kindara is an app on her phone that helps her chart her temperatures. As Mukooza explained, “the temps, when I ovulate, it rises.”

She is part of a growing movement of young women who are saying no to hormonal birth control and yes to a kind of birth control that sounds at first like a real throwback with a little extra high-tech twist.

These women are using Natural Family Planning, also known as Fertility Awareness Methods (FAM).

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Many experts caution that this is one of the least successful methods to use, because it can be so complicated to do correctly. But with new technology, some women think it is the best option for them.

While many women use these methods to help with conception, an increasing number are using these same methods to avoid getting pregnant.

Born initially out of the Catholic Church, FAM is starting to lose its religious connotation as more secular woman turn to it. Many say they are wary of the effects of hormonal birth control.

According to the Centers for Disease Control and Prevention, just between 1-3% of women use FAM as a form of contraception. However, a study from the University of Iowa found that if more women knew about it, 1 in 5 women would actually consider it as an option.

When Mukooza’s then-boyfriend, and now-husband, asked her to consider using the pill or getting an implant, she was vehemently against it.

“I wouldn’t have it,” she says. “I was literally scared of hormonal birth control. I didn’t like the potential side effects.”

“I’m a healthy person. I try to eat healthy food, so the idea of being pumped with synthetic hormones didn’t appeal to me, in fact, it was scary,” Mukooza says.

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The pill is the most common form of pharmacological birth control. Studies show some 4 out of 5 American women use them. Yet, nearly 30% of all users stop using the pill because of side effects that include nausea, weight gain, sore or swollen breasts, spotting and mood changes according to research from the CDC.

One of those who users who stopped taking the pill is 29-year-old Kacey (she asked that we not use her last name).

Kacey had been on estrogen-based birth control pills since she turned 19.

When she was 25, doctors found that she had an increased risk for strokes, and switched her to progesterone-based birth control.

“I was a mess. For two weeks, a month, I was completely a wreck,” she says.

Aside from just feeling emotionally out of sorts, Kacey would have two to three periods a month and her skin broke out constantly.

Thinking an IUD would be a better fit, she switched last year.

“Every symptom I had was way more amplified,” she says. She was fed up, and three months ago she started FAM. Last month, Kacey had the IUD taken out. “It’s worth it to not feel like a 16-year-old all the time.”

FAM is frequently referred to as the rhythm method – a system in which women predict their likely fertile days based on the lengths of their cycles. However, FAM advocates say there is a clear distinction. This method is much more careful.

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Ilene Richman, director of the Fertility Awareness Center, describes it this way, “It’s a process of becoming aware of the signals your body is giving you and keeping track of them.”

Richman explained that after a women ovulates, her basal body temperature, the body’s lowest temperature throughout the day, would rise. In addition, “A woman who cycles naturally, is going to experience a wetness around the time of ovulation,” Richman says.

When women become more fertile, their bodies produce fluids that help give sperm their best chance at fertilizing the egg. Once a woman ovulates, the consistency of that fluid changes. A woman’s cervix will also change positions, based on whether or not she has ovulated.

Charting temperatures, noting fluid consistency, and checking cervix position can seem overwhelming at first. “I think it can be a little difficult to remember it all in the beginning, but it really isn’t that difficult,” explained Kacey. “Once you get it, you fall into a rhythm.”

The CDC and the American College of Obstetricians and Gynecologists are quick to point out that FAM is one of the least-effective methods of birth control.

“You hear about 25%,1 in 4, who use it correctly can expect to get to get pregnant.” says Dr. Nathaniel DeNicola, an OBGYN with the University of Pennsylvania Health System.

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But FAM supporters, such as Sarah Bly, a fertility awareness instructor, says that number needs to be parsed out further.

“The perfect use rate is 99.6%-99.4% which is really good,” Bly says. Meaning women who are very particular about keeping their health statistics and not missing even a single day. “A lot of statistics that (the doubters quote) are typical use, which include women taking risks,” Bly says.

A German study from 2007 that tracked 900 women over 20 years consistently using FAM methods found that only 2% of those women had an unintended pregnancy.

DeNicola agrees that it can work for some.

“For the right patient, who is really willing to track the days, and are willing to track the temperature,” he says.

But, FAM can be a bad option for women with more irregular bleeding or frequent sources of infection or fever that make body temperature difficult to track.

“Even one day (miscalculated) can result in pregnancy,” says DeNicola.

Strictly recording temperatures and noting fluids can be tricky. But a growing number of new apps, such as Kindara, Glow, and Ovuline – can make it a lot easier. In fact, women’s health apps have some of the highest number of subscribers of all health apps.

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Mukooza, who uses Kindara, says it has made this method so much easier to keep track of temperatures and her history. It also gives her a community of other women using the app for the same purpose.

Having that kind of community is important because many of these women say they don’t feel supported by their family or friends in their choice of birth control.

“My mother and sister think I’m absolutely insane. So do all of my girlfriends,” Kacey says.

Will Sacks, Kindara founder, says the community aspect of the app has been important for many customers. “It helps normalize it. They feel, I’m here with thousands of other women, and I can ask questions,” Sacks says.

Keeping such detailed records on your own fertility may not be the best fit for everyone, but it has made an increasing number of women at least feel like they have more options.

“I’m about to approach my 30s, and am thinking about having kids. It’s terrifying to not know how your body functions, and it’s fertility,” said Kacey, “I wish it (FAM) was presented as a more viable option.”