There are a lot of misconceptions about the fertility awareness method—especially regarding its use as a form of birth control.
In the 1920s, doctors Kyusaku Ogino and Herman Knaus discovered that ovulation occurs fourteen days before the first day of menses—a birthing person’s natural period. Obstetrician-gynecologist Dr. Leo Latz heightened the visibility of this information when he published The Rhythm of Sterility and Fertility in Women, which described formulas for predicting ovulation based on previous cycles. Today, many consider fertility awareness to be among the least viable methods of contraception. Yet at the time of publication, the calendar-based method was one of the most effective methods.
The scope of fertility awareness is quite broad. Among the most popular methods are the ovulation and sympto-thermal methods. The ovulation method plays on the ability of our cervical mucus, produced by the cervix, to communicate the state of our fertility. Developed in the 1960s by Dr. John and Dr. Evelyn, the cervical mucus method of fertility awareness was founded on the nascent discovery that menstruators could track the fertile and infertile windows of their cycles based on changes in the cervical mucus. Ultimately, the state of the cervical mucus sends a message about where one is in their cycle—stretchy, thin cervical mucus indicates ovulation, while thicker cervical mucus says otherwise. Dr. Thomas Hilgers, Sue Hilgers, Diane Daly, and Ann Prebil, refined the method in the 1970s. The Creighton Model Fertility Care System employed a standardized teaching, charting, follow-up, and pregnancy evaluation system.
One thing is clear. Despite popular misconceptions that deem fertility awareness unsound, fertility awareness has a scientific basis. Equally as clear is its empowering nature. It endows birthing people with personal agency. Fertility awareness can help with conception, and it can help people avoid pregnancy.
We spoke with health and sex educator Cindy Luquin about the role of fertility awareness in enabling menstruators to harness their innate power and attunement with their bodies.
Cindy Luquin (she/they) is the founder and queer positive educator behind Pleasure To People, an educational consulting agency that integrates LGBTQ+ advocacy, reproductive justice and mentorship on various public health campaigns and projects. Her introduction to fertility awareness is personal. Born into a religious family, Luquin did not have great exposure to conversations about contraception. Rather, she often found herself surrounded by essentialist messaging about women’s central role on Earth. “I grew up in a very conservative family. I am first generation born here in the U.S., but my family comes from Guatemala and El Salvador. I grew up in an immigrant household. And so, very religious. It was a mix between Catholicism and Pentecostalism. And so there was no conversation around sex or sexuality. Even if there was conversation around fertility, it was always seen as like: ‘you’re a woman. Therefore, it is your duty to procreate.”
Despite the absence of nuanced conversations about reproduction at home, Luquin would learn more about contraception with time. With this knowledge came a heightened understanding of the scope of her reproductive agency, though, in retrospect, she was still uninformed. “Again, still no education around what was going on with my body, and menstruation, and all that stuff.” When she got to college, she decided to get on the birth control pill. While oral contraceptives are highly effective, they are not without risk. Unfortunately, Luquin would be among the people who faced the adverse effects.
“Post-college, I was married. I started feeling pain. I went to the doctor finally. I had health insurance. I was able to get a physical. I found out I had a cyst on both my ovaries. One was too large. It had actually consumed the entire right ovary. So, I had an emergency removal.” From there, she sought alternatives. “That led me down the path of like…–I don’t want to take birth control pills anymore, because obviously, it’s not working with my body.”
At the core of her personal decision to get on the birth control pill was the acceptance of her sexual agency. There had to be another way. It was through this effort at exercising reproductive agency that Luquin learned about fertility awareness methods. “I started to read up on something else, and that led me down the path of this thing called fertility awareness. I started learning. I started expanding.” While the term encapsulates practices backed by science in the Western world in the 1900s, she defines these practices as ancestral. “I started tying in more of the ancestral lineage. This is a practice that has been going on forever. It has gone on in African cultures, and different indigenous cultures.” Undoubtedly, fertility awareness existed before the biomedical field of the Western world legitimized its use.
While Luquin acknowledges the empowering nature of fertility awareness, she understands that current frameworks of understanding are not above critique. Fertility awareness can be a feminist practice, but much like with feminism and sexual liberation, we must resist its infiltration by binaries and white supremacist ideologies. “When it comes to white feminism, it’s about sovereignty, and agency, which are all great things. But it has also demonized science. These medications and contraceptives exist for a reason. A lot of people use them, and there’s nothing wrong with that. It’s just a personal decision. It’s almost a pipeline of white feminist wellness, and then it seeps into a QAnon mindset, and that is very dangerous for people of color. That’s not centered on cultural knowledge. That’s just centered on the language of: ‘we know the way now. This is purity, again. But we’ve repackaged purity in a new way’.”
Rather than spend time unpacking the scare tactics often employed to discourage fertility awareness, Luquin chooses to acknowledge their foundation. While many naysayers center the heightened impact of human error, Luquin treats it as a teacher. “Let’s say you’re using it to avoid pregnancy, and you do get pregnant, what is your plan for when that does happen? I think we need to be having those conversations, too. We need to include the reproductive continuum, which involves all situations. All the things that happen in people’s lives, like unintended pregnancy. Sometimes life changes. Maybe you travel, and you forget to track. Maybe your cycle is off.” For sex educators, accounting for human error means preparing to support people through any and all situations with regards to their reproductive journey.
Despite its roots in cultures through space and time, fertility awareness is only recently growing in popularity in the United States. In addition to current frames of understanding, we must also question the obscuration of ancestral knowledge. “I just try to lean on the knowledge that Black and Indigenous women have been doing this forever,” says Luquin. “In order for us to truly strive for sexual liberation, I think that we need to listen to people who have experienced the most. [Fertility awareness] is nothing new. It just feels new, because people haven’t been listening.”