Skip to main content

Main menu

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
      • The Challenge Initiative Platform
      • Call for Abstracts
      • The Responsive Feedback Approach
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search

User menu

  • My Alerts

Search

  • Advanced search
Global Health: Science and Practice
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search
  • My Alerts

Global Health: Science and Practice

Dedicated to what works in global health programs

Advanced Search

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • Alerts
  • Visit GHSP on Facebook
  • Follow GHSP on Twitter
  • RSS
  • Find GHSP on LinkedIn
COMMENTARY
Open Access

Fertility Awareness Methods: Distinctive Modern Contraceptives

Shawn Malarcher, Jeff Spieler, Madeleine Short Fabic, Sandra Jordan, Ellen H Starbird and Clifton Kenon
Global Health: Science and Practice March 2016, 4(1):13-15; https://doi.org/10.9745/GHSP-D-15-00297
Shawn Malarcher
aUnited States Agency for International Development, Office of Population and Reproductive Health, Washington, DC, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jeff Spieler
b Independent Consultant, Washington, DC, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Madeleine Short Fabic
aUnited States Agency for International Development, Office of Population and Reproductive Health, Washington, DC, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sandra Jordan
aUnited States Agency for International Development, Office of Population and Reproductive Health, Washington, DC, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ellen H Starbird
aUnited States Agency for International Development, Office of Population and Reproductive Health, Washington, DC, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Clifton Kenon
aUnited States Agency for International Development, Office of Population and Reproductive Health, Washington, DC, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
PreviousNext
  • Article
  • Info & Metrics
  • Comments
  • PDF
Loading

Fertility awareness methods—the Lactational Amenorrhea Method, the Standard Days Method, and the Two Day Method—are safe and effective, and they have important additional benefits that appeal to women and men. Including these modern contraceptives in the method mix expands contraceptive choice and helps women and men meet their reproductive intentions.

This peer-reviewed commentary represents the technical position of the Office of Population and Reproductive Health of the United States Agency for International Development.

Fertility awareness methods (FAMs), comprising the Lactational Amenorrhea Method (LAM), the Standard Days Method (SDM), and the Two Day Method (TDM), are often left out of the basket of contraceptive options for women and couples because governments, donors, policy makers, and providers perceive them as inferior contraceptive methods. When FAMs are offered as an option, FAM users may be incorrectly lumped with traditional method users in reports and data analyses. Notably, a recent unpublished review of contraceptive method classification commissioned by the World Health Organization (WHO) found that LAM was deemed a “traditional” rather than a “modern” method in 2 of 5 major family planning publications or data-reporting sources. SDM was included as a modern method in only 3 of 6 publications, and the Two Day Method appeared in only 1 publication.

WHY DO WE CARE?

Fertility awareness methods are commonly misperceived as traditional methods and thus are often left out of family planning programming.

“What gets measured gets done.” As governments and donors recommit themselves to advancing the rights of women and girls to decide—freely and for themselves—whether, when, and how many children to have, more attention is cast on the key measures of success laid out at the London Summit on Family Planning in 2012. As agreed on by committed governments and donors, key indicators of success explicitly identify modern method use as the outcome of interest. In this context, common misperceptions that FAMs are traditional methods mean that countries do not prioritize investments in their introduction or expanded provision. These methods may be absent from training curricula, counseling materials, logistics systems, and procurement processes. FAM users may be left out of key monitoring and data collection activities. If users of FAMs are not counted as modern contraceptive users, we as a community are failing to recognize a valid and important choice to meet client needs—what gets counted gets supported.

WHAT MAKES FAMS “MODERN”?

The United States Agency for International Development (USAID) supports FAMs as modern contraceptives because these methods meet the criteria for a modern contraceptive. FAMs:

  • Are effective at pregnancy prevention,

  • Are safe,

  • Are based on a sound understanding of reproductive biology,

  • Include a defined protocol for correct use, and

  • Have been tested in appropriately designed studies to assess effectiveness under various conditions.

