Cycle It Out

The Atlantic has an interesting piece on the return of the rhythm method:

With its blinking face and patented “LadyComp algorithm,” Daysy seems newfangled, but its core technology is one septuagenarians would recognize. It relies on the basal body-temperature method of family planning, based on the fact that women’s bodies are a few degrees hotter just after ovulation. But while in past decades women who employed this method had to hand-chart their temperatures on graph paper, Daysy tracks the readings automatically and ports the data onto a companion iPhone app that lets the user see her “cycle forecast” and “temperature curve.” Because it’s personalized, it claims to predict a woman’s chance of pregnancy with an accuracy of 99.3 percent—roughly the same as that of birth-control pills.

Becca began using Daysy in June after stints on the Pill and on Nuvaring, the hormonal vaginal ring. (All of the women in this story asked me to use only their first names.) Both methods caused mood changes that she found unsettling, such as bouts of unexplained crying, and the Pill made her nauseous nearly every morning. She and her boyfriend had been together for a while, so although he was wary of “natural” contraception at first, the Pill’s nasty effects on Becca persuaded him to give it a try.

Becca has about 10 “green” days a month, and at other times, the couple uses condoms.

Jennifer Fitz at Patheos argues that abstinence, and not condom use, should be the order of the day for the remaining ten days:

Meanwhile, when the CDC publishes rates for the effectiveness of condoms (and other barrier methods of contraception), they are assuming that you are blithely using a condom whether you are fertile or not. The pregnancy rate for condom use lumps together both the times when it was impossible to conceive (most of the time) and the sliver of time when you might have been able to conceive.

Thus if you are using fertility awareness and are counting on a condom or other barrier method to avoid pregnancy during your fertile time, be aware that your contraceptive is much less effective than the number calculated by the CDC.

That’s not accurate. Well, it is accurate to say that, as the title of the piece does, that all condom failures actually occur during fertility days. I mean, a condom may burst outside that window, but it won’t be a failure because no pregnancy will result. Where Fitz is wrong is how the CDC compiles its numbers. It’s a common misunderstanding.

A common example of CDC literature is this PDF or this chart which looks at the various forms of contraception and their efficacy over the course of a year. With no contraception, a 85 women out of 100 will get pregnant. The numbers go down from there to various degrees. However, since we’re talking about over the course of a year, the efficacy of condom use in and out of the fertility window is actually accounted for.

Let’s assume Dick and Jane have sex twice a week. Let’s assume a month with 8 days of fertility, and on their schedule sex will occur twice within that prior and seven times outside of it. All seven of the outside-window instances will not result in pregnancy, obviously, and so it really doesn’t matter whether he is wearing a condom then or not (for pregnancy’s sake, anyway). Since we’re talking about the course of a year, they do not affect the CDC’s statistics since failure rates will, as Fitz points out, always occur during the fertility window. So the failure rate the CDC uses is the failure rate during the periods that Fitz is talking about.

The danger of using condoms (and various other forms of contraception, including the diaphram and withdrawal) only during that window is that you will misjudge and be left entirely without protection. That’s what the app The Atlantic talks about is trying to address. Various forms of measuring out the cycle have met with varying degrees of success, and perhaps this will have the outstanding degree of success that the app developers claim. Or perhaps not. And perhaps people will be flawless in their execution, and perhaps not. That’s outside the scope of Fitz’s complaint, though, because she’s focusing on the condom aspect.

My own view is actually, is not all that far from Fitz’s. If you’re worried about pregnancy, steering clear during that week is not a bad idea. Or slowing down. It’s very prudent advise. However, there’s no reason not to incorporate multiple methods (cycle+condom, cycle+withdrawal, cycle+withdrawal+spermicide) if you want to make love four weeks out of the month. The good news is that if you can monitor it, you know which weeks you don’t have to worry.

The sex-ed I had going through school tended to be a bit on the myopic side. In middle school, it was mostly about abstinence. Too young to have sex, truly, but also not trustworthy with contraception. Fair enough. High school shifted to condoms for the boys and the Pill for the girls, which was good. However, if anything was taught about cycles, it didn’t stick as a form of fertility suppression. In a lot of conversations about contraception, this-time-of-the-month-but-not-that-time-of-the-month was never discussed. There was the vague notion that sex during ovulation was bad, but nothing of the female cycle was explained to the boys either in sex ed or out of it. The cycle method wasn’t even given the (questionable) “it will always fail” explanation that withdrawal was.

I think the reasoning goes back in part to why a number of abstinence-only or abstinence-plus advocates worry about teaching contraception or leaning on it too heavily even apart from proscriptions on sex: Kids can’t be trusted to do condoms or The Pill right. People who think that’s nonsense, on the other hand, often seem wary of teaching young people about the cycle or withdrawal with fears along similar lines: The more you teach it, the more they’ll think it’s okay and will do that in lieu of better methods of contraception.

Hopefully, this will all eventually be moot because there are rock-solid forms of contraception available. Distributing it broadly will require money and an attitudinal shift. While general contraception availability in general has less-than-stellar results in preventing unwanted pregnancy, it’s difficult to imagine wider IUD availability – or free pricks to the prick – not having more impact than the less reliable forms we often rely on. And if we’re not going to have truly comprehensive sex ed, we need to start focusing a lot of energy on that.

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