It is the stance of the Nordic Union for Fertility Awareness that fertility awareness based methods (FABMs) are modern methods of birth control that should be offered as a choice in all contraceptive counselling. Because there is a variety of FABMs, there is a variety of efficacy between different methods when used for contraception. Methods that teach a standardised observational routine of evidence-based biomarkers together with standardised charts, notations, interpretations and guidelines for avoiding pregnancy can be expected to be very effective (up to 99% or more) with perfect use. All and all, perfect use efficacy rates vary between 95 and 99.6 % depending on the method. More detailed information about the efficacy of the methods taught by educators certified by NUFA can be found in the method descriptions.

We want to emphasise that typical use failure rates comparable to the typical use rates of the more popular methods such as hormonal contraceptives and barrier methods cannot at present be provided for FABMs because of their current marginal nature: there have not been enough users of these methods to calculate method-specific typical use failure rates at a population level. Often cited typical failure rate of 24% for FABMS comes from a population survey where most people in this category were in fact using a calendar-based method and is not indicative of the typical user rate of all FABMS or any particular method. Studies of different methods do provide typical use failure rates among the study participants which does give us an idea of the general effectiveness but may not be reflective of their failure rate at a population level. 

FABMs can be effective, side-effect free and low-cost methods of birth control but they do need to be not only learned thoroughly but also practiced consistently in order to be highly effective. Since all FABMs are behavioural methods, there is a lot of room for error and ultimately the efficacy of the method is very user-dependent. Qualified instructors can help people get the most out of their fertility awareness practice and enable them to use their method of choice in a way consistent with its perfect use. Practitioners certified by NUFA have completed a rigorous training and can help their clients to reach a deep, practical understanding of the method they teach while taking into account individual circumstances and most importantly, know where to refer clients with reproductive situations that are out of the scope of their particular training.

Note: The efficacy rates of different FABMs come from studies where all participants were taught by accredited teachers and the training and teaching methodology was standardised. In other words, the study participants didn’t learn how to practice the methods by reading a book or from social media, and they didn’t just download an app. Self-taught users of these methods cannot expect the same efficacy rates because they are learning the method in an entirely different manner and are not receiving individualised guidance.

Are FABMs for everyone?
Choosing a method of birth control is a process in which many factors should be considered. For the purpose of contraceptive counselling, FABMs should be considered as an option for people who either don’t want to or cannot use an artificial method of birth control including hormonal contraceptives, barrier methods and IUDs, for people who want a side-effect free method of birth control and for people who are motivated to learn a new life skill.

FABMs as methods of birth control are not suited for people who want a non-user-dependent method of birth control and are contraindicated for people who are in an intimate relationship not allowing the use of a co-operative method of birth control (e.g. involving sexual coercion/violence) or for people with cognitive challenges that do not allow for the use of a user-dependent method of birth control.

There are circumstances where learning or practicing fertility awareness as a birth control method can be more challenging than usual and consulting with a qualified instructor is highly recommended. These include:

• During the first years of the menstrual cycle (after menarche)
• During perimenopause
• After stopping hormonal birth control
• After giving birth and/or during breastfeeding
• When for other reasons experiencing irregular or otherwise complicated menstrual cycles

FABMs can be combined with other non-pharmaceutical methods such as a condoms or a diaphragm but this would not reflect their “perfect use”. Combining a specific FABM with other methods and the resulting efficacy rates can be discussed with a method’s instructor.

FABMs do not protect against sexually transmitted diseases and should always be combined with a condom when there is a risk of transmission.