There are four main methods that we term 'natural': abstinence, Fertility Awareness method (FAM), Lactational Amenorrhea method (LAM), and withdrawal.
These methods all require the cooperation of the sexual partner, and generally speaking, a good awareness of the body and its natural rhythms and cycles.
The chart below indicates the efficacy of each method; more information on efficacy can be found on the pages for each natural method.
Fertility Awareness Method
|Lactational Awareness Method||98-99.5%|
What is Abstinence?
Abstinence can mean different things for different people but strictly speaking it means no sexual contact of any kind, especially no penis-to-vagina contact. For a variety of reasons, many people may choose abstinence at some point in their life.
In terms of birth control, abstinence means not allowing sperm near the woman's body below the waist.
In terms of STI protection, abstinence also means no oral-genital, anal-genital, or intimate skin-to-skin contact.
How effective is it?
If used consistently, abstinence is 100% effective in preventing pregnancy and STIs.
- Abstinence is free, available to all, and can be started at any time in one's life
- Abstinence may encourage people to build relationships in other ways - there are ways to be intimate with someone that don't involve sexual activity
- Abstinence may be the course of action which you feel is right for you and makes you feel good about yourself
- There are no medical or hormonal side effects
- If you are counting on abstinence and change your mind in the heat of the moment, you might not have protection handy.
- Choosing abstinence does not mean that your sex drive (libido) goes away and you may need to find other ways to redirect your sexual energy.
Important points to think about
- There are many reasons people choose abstinence; it is important to make your decision for yourself and define what abstinence means to you and, if you are in or beginning a relationship, what it means to your partner.
- You don't have to be a virgin to practice abstinence - many people abstain from sex at different times, and for different reasons.
- Find someone that you trust, respect and feel safe with to discuss your decision.
- Have barrier methods handy 'just in case' you change your mind
- Seek emergency contraception if intercourse occurs without contraception
Some churches and sex education programs have organized support groups or curricula for young people wanting to wait until marriage before having intercourse. If this is your decision, you may find one of these groups helpful to you.
Revised March 2009
What is fertility awareness (FAM)?
Fertility awareness (also called natural family planning or rhythm method) is a way to predict fertile and infertile times in your cycle. FAM is based on body signs, which change during each menstrual cycle in response to the hormones that cause ovulation (the release of an egg). If you use FAM and don't want to get pregnant, you must abstain (not have intercourse at all) or use another contraceptive during your fertile times.
What facts are Fertility Awareness Methods (FAM ) based on?
- An egg is usually released once in each menstrual cycle.
- The egg lives 12 to 24 hours.
- Sperm can live up to five to six days in the uterus, and be able to fertilize an egg during this time.
- This means that a woman is fertile for as long as six days before ovulation and two or three days after ovulation, a total of seven to eight days of fertility in her cycle each month.
When does a woman normally ovulate (release an egg)?
- Ovulation normally occurs once in a menstrual cycle (between periods).
- The egg is normally released 14 days before your period starts. If a woman has regular monthly periods (the number of days between the start of each period is exactly the same) then ovulation will occur at the same time during each cycle.
How effective is using FAM in preventing pregnancy?
- If 100 couples use FAM for one year, an average of 25 women will become pregnant during that time.
- If FAM is used perfectly, only 1 to 9 will become pregnant in the first year of use.
- The effectiveness depends on many factors including the regularity of the woman's menstrual cycle and the ability to use the methods accurately and consistently.
How do fertility awareness methods work?
Some methods depend on abstinence during fertile times, others rely on a backup method of birth control, such as condoms and spermicide or a diaphragm, during fertile times. Having intercourse during your fertile time, of course, adds a risk of pregnancy since there is a chance of failure for any method of birth control.
Also, a spermicide placed into the vagina can make it difficult for the woman to observe mucus changes.
What are the different methods?
There are a variety of fertility awareness methods that use one or more fertility signs.
Calendar (Rhythm) Method predicts when ovulation will happen based on when ovulation occurred in past cycles.
Ovulation (Mucus) Method involves watching the changes in cervical mucus. Normal vaginal discharge changes at the time of ovulation. When you're most fertile, there is more mucus, and it feels wet and slippery (like raw egg white). After ovulation, there is less mucus and it's sticky, blocking sperm from entering the uterus. Women can check their mucus daily to tell when they're most fertile.
Basal Body Temperature Method (BBT) depends on taking daily temperature readings to determine when ovulation is occurring. There is a rise in temperature when ovulation occurs. By taking your temperature first thing every morning, and graphing the results, you can often tell if you've ovulated.
Sympto-Thermal Method uses a combination of various methods that identify symptoms of ovulation. These include the mucus method, basal body temperature, cervix changes, and other symptoms such as breast tenderness, abdominal heaviness, slight lower abdominal pain, or slight bleeding (spotting). This method may work better for women with irregular or less distinct mucus changes.
