Date: November 30th, 2017
By: Pat Paluzzi
Long before I came to work at Healthy Teen Network, I practiced as a Certified Nurse Midwife (CNM). My first job was in a freestanding birthing center where two CNMs offered a full scope of services to families seeking alternatives to medically focused care, including an out-of-hospital birth experience. I worked there for almost five years, providing gynecologic and family planning services along with prenatal, intrapartum, and postpartum care. I have fond memories and great birth stories from that time. I also tried to teach many educated, well-meaning adults how to use natural family planning (NFP) as a means of contraception.
I cannot for the life of me, reconcile my experience with attempting to teach NFP, which is what fertility awareness means for contraception, with what I know about teens and young adults. They are simply not compatible, and yet this is the recommendation from this administration for what should be part of this country’s focus on reducing teen pregnancy moving forward (along with abstinence, of course).
NFP combines the basal body temperature method, the cervical mucus method, and the calendar/rhythm method. It is used both as a means of preventing pregnancy and as a way to target a woman’s most fertile time for getting pregnant. Let me provide a brief but fairly complete explanation of what it takes to do NFP successfully (which still means only about a 74% success rate). As you read this, I ask you to consider any teens you know, or recall your teen self, and how likely you or they are/were able to follow these instructions.
What it is: The basal body temperature (BBT) is the temperature when fully at rest. Ovulation may cause a slight increase in BBT. We are most fertile during the two to three days before our temperature rises. By tracking the BBT each day, we may be able to predict when we’ll ovulate.
How to do it: Taking your BBT requires a particular thermometer and a strict method. You must take your temperature before rising in the morning as any activity can raise the BBT. Take your temperature at the same time every morning. Take your temperature after at least three consecutive hours of sleep. Keep your thermometer accessible from your bed, so you do not have to get up to get it.
What it is: In simple terms, cervical mucus is a fluid secreted by the cervix, the production of which is stimulated by the hormone estrogen. Throughout the menstrual cycle, the amount and quality of cervical mucus that is produced fluctuates, and by observing these changes one can begin to predict the most fertile days in one’s cycle. As you approach ovulation, your estrogen levels begin to surge, which causes your cervix to secrete more cervical mucus that is of a so-called “fertile quality.” This fertile-quality cervical mucus, also known as egg white cervical mucus, is clear and stretchy, similar to the consistency of egg whites, and it is the perfect protective medium for sperm in terms of texture and pH.
How to do it: The most accurate way to identify changes in cervical mucus is to collect and observe a sample of mucus on a daily basis. To do this, wash and dry your hands well, then insert your middle or index finger into your vagina, getting as close to your cervix as possible. Remove your finger and observe the consistency of the mucus sample by rolling the mucus between your thumb and finger, pressing your fingers together, and then slowly moving them apart. Log the results daily.
What it is: The calendar method involves tracking your menstrual cycle in order to predict fertile and non-fertile days. Before you can use the calendar method as birth control, you need to keep track of the length of your menstrual cycles for at least 6 periods.
How to do it: Mark the first day of your period on a calendar (this is day 1). Then mark the first day of your next period. Count the total number of days between each cycle (the number of days between the first days of each period).
To predict the first fertile day (when you can get pregnant) in your current cycle:
- Find the shortest cycle in your past record.
- Subtract 18 from the total number of days in that cycle.
- Count that number from day 1 of your current cycle, and mark that day with an “X.” (Include day 1 when you count.)
- The day marked “X” is your first fertile day.
For example: if your shortest cycle is 26 days long, subtract 18 from 26—you get 8. Then, count 8 days starting from day 1 (the first day of your period). If day 1 was on the 4th of the month, you’ll mark X on the 11th. So the 11th is your first fertile day of this cycle—you should stop having vaginal sex on this day or start using another method of birth control.
To predict the last fertile day in your current cycle:
- Find the longest cycle in your record.
- Subtract 11 from the total number of days in that cycle.
- Count that number from day 1 (the first day of your period) of your current cycle, and mark that day with an X. (Include day 1 when you count.)
- The day marked X is your last fertile day.
For example, if your longest cycle is 30 days long, subtract 11 from 30—you get 19. Then, count 19 days starting from day 1. If day 1 was on the 4th of the month, you’ll mark X on the 22nd. So the 22nd is your last fertile day of this cycle—you can start having unprotected sex the next day.
All of these methods require planning and impulse control, neither of which are available to most teens as the limits of executive planning and impulse control are notably missing in the teen brain. Many teen girls will be reluctant to test for cervical mucous as this involves acts they will likely consider gross. Honestly, who among you even understands the calendar method? And finally, all of these require complete cooperation between sexual partners, a rare commodity in teen relationships.
I leave it to you to judge if NFP will be an effective means of reducing the teen pregnancy rate. As for me, I am thinking this is a slam-dunk failure—and another crushing blow from this administration to young people.
About the Author
Patricia Paluzzi, CNM, DrPH, President and CEO of Healthy Teen Network, has been active in the fields of reproductive, and maternal and child health for over 40 years, as a clinician, researcher, administrator, and advocate. Her clinical and content expertise spans the full scope of midwifery care, substance abuse, intimate partner violence, high-risk maternal child health (including pregnant teens), incorporating men into clinical services, and trauma-informed approaches.