Fertility tracking is part of a slate of high-risk, low-reward family planning methods that have lately taken on a new sheen in the eyes of the federal government. After shutting down the department that supervises federal family planning funding and setting the conditions to erode abortion and preg nancy care nationwide, the Trump administration is now evangelizing a single type of birth control: fertility awareness methods, which include everything from cycle-tracking to digital apps. by Megan Burbank Earlier this year, a company called Natural Cycles introduced their new wristband. For just $129.99, the wristband would sync with their app and offer the wearer “digital birth control,” tracking people’s fertility based on their body temperature and cycle. Sound too good to be true? It was. The app, and the animating principle behind it—quit hormonal birth control! there’s a better, easier way!—is part of a slate of high-risk, low-reward family planning methods that have lately taken on a new sheen in the eyes of the federal government. After shutting down the department that supervises federal family planning funding and setting the conditions to erode abortion and pregnancy care nationwide, the Trump administration is now evangelizing a single type of birth control: fertility awareness methods, which include everything from cycle-tracking to digital apps. Cycle-tracking has been around for a long time, largely for people trying to conceive. If you’re struggling to get pregnant, doctors might encourage you to track the window in your menstrual cycle when you’re most likely to be fertile. But as birth control, fertility awareness is much more likely than other methods to result in unintended pregnancy, and that may be precisely the point: Given the right wing’s pronatalist agenda and ongoing obsession with the birth rate, a birth control method that doesn’t work is a feature, not a bug. Right-wing activists—most recently in the New York Times—claim that fertility awareness methods are a reasonable alternative to gold-standard birth control methods like the IUD or the subdermal implant, because, as one proponent put it, women “don’t need to put these extra chemicals and devices into their bodies to figure out what’s going on. They can do it in a natural way.” This is, in a medical sense, terrible advice. “Fertility awareness” refers to several approaches that require users to do things like monitor their body temperature and cervical mucus thickness to estimate when their most fertile windows are, and to avoid sex during those times or use a barrier method like condoms. When used with barrier methods, says Sarah Prager, professor of obstetrics and gynecology at the University of Washington, this can work. But for most people, fertility tracking is “difficult and impractical,” she says. Because fertility awareness methods rely on accurate cycle tracking, says Prager, and “if somebody has irregular cycles, these methods can’t be used.” Available research also suggests that fertility awareness methods just don’t work as well as other forms of birth control. All birth control methods have two rates of failure: one with typical use (how most people use the method), and one with perfect use (how the Pleasures to Have in Class do). For some set-it-and-forget-it methods, like IUDs or the subdermal implant, these numbers are virtually identical: It’s hard to take your birth control incorrectly when it’s embedded in your bicep tissue. Fertility awareness methods, on the other hand, have the biggest gap between perfect and typical use, and, by their sheer complexity, provide users many chances for things to go sideways. Prager puts it this way: “They’re just not reliable when used by the majority of people, because most people cannot use them reliably.” Fertility awareness methods work so poorly that they’ve been a source of scandal even in the politically secular Femtech world. In 2018, Olivia Sudjic chronicled at the Guardian her experience using Natural Cycles, which touted itself as 93 percent effective with typical use. Despite following the instructions, Sudjic was one of many users who ended up pregnant. She had an abortion, realizing much too late that “the ideal Cycler is a narrow, rather old-fashioned category of person”—someone in a committed relationship, with a stable routine that allows for assiduous cycle-tracking: “Shift-workers, world-travellers, the sickly, the stressed, insomniacs and sluts be advised.” Even some proponents of fertility awareness methods acknowledge this tension. Samantha Kopy, a fertility awareness method instructor quoted extensively in the New York Times piece, said these methods are challenging to use “if you have pretty flippant reasons for avoiding pregnancy—just like, ‘Oh, we kind of want to travel,’ or, ‘We’d like to save for a better car.’” But even setting aside the judgment in this statement (any reason to not want to get pregnant is a good one), it seems the difficulty is the point. After all, Kopy’s class is organized by Whole Mission, a religious family planning organization whose managing director is a moral theology teacher at a Catholic high school. Not someone I’d turn to as an authority on reproductive health. As it so often does, in pushing fertility awareness methods, the right is also exploiting very real concerns within reproductive health care: frustration with the side effects of birth control. If you’re a sexually active person with the capacity to get pregnant, by the time you’re on the off-ramp from your fertile years, you will likely have spent an enormous chunk of your life with some combination of a rod in your arm, a cheerfully named IUD in your uterus, an alarm on your phone reminding you to take your teeny-tiny pink pill, a shot in your lower back, a NuvaRing in your refrigerator, a box of condoms under your bed, or something else entirely. Reliable, long-acting birth control is a miracle of modern medicine, but the burden of Not Getting Pregnant can be a maximalist odyssey, one that makes you feel like you’re living in thrall to the whims of your own reproductive system. It’s natural to look for an out to the Groundhog Day rigamarole that is having a uterus and not wanting a baby to show up in it. But it won’t come from an agenda that’s designed to fail. After all, no one tastes the rainbow of synthetic progesterone because they want to “figure out what’s going on” or understand the beauty of their fertility. They do it for two reasons: because it’s medically indicated or because they don’t want to get pregnant. The good news is that unlike most of the modalities pushed by MAHA grifters like Olivia Nuzzi’s sexting buddy, hormonal birth control has been rigorously studied, and is safe and effective. That’s the signal Prager hopes her patients will hear within the noise of medical misinformation. Studies have examined the overall mortality rates for people with uteruses, comparing people who’ve never used hormonal birth control and people who’ve used it. “Mortality is actually lower for people who have ever used hormonal contraception,” says Prager. This is likely because of the major health risks that come with every pregnancy, whether wanted or not. The scientific truth is that it’s always much safer to be on birth control than to be pregnant—especially in a country with wide health disparities and increasingly fewer pregnancy care providers as the fallout of losing Roe carries on. No amount of fearmongering about birth control can change that. ...read more read less