Many young minority women who use natural family planning (NFP) to prevent pregnancy may not be doing so correctly. That’s the troubling finding from a recent Child Trends study exploring how young, minority women in the United States use natural family planning methods of birth control.
Unlike many other methods of birth control that do not require the user to know how the methods work for them to be effective (for example, a woman does not need to know how an IUD works for it to be a highly effective method of birth control), NFP relies on the user’s ability to track her menstrual cycle, to be able to accurately identify the point in her cycle when she is most likely to get pregnant, and to either abstain from having sexual intercourse or to use another method of birth control during that time. Yet this study, which drew from interviews with young black and Latina women who had used NFP to prevent pregnancy, found that, while most of them abstained from sexual intercourse when they thought they were at the point in their cycle when they could get pregnant, only about half of them correctly identified when that point was.
This is consistent with previous research by Child Trends that found that only about one-third of unmarried young adults have 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). But it is also alarming, given that the young women in this study were NFP users – meaning that these women actively needed accurate fertility awareness knowledge to avoid an unintended pregnancy. In general, most young adults think they have the knowledge they need to prevent an unintended pregnancy – but it appears that they might not know as much as they think they do in this area.
Importantly, when NFP methods are used perfectly, these methods can be highly effective – about as effective for avoiding unintended pregnancy as diaphragms or condoms – but when used incorrectly, they are not especially effective. This knowledge gap may be especially important for racial and ethnic minorities, who have particularly low levels of fertility awareness knowledge and disproportionately high rates of unintended pregnancy.1 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.
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. 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. The good news is that social media and technology may be a way to improve knowledge and to help young adults use NFP more effectively. 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:
- Bedsider.org provides detailed information about all contraceptives available in the U.S., including several NFP options, and provides links to sources for more information on NFP.
- 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).
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. But, for the not-insignificant number of young women who rely on NFP methods of birth control, preventing unintended pregnancies is a matter of having accurate knowledge about fertility and being empowered to use this knowledge to protect against an unwanted or mistimed pregnancy.
Elizabeth Cook, MSPH, Research Analyst
Amanda Berger, Ph.D., Research Scientist
Lina Guzman, Ph.D., Program Area Director
 Finer, L. B. & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception, 84(5), 478-485.