Wednesday, May 27, 2015

When articles on NFP are stupid...

Today I read an exceptionally stupid article on NFP. The article begins by outlining that using NFP effectively requires users to correctly identify when they are fertile. I don't think any of us would disagree with that. There were some incredibly troubling portions...
accurate “fertility awareness knowledge” (defined as knowing that there is a certain time in a woman’s menstrual cycle when she is most likely to become pregnant and being able identify that time as roughly halfway between her two periods)
Looking through the links, I found that the survey asked if a woman was most fertile "before", "after", or "halfway between" periods. What a terrible way to ask! I'm not sure what I would have marked, since the best answer is "it depends." I suppose in a perfect 28 day cycle with ovulation on day 14, fertility would be roughly halfway, but few women have this perfect cycle. If a woman has a 21 day cycle, with ovulation on day 7-10, wouldn't "after" her period be the most sensible answer? And with my long 38 day cycles, treating "halfway" through my cycle as fertile would be a quick ticket to pregnant.

Knowing that roughly one in five U.S. women has used NFP, it is possible that incorrect NFP use is one of many reasons why half of all pregnancies in the U.S. are unintended.[1]
The stats seem to at least partially back this one up - according to the Guttmacher Institute, 5% of unplanned pregnancies occur in women who use contraceptives correctly and consistently, 49% to women who use contraceptives inconsistently, and 54% to women who did not use contraceptives. It's unclear whether using NFP would qualify for "did not use contraceptives" or "used incorrectly." That being said, it's pretty clear that unplanned pregnancies are caused by many things other than NFP use.

So how can young adults learn more about fertility and NFP? Medical providers could be an important source of information for this population, but they often lack the time or tools to delve deeply into their patients’ contraceptive needs, beliefs, and misconceptions. 
I actually agree with this. It is too bad that doctors aren't better informed on using NFP correctly.

High schools and colleges could also serve as sources of information, but Child Trends’ prior research has failed to establish a link between receiving sex education and having more accurate fertility awareness knowledge.
This doesn't surprise me in the least. Most high school sex ed curriculum I have seen very purposefully emphasizes that one must always assume that a woman is fertile. In abstinence-only curriculum, this is emphasized to show that pregnancy is always a risk of sex. In comprehensive curriculum, this is because NFP is not considered a reliable method to space births and hormonal methods and condoms are considered more appropriate for young adults. In other words, neither curriculum tries to educate young adults on understanding their fertility.

For example, there are several existing websites and phone apps that are making it easier than ever to gain better fertility awareness knowledge and to learn more about NFP. For instance: ...
  • CycleBeads offers three products that can help a woman easily track her menstrual cycle: an online service, a phone app, and an at-home bead visual aid (with each colored bead representing a day in a woman’s menstrual cycle and certain colors representing the woman’s fertile period). These tools can be used either to prevent pregnancy or to plan a pregnancy and can make NFP tracking easier than ever. 
  • Period Tracker is a free, simple phone app that estimates the user’s fertile time based on the average length of her last three menstrual cycles (all the user needs to do is press a button on the app when her period begins).

I can't believe that I just read two recommendations for calender based methods - the least effective of NFP methods - in an article encouraging NFP education. Stunning! I think this connects well to the idea that doctors and medical professionals (and people writing studies and articles as well) should be better  researched on NFP methods.
Of course, the best ways to prevent unintended pregnancies are to abstain from sexual intercourse altogether or to use a highly effective form of birth control (such as a hormonal method or an IUD) when engaging in sexual activity.
 While I'd certainly agree that abstinence is the only sure way to avoid pregnancy, it's also quite clear that there are NFP methods that are highly effective and comparable to hormonal contraceptives. Of course, if a woman is using CycleBeads or other calender-based methods, she is not using one of these highly effective NFP methods, so perhaps I should give the author a break. I am shocked that such an ignorant article was published by such highly educated researchers, and horrified that the most accurate and helpful NFP information was provided instead by internet comment.

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