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Experiences and Practices of Women Using Fertility Awareness-Based Methods of Contraception

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Experiences and Practices of Women Using Fertility Awareness-Based Methods of Contraception EXPERIENCES AND PRACTICES OF WOMEN USING FERTILITY AWARENESS-BASED METHODS OF CONTRACEPTION Cassandra Gonzalez September 2019 Experiences and Practices of Women Using Fertility Awareness-Based Methods of Contraception Cassandra Gonzalez 910609269050 Contact author: [email protected] or [email protected] MSc Program: Communication, Health, and Life Sciences, Specialization- Health and Society, Chair Group: Consumption and Healthy Lifestyles Supervisor: Dr. Chizu Sato Minor Thesis Code: CHL – 80424 Date Submitted: September 23, 2019 1 Abstract Fertility awareness-based methods of contraception (FABMs) are growing in popularity. Using a combination of social practice theory and a contraceptive decision- making framework, this research sought to understand the priorities, contexts, and influences that motivate women to turn to these methods and how they turn this choice into a practice over time. It also sought to understand how female health- focused smartphone applications and devices known as Femtech have contributed to the practice. Seven women were interviewed about their experiences using FABMs to avoid pregnancy. This research found that major motives for using FABMs as contraceptives were dissatisfaction with other available contraceptive options, feminist, women’s liberation, and “hippie” values, and a desire for increased body literacy. The respondents discovered FABMs largely through the internet and sometimes word-of-mouth. Social media, online communities, and FABM specialists were found to play substantial roles in providing FABM-related education and support. In-person communities including friends, family, and mainstream healthcare professionals were found to play minimal roles though partners often played important roles in the research and implementation processes and “alternative” healthcare providers were more supportive. Users were also found to have ambivalent attitudes towards pregnancy intention. They utilized Femtech for convivence but were skeptical about the effectiveness of these tools and felt strongly about having a deep knowledge of FABM practices before integrating Femtech into one’s practice. They had high confidence in their abilities to learn and apply the principles of a FABM. FABM-users were found to be passionate about the methods and engaged in them as meaningful social practices. Key words: fertility awareness, contraception, body literacy, social practice, pregnancy intention 2 Table of Contents ABSTRACT ............................................................................................................................................ 2 INTRODUCTION .................................................................................................................................... 5 THE SCIENCE OF FERTILITY AWARENESS-BASED METHODS ................................................................................. 6 TYPES OF FERTILITY AWARENESS-BASED CONTRACEPTIVE METHODS .................................................................... 9 THE APPEAL OF FERTILITY AWARENESS-BASED METHODS ................................................................................ 10 FEMTECH .............................................................................................................................................. 16 RISKS & CRITIQUES OF FERTILITY AWARENESS-BASED METHODS ...................................................................... 22 RISKS & CRITIQUES OF APPLICATIONS & DEVICES .......................................................................................... 23 PROBLEM STATEMENT AND RESEARCH QUESTIONS ........................................................................... 27 THEORETICAL FRAMEWORK ............................................................................................................... 29 CONTRACEPTIVE DECISION-MAKING & SOCIAL PRACTICE ................................................................................ 29 METHODS ........................................................................................................................................... 36 DATA COLLECTION .................................................................................................................................. 36 STUDY POPULATION ................................................................................................................................ 37 DATA ANALYSIS ...................................................................................................................................... 38 RESULTS ............................................................................................................................................. 39 BACKGROUND CHARACTERISTICS AND DETERMINANTS .................................................................................... 39 REPRODUCTIVE HEALTH AND CONTRACEPTIVE OUTCOMES ............................................................................... 50 SOCIAL PRACTICE .................................................................................................................................... 53 DISCUSSION ........................................................................................................................................ 59 PRACTICAL IMPLICATIONS ......................................................................................................................... 63 THEORETICAL REFLECTION ........................................................................................................................ 66 LIMITATIONS .......................................................................................................................................... 67 SUGGESTIONS FOR FURTHER RESEARCH ........................................................................................................ 69 REFLECTION ........................................................................................................................................... 70 CONCLUSION ...................................................................................................................................... 72 REFERENCES ....................................................................................................................................... 73 3 APPENDIX ........................................................................................................................................... 83 INTERVIEW GUIDE ................................................................................................................................... 83 INTERVIEW EMAIL ................................................................................................................................... 84 INTERVIEW INFORMATION SHEET ............................................................................................................... 84 INTERVIEW CONSENT FORM ...................................................................................................................... 86 4 Introduction Fertility awareness-based methods (FABMs) of birth control are growing in popularity with increased scientific understanding of the methods (Malarcher et al., 2016) and the accessibility of smartphone applications and devices to assist with the practices (Alptraum, 2019). FABM is an umbrella term that refers to all types of birth control and family planning practices that work by tracking women’s cycles and identifying their fertile window. These practices vary widely in what indicators they use to identify the fertile window and the reliability of those indicators. These practices can be used to both avoid and plan for pregnancy (Frank-Herrmann et al, 2007) as well as for general health knowledge (Urrutia, 2019). After long being viewed as “traditional” rather than “modern” contraceptive practices and disregarded by governments, donors, policy makers, and providers who deemed them inferior to hormonal and barrier methods, FABMs are starting to be viewed as legitimate contraceptive options in some circles. By identifying the fertile window, couples can abstain from intercourse or use barrier methods of birth control during those days to prevent pregnancy. These methods have for decades been largely confined to devout Christian groups and women’s health activists, but these methods of avoiding pregnancy have become more popular among other social groups with growing interest in more “natural” lifestyles (Sifferlin, 2018) as well as with concerns about the side effects and risks of other forms of birth control including oral contraceptives and intrauterine devices (IUDs) (Oddens, 1999). FABMs have been formally used since at least the 1930s when they were recommended by the Birth Control Research Bureau in the United States, a precursor to Planned Parenthood. Books like Our Bodies, Ourselves and Taking Charge of Your Fertility are among early ways that women got information on these practices. Now, there are courses in FABM methods both in person and online, coaches and specialists that work one-on-one with users, and robust online communities sharing information on these practices. 5 This introduction will outline the scientific basics of how FABMs can be used as contraceptive methods, the different types of FABMs and their distinctions, the appeal of these methods, the role of FABM-related technology known as Femtech, and risks and critiques associated with these methods. The Science of Fertility Awareness-Based Methods In recent years, FABMs
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