Its convenience and nearly 100-per-cent rate of success are no doubt the major draws. However, numerous studies suggest there's a high price to pay for taking the Pill. Indeed, thrombosis, stroke, cancer, brittle bones and a reduced libido are just some of the health risks associated with these agents (Bennett J, Pope A. The Pill: Are You Sure It's For You? Crows Nest, N.S.W., Australia: Allen & Unwin, 2008).
Happily, the Pill isn't the only option if you don't want to become pregnant. As well as the safer conventional forms of contraception (see box, page 19), there are also a number of natural alternatives for preventing pregnancy.
Other effective methods
Although most women know little about them, there are a number of device- and drug-free birth-control methods-known as 'fertility awareness-based methods', or FABMs-that are both safe and effective. These methods involve learning to recognize the signs of ovulation (when an egg is released from the ovaries), and either abstaining or using a barrier method during such fertile times.
Ovulation signs include changes in body temperature, the quality of cervical mucus and position of the cervix. There are also secondary signs, such as ovulation pain and breast tenderness, which may be helpful. Each of these signs can be used on its own-the Billings ovulation method, for instance, relies upon the mucus changes alone-or all together as a cross-checking system, known as the symptothermal method.
According to the scientific literature, the following methods compare favour-ably with the conventional means of birth control.
The Billings ovulation method
Developed over 50 years ago by Australian physicians Evelyn and John Billings, this method relies upon the changes in vaginal mucus that occur regularly throughout the menstrual cycle to identify when a woman has released an egg and is, therefore, fertile. In general, fertile mucus is clear, wet, slippery, stretchy and changeable in quality-rather like raw egg whites-while infertile mucus is unchanging and usually dry, sticky, cloudy and non-stretchy.
Studies carried out by the World Health Organization (WHO) have indicated that 93 per cent of women, regardless of their level of education, are capable of identifying and distinguishing fertile from infertile mucus. Moreover, when used correctly, this method has a 98- to 99-per-cent rate of effectiveness.
Typically, however, with this form of birth control, around 10-20 per cent of women will nevertheless have an unintended pregnancy within a year of following it. This is mostly due to a conscious departure from the method's rules (J Am Board Fam Med, 2009; 22: 147-57).
A variation of the Billings method, known as the Creighton model or NaProTechnology, is more standardized in the way in which cervical mucus is characterized through the use of pictures and precise words to describe the changes. In a study of more than 1800 couples, efficacy rates for avoid-ing pregnancy were between 96 and 99.5 per cent (J Reprod Med, 1998; 43: 495-502).
For more information about these methods, visit www.boma-usa.org (The Billings Ovulation Method Association) and www.aafcp.org (American Academy of FertilityCare Professionals).
The symptothermal method
This also relies upon observations of cervical mucus but, in addition, it also incorporates body-temperature read-ings (which rise after ovulation) and historical cycle data to determine fertility. This method is based on the idea that, by using more than one sign of ovulation, the woman will be more accurate in predicting her 'safe' days.
In a study in Germany that included 900 women, researchers found this method to be a "highly effective" form of family planning. The results showed that using the symptothermal method (STM) correctly, and abstaining from intercourse during the fertile time, led to a rate of 0.4 unintended pregnan-cies per 100 women per year (99.6-per-cent effective). Thus, the researchers concluded that the successful use of the STM is "comparable to the method effectiveness of modern contraceptive methods like oral contraceptives".
Surprisingly, though, they also found high rates of effectiveness when barrier methods, such as condoms, were used during the fertile time rather than abstinence, with 0.6 unintended pregnancies per 100 women per year, which works out to
an effectiveness rate of 99.4 per cent.
In addition, the overall pregnancy rate-in other words, the calculated rate when all women were included, even those who didn't always follow the rules (typical use)-was just 1.8 per cent (98.2-per-cent effective) per year (Hum Reprod, 2007; 22: 1310-9). This figure is considerably lower than the typical-use rate for the Pill, which is around 8 per cent (or 92-per-cent effective). Nevertheless, previous studies have reported unplanned pregnancy rates
as high as 13-20 per cent for typical users of the STM (J Am Board Fam Med, 2009; 22: 147-57).
For more information on this method, visit www.ccli.org (The Couple to Couple League International).
The Standard Days Method
Based on monitoring the days of a woman's menstrual cycle, this is a modern user-friendly version of the so-called 'rhythm method', which was introduced in the 1920s before the availability of hormonal methods of contraception.
This system is only appropriate for women who have menstrual cycles that generally last for between 26 and 32 days. With this method, women
are taught to avoid unprotected intercourse on potentially fertile days-specifically, on days 8 through to 19 of their cycles-to avoid pregnancy. The women can also use CycleBeads, a colour-coded string of beads that represents the menstrual cycle, to help keep track of their fertile and infertile days.
Studies show that the Standard Days Method is more than 95-per-cent effective when correctly used, and 88-per-cent effective with typical use (J Midwifery Womens Health, 2006; 51: 471-7; J Am Board Fam Med, 2009; 22: 147-57).
For more information on this method, see www.irh.org (Georgetown University's Institute for Reproductive Health).
This short-term technique is based on the natural effect of breastfeeding on fertility. Breastfeeding-and, in particular, exclusive breastfeeding-suppresses the release of the hormones that are necessary for ovulation. Provided that certain conditions are met-the baby is exclusively breastfed and is fed often, day and night; the mother's menses have not returned; and the baby is less than 6 months old-this method is 98-per-cent effective at preventing pregnancy.
For working women, however, the effectiveness rate drops to 95 per cent, even if they express their milk every
4 hours, suggesting that it is the suck-ling of the infant that contributes significantly to the contraceptive effect of lactation (J Am Board Fam Med, 2009;
For further information, visit www.irh.org (Georgetown University's Institute for Reproductive Health).
Benefits and risks
FABMs offer numerous benefits besides a lack of pharmaceutical side-effects. In one survey, couples using natural methods reported better communi-cation and sexual interactions as well as deeper intimacy and respect for their partners. FABMs are also associated with lower divorce rates-at least in the US (J Am Board Fam Med, 2009; 22: 147-57).
Another major advantage is that FABMs are immediately reversible. As soon as the woman stops using the method, she can fall pregnant-unlike some hormonal contraceptives after which fertility can take quite a while to return. Moreover, she can use the knowledge she's gained about her fertility to boost her chances of conceiving.
But what are the drawbacks? FABMs require a high level of organization and commitment and, so, are not for everyone. Clearly, they also don't offer any protection against sexually transmitted infections, which means that they shouldn't be used unless both partners have been tested, or condoms are used as well.
Another disadvantage is that there's a high risk of failure if the woman's fertility signs are not correctly identified or calculated, and this may depend on how well the method was taught. Other factors-for example, if the woman is tired, stressed or ill-can also make it difficult to interpret the signs appropriately.
Another concern that's often raised about FABMs is the potential for less-frequent sex. However, in a compara-tive study involving couples worldwide, the monthly average for FABM users was roughly the same as the others' (J Am Board Fam Med, 2009; 22: 147-57).
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