Over the past few weeks, women have had to grapple with what, exactly, a Trump presidency is going to mean for their reproductive futures. Though a full repeal of Roe vs. Wade—or, even more nightmarish, nationwide criminalization of abortion—seems relatively unlikely, at least in the short term, there's a very good chance that access to birth control is going to get a lot more costly pretty darn quickly. Under Obamacare, women have enjoyed free access to contraceptives, but if Trump repeals (or even just reforms) Obama's healthcare legislation, that right to free contraception is likely to disappear.
For many women, there's an obvious answer to this situation: getting an IUD before Trump has the chance to gut the Affordable Care Act. There's a lot of logic to this plan. IUDs are long lasting (upwards of twelve years of effectiveness for some models). If a woman gets one now, she can be guaranteed free birth control for far longer than Trump'll be in office.
But rushing out to get an IUD isn't an option for everyone. If, say, you're currently pregnant, or not interested in committing to a long term contraceptive right at this moment, or just really not into the idea of jamming a piece of plastic up into your uterus (it's not for everyone!), closing out 2016 with an emergency IUD insertion probably isn't your best bet. So what's a woman to do if she finds herself in the midst of the Trump Administration desperately in need of birth control, but unable to afford (or, horror of horrors, easily access) it?
As luck would have it, there are apps that promise a low cost, tech driven solution.
Over the past few years, there's been a rise in apps focused on natural family planning, so much so that a few years ago The Atlantic hailed "the return of the rhythm method." During the Obama Administration, a number of women turned to these apps as part of a backlash to hormonal birth control. Under Trump, these apps could offer a decent option for women looking for an affordable (or free!) birth control option that the government can't take away from them.
At heart, these apps are a tech-enhanced variation on the age-old rhythm method, also known as the fertility awareness method or FAM. Though they take different approaches—some are purely focused on tracking and predicting the menstrual cycle, others factor in basal body temperature and the state of cervical mucus as well—they're all built around the same general idea. There are only a certain number of days per month when pregnancy is possible, and if you avoid sex (or use condoms) during those days, avoiding pregnancy is pretty simple. In theory, anyway.
The rhythm method's long been a bit of a joke in reproductive health circles, sometimes quite literally. (Q: What do you call people who use the rhythm method? A: Parents.) But app-enabled FAM has allowed the method to reclaim a little bit of respectability by upping its effectiveness through the reduction of human error. Rather than relying on users to do do the math of figuring out what days are "safe" and what days aren't, FAM apps take all the relevant data—frequency of periods, cervical mucus state, daily temperature, what have you—to create a nuanced picture of when eggs are, and aren't, in play.
Which certainly makes things easier, and potentially more effective. While Planned Parenthood reports a 76 percent effectiveness rate for typical FAM users, apps like Natural Cycles claim a potential effectiveness rate that rivals some hormonal contraceptives. But that for Natural Cycles, or any of its peers, to truly be effective, users have to put in a good deal of work. And that's where things get a little bit tricky.
When I reached out to Planned Parenthood to find out whether these apps live up to their claims, a representative explained that the organization doesn't evaluate fertility apps and, as a result, can't comment on their reliability or recommend them as a contraceptive method. If you'd like more of a sense of where the organization stands of FAM, consider this: Planned Parenthood's own period tracking app, Spot On, will soon include information about fertility—but the app will caution users not to rely on that information as a primary method of birth control.
Why the hesitancy around FAM apps? For starters, there's a greater chance for user error. At a bare minimum, FAM apps require users to log information about their menstrual cycle (which can be more of a pain in the ass than it seems, especially if your cycle is irregular). For maximum effectiveness, it's important to take your temperature daily. To that end, a handful of apps, like Daysy and Kindara, sell their own branded thermometers, an addition which can transform a free birth control option into one that costs a few hundred dollars.
And, of course, the method only works if users actually pay attention to the information supplied by the app: knowing what days are, and aren't, safe for unprotected sex doesn't mean much if you and your partner aren't 100 percent committed to avoiding the old in and out (or wrapping it up) on days when an egg might be in the mix.
Even with the fancy technical upgrade, FAM still works best for a pretty limited population: namely, users who don't mind (or actively enjoy) data collection, have a relatively regular cycle, and are willing and able to pay attention to when, exactly, they might be fertile (and can trust their partners to respect that those days aren't for barebacking). As a method someone's actively choosing—because they don't want to rely on a hormonal method, aren't interested in committing to an IUD, or just enjoy the idea of quantified self contraception—it can be a decent option.
But if you're falling back on it because you can't afford hormonal birth control, or can't get access to a more effective option? Well, it's certainly better than nothing. But better than nothing might not be good enough if the assault on abortion rights continues apace.
Which is, of course, all the more reason to continue to advocate for affordable access to effective contraceptives, and fight the threatened defunding of Planned Parenthood (as well as assaults on other reproductive rights orgs). And if the worst does happen? Well, cross your fingers Trump and Pence don't find a way to outlaw condoms, and maybe stock up on emergency contraception—as luck would have it, it's got a shelf life of up to three years.
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