Ask the CDC to report accurate data on side-effect free and effective Fertility Awareness Based Methods



Addressed to Dr. Anne Schuchat, MD (RADM, USPHS), Acting Director, Centers for Disease Control and Prevention

Dear Dr. Schuchat,

A surveyi of more than 2500 people that use Fertility Awareness Based Methods (FABMs) from several Western countries showed that a large majority of them view these methods positively due to improved self-knowledge, relationships, and satisfaction with frequency of sexual intercourse.

Yet, in the United States, less than 5% of womenii use natural methods of family planning, including the sympto-thermal method, the primary method used by people in this study and one of the most effective ones available based on large individual prospective trialsiii.

This may be due in part to the fact that the Centers for Disease Control and Prevention’s website currently reports that the combined typical “failure rate” for all FABMs, also known as “natural methods,” is 24%iv .

This rate misrepresents the actual effectiveness of individual modern FABMs. Based on the highest quality published medical research, the effectiveness rates of FABMs with correct use are between 95.2 and 99.6%, depending on the method. Even with typical use, the effectiveness rates of FABMs are comparable to most commonly used forms of birth control, with unintended pregnancy ranging from 2-14%v.

The 24% “failure rate” quoted by the CDC comes from a retrospective surveysvi based on patient recall, a flawed methodology which is less likely to report accurate success rates.

Additionally, the study’s authors failed to account for the fact that FABMs can be used both to avoid or achieve pregnancy as “it was assumed that there was a contraceptive failure if a method was used continuously before and after conception of a pregnancyvii.”

Furthermore, in the survey, 86% of the respondentsviii reported using variations of the calendar rhythm method—an outdated and less effective fertility awareness-based method—as their primary form of contraception. This lumping together of FABMs masks important differencesix in the effectiveness of modern methods, which utilize various observations of specific physical signs to prospectively determine the fertile window.

That’s why we are asking the CDC to update its website to reflect the best data available and to cite the individual effectiveness rate of each unique type of evidence-based FABM, for example: Billings Ovulation Method®, Creighton Model, Sympto-Thermal, Sympto-Hormonal, and Standard Days Methods.

Women and medical professionals deserve accurate information about effective ways to prevent pregnancy based on the best research available. FABMs are increasingly in demand as women seek effective family planning options that are free from hormones and side effects.

Indeed the World Health Organization recognizes that FABMs are the only methods of family planning with no medical side effectsx.

It has been reported that up to 61% of women say they would be interested in using these methods to avoid pregnancy if they were properly informed about themxi. Yet only 3 to 6% of medical professionalsxii are aware of the actual effectiveness rates of FABMs. As a result, women may not have access to FABMs.

Only the CDC is in a position to correct this misinformation.

We appreciate your consideration of this urgent matter, and count on your understanding of the needs of physicians and the women they serve and your commitment to share the most up to date, high quality data.


Marguerite Duane, MD, MHA, FAAFP
Co-Founder and Executive Director of FACTS
Fertility Appreciation Collaborative to Teach the Science
Adjunct Associate Professor
Georgetown University School of Medicine

Gerard Migeon
Co-founder, President and CEO,
Natural Womanhood

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[ i ] Unseld M, Rötzer E, Weigl R, Masel EK and Manhart MD (2017) Use of Natural Family Planning (NFP) and Its Effect on Couple Relationships and Sexual Satisfaction: A Multi-Country Survey of NFP Users from US and Europe. Front. Public Health 5:42. doi: 10.3389/fpubh.2017.00042

[ ii ]  Use of Contraception in the United States: 1982–2008, Vital and Health Statistics, August 2010

[ iii ] Frank-Hermann P., Heil J., Gnoth C., et al. “The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple’s sexual behaviour during the fertile time: a prospective longitudinal study.” Human Reproduction. 22 (2007): 1310-1319.

Frank-Hermann P., et al. “Natural family planning with and without barrier method use in the fertile phase: efficacy in relation to sexual behavior: a German prospective long-term study.” Advances in Contraception. 13 (1997):1790-189.

[ iv ]Appendix D: Contraceptive Effectiveness Recommendations and Reports April 25, 2014

[ v ] Manhart MD, Duane M, Lind A, et al. Fertility awareness-based methods of family planning: a review of effectiveness for avoiding pregnancy using SORT. Osteopathic Fam Physician. 2013;5(1):2–8.

[ vi ] Trussell J. Contraceptive Efficacy. In Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, Policar M. Contraceptive Techology: Twentieth Revised Edition. New York NY: Ardent Media, 2011.

[ vii ] Vaughan B, Trussell J, Kost K, Singh S, Jones R “Discontinuation and resumption of contraceptive use: results from the 2002 National Survey of Family Growth” Contraception 78:271-283, 2008

[ viii ] Mosher WD, Jones J. Use of Contraception in the United States: 1982-2008. National Center for Health Statistics. Vital Health Stat 23 (29). 2010.

[ ix ] Lamprecht, V, Trussell, J “Natural family planning effectiveness: Evaluating published reports.” Advances in Contraception 13(2/3): 155-165, 1997.

[ x ] Festin MPR, Diariea J, Solo J, Kiariea J, Malarcher S, Van Look PFA, Temmerman M. Moving towards the goals of FP2020 — classifying the goals of contraception. Contraception. 2016; 94: 289-294.

[ xi ] Survey of attitudes regarding natural family planning in an urban Hispanic population

Clinton J. Leonard, William Chavira, Dean V. Coonrod, Contraception, October 2006 Volume 74, Issue 4, Pages 313–31

[ xii ] Choi J, Chan S, Wiebe E.  Natural Family Planning: Physicians’ Knowledge, Attitudes, and Practice

J Obstet Gynaecol Can 2010;32(7):673–678.


Fertility Appreciation Collaborative to Teach the Science

Natural Womanhood

Know your body