The Pill: Overkill?

According to the Guttmacher Institute, 99% of sexually active, American women of reproductive age have used some kind of artificial contraception in their lifetime. This could mean various hormonal contraceptive or barrier methods. That's a pretty staggering statistic! It would seem that contraception is a nearly universal experience for the American woman.

But should it be? I personally believe that most contraception is overkill for pregnancy prevention. That may seem like a strange thing to say, given that contraception by definition is intended to prevent pregnancy!

Human Fertility and Birth Control
To explain what I mean, I'll have to tell you a little bit about how female fertility works.

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In order to conceive a child, three things must be present. An egg (or ova), which is released from the ovaries at ovulation, sperm from a woman's male partner, and fertile quality cervical mucus, produced by a woman's cervix around the time of ovulation. During the course of a woman's cycle (usually lasting around a month), ovulation only occurs once. After ovulation, an egg can only survive for up to 24 hours. In order for normally short-lived sperm to survive long enough after intercourse to reach the released egg, there must be fertile quality cervical mucus, which is only present a handful of days around the time of ovulation. If this cervical mucus isn't present at the time of intercourse, or if it is but the time of ovulation has already passed, conception can't happen. Basically, there is only a short time each cycle when conception is possible.

Next, I'd like to explain how hormonal contraception works. To clarify, when I say hormonal contraception I mean anything that introduces artificial forms of hormones into a woman's body, such as synthetic estrogen, synthetic progestin, or both. This could mean the Pill, the Depo shot, an under-skin implant, a vaginal ring, a patch, or a hormonal IUD. Various kinds of hormonal birth control use different levels and combinations of artificial hormones as well as different delivery systems, but the mechanism by which they function is nearly identical.
Basically, hormonal birth control works to artificially suppress, sabotage, and shut down a healthy, functioning female reproductive system. Not only during intercourse, but all day long, seven days a week, for as long as she uses the contraceptive (and even beyond!)

Even using a barrier can be a largely useless exercise, except for those few days a month that a woman is potentially fertile. If a couple uses a condom on a day that the woman is not fertile, and then she does not conceive, the couple will then congratulate themselves that their contraceptive choice worked so well. But in this situation, the condom had absolutely no effect on their lack of conception. It was simply not needed. (Even when used during the fertile time, condoms have up to a 18% typical use failure rate among the general population)

Now are you beginning to see why I say that contraception is overkill?

Safe Sex (or not)
There is a perception in our society that 'unprotected' sex is risky and dangerous. Even married couples are considered irresponsible for ditching contraception unless they are actively trying to get pregnant. But I argue that in a monogamous, faithful relationship (even when the goal is pregnancy avoidance), contraception is not only completely unnecessary, but can itself be dangerous.

Unnecessary? Here's where you say, "but Rebecca, you don't expect everyone to have 10 kids, do you?" Of course I don't. But I'll get to that in a minute. Let's focus on the danger part first.

Hormonal birth control poses many risks to women. Common side effects include headaches, mood swings, weight gain, acne, depression, loss of libido, nausea, vomiting and more. Many women accept these side effects as necessary if they are serious about avoiding pregnancy. There are other very rare, but extremely serious side effects that are associated with use of oral contraceptives, such as heart attack, blood clots, and strokes. Oral contraceptives have also been shown to increase the risk of certain cancers. All this, to prevent pregnancy that is only possible during a small window every cycle? Isn't there a better way?

I'm so glad you asked.

What every woman deserves to know
Enter natural family planning (NFP), a fertility awareness based method of family planning. NFP is based on the biological principles of human fertility outlined above, and works with a woman's fertility, not against it. Every woman has reliable, physical signs that indicate her state of fertility throughout the cycle. Various methods of NFP involve a woman taking her temperature, noting mucus appearance and sensation, and/or checking the position of her cervix. These signs can be recorded on a chart, and that chart interpreted to accurately pinpoint where a woman is in her fertility cycle. A woman can reliably know on any given day if an act of intercourse could possibly result in conception, or not. If a couple is avoiding pregnancy, they simply abstain on the days when a woman is potentially fertile. As for the days when conception isn't possible, then couple can enjoy coming together with no barriers, no artificial hormones or chemicals, and no worries. Simple, safe, and 99.4% effective!

So why don't more people know about this? To be honest, I'm not entirely sure. The conspiracy theorist in me would say that since there is no profit to be made from NFP, no one is talking about it. Birth control pills make a fortune for pharmaceutical companies, who push doctors to offer it to women. As such, many women are not informed about the risks of hormonal birth control, nor the alternatives. And honestly, most medical doctors are not even familiar with natural family planning or it's effectiveness. It's not taught in medical school. Doctors may equate NFP to the outdated Rhythm Method, which relies on counting calendar days to 'guess' what the most fertile days of a woman's cycle might be, rather than using her tell-tale physical signs to glean that information. 
Sadly, even if doctors do know about NFP, many don't believe couples capable of exerting the kind of self-control that periodic abstinence requires. It seems that most medical providers believe that women would prefer to shoulder the risk and side effects of chemically suppressing an entire bodily system, rather than taking a cold shower once in a while. It's kind of insulting, really.

Thankfully, there IS a growing awareness of fertility based methods of family planning emerging. Books are being written, studies done, websites created, and communities both local and online dedicated to educating and supporting women and couples in learning fertility awareness.

So next time you reach for your morning dose of carcinogens, ask yourself, "Is this overkill?"

Rebecca Menning
Fertility Educator

If you are interested in learning more, visit the F.A.Q page on my website, or click here to view my class offerings. Any questions can be sent to [email protected]

 photo by Areeya-freedigitalphotos.net