The Standard Days Method is an easy way to track the fertility cycle and fertile window for women whose menstrual cycle lengths are 26–32 days. The SDM algorithm is based on data from 7,500 cycles collected as part of a 5-country clinical trial supported by WHO. A second clinical trial of SDM followed, which documented a 95% effectiveness rate in perfect use and an 88% typical use rate; the typical use rate is commensurate with barrier methods, including male and female condoms and diaphragms.1,2

The Two Day Method is a modification of the Billing's Ovulation Method and relies on a woman’s assessment of her cervical secretions to identify her fertile days. The algorithm is based on data from multiple, large data sets. Clinical trials following more than 400 women for 13 cycles of method use showed an efficacy rate of 96% with perfect use and over 86% with typical use, also commensurate with barrier methods.3

The Lactational Amenorrhea Method, based on the fertility-suppressing effects of breastfeeding, requires that a woman be within 6 months postpartum, exclusively or nearly exclusively breastfeeding, and amenorrheic.4 Multiple studies have documented an efficacy of 99% in perfect use and 98% at 6 months in typical use, commensurate with effectiveness of injectables and combined oral contraception.5

ADDITIONAL BENEFITS OF FAMS

Fertility awareness methods are knowledge-based, relying on women’s understanding of their fertile cycle and, in the case of LAM, of how breastfeeding practices can temporarily suppress fertility. In addition to offering a safe and effective alternative to other contraceptive methods, FAMs offer several additional benefits:

  • They do not require clinical intervention, such as hormones, devices, or procedures.

  • They are controlled by a woman and her partner.

  • They increase a woman’s understanding of her fertility and biological processes.

  • In the case of SDM and TDM, they provide the opportunity to facilitate pregnancy planning.

  • FAMs can be offered through a wide variety of channels, including settings completely outside the health system.

Fertility awareness methods do not require clinical intervention and can be offered through a variety of service delivery channels.

Technical experts report that providers trained in FAMs appreciate their improved capacity to explain the basic concepts of fertility to their clients. This knowledge helps reassure their clients about the safety and efficacy of contraceptive methods generally, which may lead to increased acceptance of family planning. Providers who counsel on methods that require awareness and involvement of both partners, such as SDM, also develop the capacity to discuss relationship dynamics and partner communication—valuable skills regardless of the contraceptive method chosen by clients.6

USAID’s family planning programs are guided by the principles of voluntarism and informed choice. That is, every individual has the right to choose the number, timing, and spacing of her/his children; to choose freely whether and when to use contraception; and to choose from a broad range of contraceptive methods, with ample information about use, advantages, and side effects. Evidence of USAID’s commitment to these principles is its support for the development, testing, refinement, and introduction of new and improved contraceptive methods as well as its support for family planning program components that make that choice real. USAID aims to help countries meet the contraceptive needs of their people. Key to achieving this aim is expanding access to a wide and diverse method mix. USAID continues to support countries and the global family planning community in their efforts to incorporate modern methods, including FAMs, into the contraceptive method mix. The more contraceptive choice we can afford to women and men, the better equipped they will be to achieve their reproductive intentions. Key to expanding contraceptive choice is overcoming misconceptions. Let’s recognize FAMs for what they are: effective, safe, modern contraception.

USAID supports fertility awareness methods as modern contraceptives.

Notes

Peer Reviewed

Competing Interests: None declared.

Cite this article as: Malarcher S, Spieler J, Fabic MS, Jordan S, Starbird EH, Kenon C. Fertility awareness methods: distinctive modern contraceptives. Glob Health Sci Pract. 2016;4(1):13-15. http://dx.doi.org/10.9745/GHSP-D-15-00297

First Published Online: 2016 Jan 25

  • Received: 2015 Sep 30.
  • Accepted: 2016 Jan 11.
  • Published: 2016 Mar 21.
  • © Malarcher et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/. When linking to this article, please use the following permanent link: http://dx.doi.org/10.9745/GHSP-D-15-00297.

