What Are Your Fertility Intentions?

“You’re using Fertility Awareness as contraception? Well… I guess it’s fine if you don’t mind getting pregnant.”

That sums up the general attitude around Fertility Awareness Based Methods (FABMs). Non-hormonal methods of contraception seem to have lost credibility in general.

LARCs, long-acting methods like the IUD or the implant, are considered the holy grail of birth control. And for good reason. Once they’re inserted, you don’t need to think about it. The device keeps doing its thing.

But many women’s feelings around a potential pregnancy are anything but black-and-white. There’s an entire spectrum of pregnancy intentions.

What does it mean to ‘not mind getting pregnant’, and how does it impact the effectiveness of Fertility Awareness?

Say a woman is trying to decide on a birth control method. Perhaps she wants a child on some level, but there are too many obstacles in her way. Maybe she doesn’t have a stable source of income, or space to house a family, or she hasn’t found the right partner yet.

If she decides to use a LARC or even the pill, she won’t have to make a cost-benefit analysis every time she has sex. It’s already taken care of.

Non-hormonal methods require you to make a conscious decision to avoid pregnancy on a regular basis and there will be times when it’s inconvenient.

When we make a decision as important as whether or not to risk an unintended pregnancy, a lot of factors come into play.

In her book, The Complete Guide to Fertility Awareness, Jane Knight lays out a model developed by Kirsten Luker. It describes the mental process women go through when weighing the risk of an unintended pregnancy against the cost of contraception. We still need some long-term studies on the model, but it’s worth seeing if these factors are influencing your decision-making process.

According to this theory, there are 3 factors women take into consideration.

Some women don’t think of an unintended pregnancy as the worst possible outcome.

As long as a pregnancy happens at the ‘right’ age, it comes with lots of social approval. It’s the pinnacle of womanhood. I’ve heard women say they were never treated better than when they were pregnant.

Treatment during the birthing process is a different story, but let’s save that for another time.

Even some teenagers like the idea of getting pregnant. I remember reading girls’ messages to teen magazines about how much they wanted a baby. It would be a way to get parental attention, or the baby’s unconditional love.

Meanwhile, contraception comes with significant drawbacks. Hormonal birth control has a whole host of potential side effects, both mental and physical. Most methods need to be picked up at drug stores or carried with you. This can open you up to judgment.

I would argue our human tendency to focus mostly on short-term consequences also comes into play. The judgment, the side effects, and the hassle are relevant right now. On the other hand, that positive pregnancy test is at least a couple of weeks away.

This is where accurate information about pregnancy risk comes in.

A woman can only conceive for about a week every cycle. And even if you timed sex right around ovulation, there’s still at most a 27% chance of conception.

This reality conflicts with what many of us have been told since we were teens: that we’ll get knocked up as soon as we let our guard down. Even with my Dutch sex ed, I don’t remember learning that pregnancy is physically impossible once a woman has ovulated and the egg is gone.

It’s understandable from a teacher’s point of view. Teens are generally more impulsive and a pregnancy at such a young age can be detrimental to physical and mental health.

We want to discourage reckless behavior, but overstating pregnancy risk can have the opposite effect. If you’ve gone unprotected multiple times and you’re still not pregnant, you may assume you calculated things right. You may even think you’re infertile.

But maybe you just avoided the fertile days by chance. And at some point, things line up just right (or, wrong), and you’ll end up with an accidental pregnancy.

If you do conceive, you’ll have to decide whether or not to continue with the pregnancy.

Women who use FABMs tend to get criticized for choosing an ‘unreliable’ method. Because we are so often told our chosen method is ineffective, we’re more likely to have a solid plan B.

Quick PSA: no birth control method is 100% effective, so we should all consider our options and see if our values align with our partner’s in case we get pregnant.

For those of us who would consider getting an abortion, a slightly higher risk may be more acceptable. That is, if access is not an issue.

If abortion isn’t an option for you, either because of personal values or lack of access, you may be extra careful.

The Frank-Herrmann study is famous in the Fertility Awareness community. This study showed the Sensiplan method can be as effective as the pill when taught by a certified educator.

The researchers did have another interesting finding, though. Some couples were taking risks by having intercourse around the outer limits of the fertile time. This resulted in a surprisingly low failure rate of 7.47 per 13 cycles in 100 women. They called this ‘intelligent risk-taking’.

This concept of ‘intelligent risk-taking’ hits at the core of what makes Fertility Awareness so empowering and why doctors hesitate to recommend it.

FABM users can tailor their method to their needs. Once people truly understand how their fertility works, they can make informed decisions about how to handle it. You know, informed consent.

This does leave room for impulsive decisions, though. An unconscious desire for a pregnancy could make it harder to stick to method rules.

With the growing popularity of cycle tracking also comes a lot of misinformation. And unfortunately, there’s a lack of regulation in the Fertility Awareness space, making it harder to compare the different methods. On top of that, FemTech has caught on, marketing fertility apps and gadgets to women.

Popular ways to use FABMs, such as using wearable temping devices and self-teaching haven’t been studied yet. Some methods rely on just one fertility sign. This makes tracking easier but isn’t as effective as methods cross-referencing multiple indicators.

However, as long as the user is aware of the failure rate and comfortable with the level of risk, there’s no issue.

Ultimately, how a woman handles her fertility is up to her.

It all comes down to what the Fertility Awareness community calls the ‘fertility intention scale’.

A woman may be trying to avoid a pregnancy (TTA), trying to ‘whatever’ (TTW), or trying to conceive (TTC).

Intentions are given a score from 0 to 10, with 0 meaning the woman would get an abortion if her method failed.

A score of 5 to 7 falls under TTW, meaning a pregnancy would be welcome and more risks are taken.

Finally, a 10 means a woman is timing sex during the fertile window and would consider treatments like IVF if needed.

If you’re at a 0 and want to use FABMs, you’d probably be best off using a method like Sensiplan and working with an instructor. But the more flexible you are, the broader your method and tracking options will be.

One of the perks of Fertility Awareness is that it’s completely customizable to the couple or individual woman.

Some methods have a checkbox on every cycle sheet to mark pregnancy intentions. This encourages you to suss out your feelings about a potential pregnancy and talk things through with your partner. I think women using hormonal birth control would also benefit from this kind of regular re-evaluation.

The BMJ has a great overview of the perfect and typical effectiveness rates of various FABM methods, compared to other types of birth control.

And if you’re looking for an instructor, have a look at my Sensiplan courses. If you’d prefer a different method, Read Your Body has a directory of educators in a wide array of methods, many offering online courses.

So, where do you fall on the fertility intentions scale?