The Truth About Fertility Awareness and Withdrawal: Facts, Myths, and Real-Life Effectiveness
I see many women who are seeking gentle, body-aware approaches to contraception and fertility. Recently, a client came to me deeply concerned after being told that using Fertility Awareness Methods (FAM)—specifically Basal Body Temperature (BBT) charting combined with withdrawal—wasn’t effective, and that she might struggle to conceive in the future as she hasn't already conceived in the past few years using this method. This is not only discouraging, but also inaccurate based on both research and traditional wisdom.
Let’s look at the facts:
- **FAM (including BBT) is a well-established, evidence-based approach.** With perfect use, modern FAMs can be over 95% effective—meaning fewer than 5 out of 100 women per year will become pregnant. Typical use (which includes human error and life’s unpredictability) sees effectiveness around 76–88%, but this can be improved with education and support.
- **Withdrawal, when practiced correctly, is about 96% effective, but with typical use, the pregnancy rate is around 22 per 100 women per year.** When you combine FAM with withdrawal or condoms during fertile days, you are layering protection, which increases overall effectiveness.
- **There is no evidence that using FAM or withdrawal harms future fertility.** In fact, tracking your cycle can help you understand your body’s rhythms and may support conception when you’re ready.
Why is this method underreported?
Many women quietly use FAM and withdrawal or condoms, but don’t always disclose this to their healthcare providers—often because of dismissive comments or misinformation from friends or professionals. This leads to underreporting, even though these methods are widely practiced and deeply rooted in women’s health traditions.
Traditional roots:
Fertility awareness is not new. Ancient cultures, including those referenced in the Talmud, recognized patterns of fertility. The first scientific record of FAM dates to the early 20th century, with the rhythm method described by Dr. Ogino and Dr. Knaus in the 1920s and 1930s. These early methods have evolved into the more accurate, symptom-based approaches we use today.
A naturopathic perspective:
As a naturopath, I value approaches that honour the body’s natural cycles and empower women with knowledge. FAM is not only about contraception—it’s about understanding your hormones, your energy, and your connection to nature. When we combine this wisdom with evidence-based practice, women can make informed, confident decisions about their reproductive health.
If you’re considering FAM, BBT, or withdrawal, seek out a trained educator and don’t let myths or negative comments undermine your confidence. These methods are valid, effective, and have stood the test of both tradition and science.
I have a YouTube video explaining the basics here:
If you'd like to learn more about FAM reach out, if there is enough interest I'll run a workshop.
Reference list for Fam withdrawal blog post
Here is a reference list you can use for your FAM and withdrawal blog post, based on the latest and most reputable sources:
1. NHS. "Natural family planning." Updated April 2025.
(Effectiveness of FAM and withdrawal, real-life use, and guidance on natural contraception)[1].
2. Frank-Herrmann, P., 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*, 2007.
(Prospective study on symptothermal method effectiveness with real-world data)[2].
3. Guttmacher Institute. "Contraceptive Failure Rates in the Developing World: An Analysis of Demographic and Health Survey Data in 43 Countries." March 2016.
(Global typical-use failure rates for withdrawal, FAM, and other methods)[3].
4. FPAA/SHQ. "Efficacy of Contraceptive Methods." July 2024.
(Summary table of perfect and typical use rates for all major contraceptive methods)[4].
5. Healthdirect Australia. "Fertility awareness (natural family planning)." Updated December 2024.
(Overview of FAM types, effectiveness, and practical considerations)[5].
6. Medical News Today. "How effective is the fertility awareness method for birth control?" March 2024.
(Recent review of FAM effectiveness and influencing factors)[6].
7. Wikipedia. "Fertility awareness."
(History and evolution of FAM, including references to the Talmud and early scientific advances)[7].
8. Dittrick Medical History Center. "Rhythm Method."
(Development of the rhythm method and advances in natural family planning)[8].
9. Everyday Health. "Birth Control in America: A Brief History of Contraception." October 2023.
(Historical context for withdrawal and FAM use before modern contraceptives)[9].
10. PMC. Grimes, D.A. "Fertility awareness‐based methods for contraception." 2004.
(Scientific review of FAM, calendar, and BBT methods)[10].
11. GMA News. "Withdrawal method tied to unintended pregnancies." August 2013.
(Withdrawal effectiveness and real-life unintended pregnancy rates)[11].
These sources provide up-to-date facts, figures, and historical context for FAM and withdrawal, supporting your blog with evidence-based information.
Citations:
[1] Natural family planning - NHS https://www.nhs.uk/contraception/methods-of-contraception/natural-family-planning/
[2] 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 - PubMed https://pubmed.ncbi.nlm.nih.gov/17314078/
[3] Contraceptive Failure Rates in the Developing World: An Analysis of Demographic and Health Survey Data in 43 Countries https://www.guttmacher.org/report/contraceptive-failure-rates-in-developing-world
[4] [PDF] EFFICACY OF CONTRACEPTIVE METHODS https://shq.org.au/wp-content/uploads/2024/07/Efficacy-of-Contraceptive-Methods_FPAA.pdf
[5] Fertility awareness (natural family planning) - Healthdirect https://www.healthdirect.gov.au/fertility-awareness-natural-family-planning
[6] How effective is the fertility awareness method for birth control? https://www.medicalnewstoday.com/articles/how-effective-is-fertility-awareness
[7] Fertility awareness https://en.wikipedia.org/wiki/Fertility_awareness
[8] Rhythm Method - Dittrick Medical History Center https://artsci.case.edu/dittrick/online-exhibits/history-of-birth-control/contraception-in-america-1900-1950/rhythm-method/
[9] Birth Control in America: A Brief History of Contraception https://www.everydayhealth.com/birth-control/contraception-birth-control-women-america/
[10] Fertility awareness‐based methods for contraception - PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC8855505/
[11] Withdrawal method tied to unintended pregnancies https://www.gmanetwork.com/news/lifestyle/healthandwellness/322317/withdrawal-method-tied-to-unintended-pregnancies/story/
[12] Pull and pray or extra protection? Contraceptive strategies ... https://pmc.ncbi.nlm.nih.gov/articles/PMC4254803/
[13] A Brief History of Scientific Advances and Development ... https://www.factsaboutfertility.org/a-brief-history-of-scientific-advances-and-development-of-nfp-methods-part-i/
[14] The history of Fertility Awareness Methods https://fidesetratio.com.pl/ojs/index.php/FetR/article/download/1093/753/
[15] A brief history of fertility charting https://www.fertilityfriend.com/Faqs/A-brief-history-of-fertility-charting.html
[16] The Next Generation of Natural Family Planning - AAFP https://www.aafp.org/pubs/afp/afp-community-blog/entry/the-next-generation-of-natural-family-planning.html
[17] Shift to less reliable 'natural' contraception methods among abortion ... https://bmjgroup.com/shift-to-less-reliable-natural-contraception-methods-among-abortion-patients-over-past-5-years/
[18] bchistory 2012 https://www.plannedparenthood.org/files/2613/9611/6275/History_of_BC_Methods.pdf
[19] The traditional practices used by couples with fertility problems, affecting factors, expected benefits, and learning paths: The Turkey Sample - PubMed https://pubmed.ncbi.nlm.nih.gov/31187766/
[20] Fertility Awareness-Based Methods for Women's Health and Family ... https://pmc.ncbi.nlm.nih.gov/articles/PMC9171018/