Advantages in using FAM for pregnancy prevention
- Inexpensive, no health risks and convenient (no devices or hormones to use)
- Acceptable to couples who have religious concerns.
- Can develop greater communication, cooperation and responsibility for partners
- Can be useful for determining optimum fertility time to achieve a pregnancy
- Can help a woman track and improve PMS symptoms
Disadvantages in using FAM
- High failure rate, difficulty in accurately predicting ovulation or fertile time.
- Requires commitment from both partners. Cannot be spontaneous with intercourse.
- Provides no protection against STIs.
- Only as effective as the contraceptive used during fertile times (e.g., abstinence, condoms)
- Many things can affect a woman's ovulation pattern, resulting in unintended pregnancies.
- A woman must abstain or use another birth control method for several days longer than the actual fertile time
- All fertility awareness methods depend both on careful, daily observation and charting of body signs, and on the cooperation of both partners in respecting fertile times.
- The method works best to prevent pregnancy if a couple has a stable relationship, good communication, and strong motivation to use it correctly.
- Some couples choose FAM because it's safe, less expensive than other methods, and requires no drugs or devices. It can be easily discontinued any time pregnancy is wanted.
Where can I get more information on Fertility Awareness methods?
You can get more information or referrals to organizations who specialize in how to use these methods by contacting SEX SENSE at 1-800-739-7367 or email, or by visiting your local OPT clinic.
A good website that provides detailed information on how to use FAM is the Cedar Rivers Medical Clinics Fertility Awareness section.
Revised March 2009
What is lactational amenorrhea?
This is a temporary contraceptive method that relies on exclusive breast feeding. It can be used from birth up to six months afterwards.
Producing milk is called lactating and not having a period is called amenorrhea, hence this method of birth control is called lactational amenorrhea (or LAM).
How does this method work?
If a woman exclusively breastfeeds her baby for six months, the hormones that produce the breast milk will also work to stop the ovaries from releasing an egg (that is, there will be no ovulation) for the first six months after the baby is born. A woman doesn't get her period during this time.
For this method to work, the following three conditions must be met.
1. The baby must be under six months of age AND
2. The woman must not have had a period AND
3. The baby must be exclusively breastfed (no formula or pablum with breast feeds at least every four hours during the day and at least every six hours at night).
How effective is it?
- Lactational amenorrhea is between 98% and 99.5% effective in preventing a pregnancy.
- If any of the criteria changes, such as you get your period or you start feeding your baby formula or pablum, then you need to assume the LAM is no longer working and you need to use another form of birth control. It is useful to have some condoms to use in case one of the criteria changes.
- It costs nothing
- Easy to use
- No clinic visits or external drugs required
- No hormones that interfere with breast feeding
- Does not interrupt intercourse
- It only lasts for six months after your baby is born
- It is not reliable if your baby is fed any pablum or formula
- It is difficult to predict if your ovaries are ready to start releasing an egg (ovulating). However, as soon as you have a period, you should use another method of birth control, if you have not already done so.
- Requires frequent breastfeeding (see above) which may be difficult for some women
- Does not protect against STIs
- LAM helps the woman's body return to its pre-pregnancy state
- Helps the woman to return to normal weight
- Vaginal dryness related to breastfeeding can be improved by using water-based lubricant
- Women who are HIV+ should discuss the risks and benefits of LAM with their physician
Revised March 2009
What is withdrawal?
The man removes his penis from the vagina before he comes so that ejaculation takes place outside the vagina. Usually, no other protection methods are used with the withdrawal method. Experience and practice helps men develop the skill to use this method effectively.
How effective is it as a contraceptive?
- Withdrawal is 73% (typical use) - 96% (perfect use) effective.
How effective is it at preventing STIs?
- There is a greater risk of contracting sexually transmitted infections (STIs) because there is no protection (barriers) between partners and body fluids.
- Withdrawal is free and always available
- No clinic visits necessary
- No equipment or supplies needed
- No side effects
- Method does not rely on woman using contraception
- Method can be used with other methods of contraception
- May be difficult for some men to know when they need to withdraw before the point of ejaculation
- There may be increased anxiety for both partners around withdrawing in time. This worry may decrease their enjoyment of sex.
- Poor to no protection against sexually transmitted infections including HIV and AIDS
- Sperm may be present in the clear fluid that comes out of the penis before ejaculation; so pregnancy might still be possible.
How to use the withdrawal method
- The man must rely on his own sensations to determine when he is about to ejaculate.
- He must then withdraw his penis prior to ejaculation and move away from the female genitalia.
- If another act of intercourse takes place, the man must urinate and wipe off the tip of his penis to remove any sperm remaining from the previous ejaculation.
Revised March 2009