Natural Fertility Awareness Methods: Empowering Couples with Greater Autonomy

Faced with the problems caused by hormonal contraception on the one hand and infertility on the other, taking these methods into account is not only a public health issue, but also a scientific and political one: the growing but still insufficient number of academic studies is an obstacle to the promotion of these natural methods in terms of public policy, insofar as they remain unknown or even suspect.

The congress was initiated by a number of Flemish and German academics, as well as the NFP-Vlaanderen (Natural Family Planning) association, which holds the Sensiplan® licence - the registered name for the sympto-thermal method. This method combines observation of a woman's body temperature and cervical mucus*. Until the beginning of the 20th century, there were no studies to test its reliability, but things have changed, thanks in particular to the German NFP working group, which received support from the German Federal Ministry for Family Affairs between 1984 and 1991 to fund academic research. Thanks to this support and the participation of a number of universities since 1987, the working group has managed to gather a great deal of data (including statistics) on women's cycles. Today, the studies (carried out mainly in Germany, Austria and Switzerland) address a wide range of issues and concerns, demonstrating the growing interest of women and couples in reclaiming the knowledge and natural control of their fertility and fecundity.

From hormonal contraception to fertility awareness: towards a calmer relationship with the body

These days, there is a growing awareness of the side effects of hormonal contraception. The oestroprogestogenic pill, the most commonly offered to women, can cause nausea, swollen breasts, headaches, water retention, mood disorders and reduced libido. Serious adverse effects have also been reported, such as the risk of vascular problems (phlebitis, stroke, etc.). 

In addition, research presented at the Louvain congress sought to highlight the conclusions of several studies (Garbett et al. (2020); Crider et al. (2014); Donhauser (2020)) regarding the possible and partially proven link between women taking hormonal contraceptives before conception and the risk of epigenetic changes in the ovaries, which could have an influence on their offspring. The use of hormonal contraception, combined with numerous environmental factors, could therefore increase the risk of autism spectrum disorder in their children. Despite these worrying factors, hormonal contraception continues to be widely promoted, notably by Belgium, which, according to one study, had the best results in terms of access to contraception in 2020, with an index of 96.4% out of 46 European countries. This index took three criteria into account: access to contraception, advice on family planning and the availability of contraceptives.

Germany, meanwhile, is taking a critical look at hormonal contraception, which is increasingly being abandoned by women. Taking note of this trend, in January 2024 the gynaecological and obstetrics societies of Germany, Switzerland and Austria published an official guideline analysing the indications, safety of use, advantages and limitations of the various non-hormonal contraceptive methods, with a view to drawing up recommendations. 

While fertility awareness methods are gaining in credibility to the point of one day becoming a reliable alternative to hormonal contraception, the challenge for them is also to offer couples genuine autonomy without falling into the contraceptive mentality* that can make it more difficult to accept an unplanned pregnancy.  Whatever the case, this shift towards more natural fertility management is an encouraging sign of a more respectful relationship with women's bodies and their fertility potential.

Fertility awareness, the first step towards natural procreation

While fertility awareness methods are widely used as a natural and more responsible alternative to contraception, they are also a valuable ally in promoting natural procreation. The Louvain congress provided an opportunity to present a number of research studies on the physical and environmental conditions for good fertility. Monitoring symptoms during the fertile period is now being revolutionised by apps that track the cycle, raising new issues about the confidentiality of data stored by commercial firms.  

At a time when recourse to artificial procreation is increasing (42,497 in vitro fertilisation cycles will be undertaken in Belgium in 2021 alone), bypassing infertility and entailing significant risks for the health of women and their offspring, knowledge of how natural fertility works could become a public health issue. 

*Cervical mucus is a substance produced by the cervix, the quantity and appearance of which change during the cycle under the effect of hormones. During the fertile period, cervical mucus becomes more abundant, clearer and stretchier. This makes it easier for sperm to travel through the cervix to the egg, increasing the chances of conception.

*The contraceptive mentality refers to the risk of transforming natural family planning methods, which neither modify a woman's fertility nor eliminate the possibility of conception, into methods of contraception. In this case, opening up to the unpredictability of a conception that may nevertheless occur is more delicate.