REFERENCES

  1. ↵
    1. Gribble JN,
    2. Lundgren RI,
    3. Velasquez C,
    4. Anastasi EE
    . Being strategic about contraceptive introduction: the experience of the Standard Days Method. Contraception. 2008;77(3):147–154. doi:10.1016/j.contraception.2007.11.001. pmid:18279683
    OpenUrlCrossRefPubMed
  2. ↵
    1. Arévalo M,
    2. Jennings V,
    3. Sinai I
    . Efficacy of a new method of family planning: the Standard Days Method. Contraception. 2002;65(5):333–338. doi:10.1016/S0010-7824(02)00288-3. pmid:12057784
    OpenUrlCrossRefPubMed
  3. ↵
    1. Arévalo M,
    2. Jennings V,
    3. Nikula M,
    4. Sinai I
    . Efficacy of the new TwoDay Method of family planning. Fertil Steril. 2004;82(4):885–892. doi:10.1016/j.fertnstert.2004.03.040. pmid:15482764
    OpenUrlCrossRefPubMed
  4. ↵
    Consensus statement: breastfeeding as a family planning method. Lancet. 1988;332(8621):1204–1205. doi:10.1016/S0140-6736(88)90279-6
    OpenUrlCrossRef
  5. ↵
    1. World Health Organization Department of Reproductive Health and Research (WHO/RHR); Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs
    (CCP), Knowledge for Health Project. Family planning: a global handbook for providers (2011 update). Baltimore: CCP; 2011. Co-published by WHO. Available from: https://www.fphandbook.org/
  6. ↵
    1. Lundgren RI,
    2. Karra MV,
    3. Yam EA
    . The role of the Standard Days Method in modern family planning services in developing countries. Eur J Contracept Reprod Health Care. 2012;17(4):254–259. doi:10.3109/13625187.2012.677077. pmid:22681177
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Global Health: Science and Practice: 4 (1)
Global Health: Science and Practice
Vol. 4, No. 1
March 21, 2016
  • Table of Contents
  • About the Cover
  • Index by Author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Global Health: Science and Practice.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Fertility Awareness Methods: Distinctive Modern Contraceptives
(Your Name) has forwarded a page to you from Global Health: Science and Practice
(Your Name) thought you would like to see this page from the Global Health: Science and Practice web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Fertility Awareness Methods: Distinctive Modern Contraceptives
Shawn Malarcher, Jeff Spieler, Madeleine Short Fabic, Sandra Jordan, Ellen H Starbird, Clifton Kenon
Global Health: Science and Practice Mar 2016, 4 (1) 13-15; DOI: 10.9745/GHSP-D-15-00297

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Fertility Awareness Methods: Distinctive Modern Contraceptives
Shawn Malarcher, Jeff Spieler, Madeleine Short Fabic, Sandra Jordan, Ellen H Starbird, Clifton Kenon
Global Health: Science and Practice Mar 2016, 4 (1) 13-15; DOI: 10.9745/GHSP-D-15-00297
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Statistics from Altmetric.com

Jump to section

  • Article
    • WHY DO WE CARE?
    • WHAT MAKES FAMS “MODERN”?
    • ADDITIONAL BENEFITS OF FAMS
    • Notes
    • REFERENCES
  • Info & Metrics
  • Comments
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Use of Fertility Awareness-Based Methods for Pregnancy Prevention Among Ghanaian Women: A Nationally Representative Cross-Sectional Survey
  • Interventions for Preventing Unintended, Rapid Repeat Pregnancy Among Adolescents: A Review of the Evidence and Lessons From High-Quality Evaluations
  • Fertility Awareness Methods Are Not Modern Contraceptives: Defining Contraception to Reflect Our Priorities
  • Investing in Family Planning: Key to Achieving the Sustainable Development Goals
  • Response to Austad: Offering a Range of Methods, Including Fertility Awareness Methods, Facilitates Method Choice
  • Google Scholar

More in this TOC Section

  • The Case for Using a Behavior Change Model to Design Interventions to Promote Respectful Maternal Care
  • Oxygen Inequity in the COVID-19 Pandemic and Beyond
  • Does the Current Global Health Agenda Lack Vision?
Show more COMMENTARY

Similar Articles

Subjects

  • Health Topics
    • Family Planning and Reproductive Health
US AIDJohns Hopkins Center for Communication ProgramsUniversity of Alberta

Follow Us On

  • Twitter
  • Facebook
  • LinkedIn
  • RSS

Articles

  • Current Issue
  • Advance Access Articles
  • Past Issues
  • Topic Collections
  • Most Read Articles
  • Supplements

More Information

  • Submit a Paper
  • Instructions for Authors
  • Instructions for Reviewers
  • GH Journals Database

About

  • About GHSP
  • Advisory Board
  • FAQs
  • Privacy Policy
  • Contact Us

© 2023 Creative Commons Attribution 4.0 International License. ISSN: 2169-575X

Powered by HighWire