Effectiveness depends on the user: Risk of pregnancy is greatest when couples have sex on the fertile days without using another method.

• As commonly used, in the first year about 15 pregnancies per 100 women using periodic abstinence. This means that 85 of every 100 women relying on periodic abstinence will not become pregnant. Most of the couples in this study were using the calendar rhythm method.
• Pregnancy rates with consistent and correct use vary for
  different types of fertility awareness methods (see table below). These rates reflect the experience of couples who volunteered to
  use these methods in research projects
  Reliable effectiveness rates are not available for the calendar rhythm method or the basal body temperature method.
• In general, abstaining during fertile times is more effective than using another method during fertile times.

Return of fertility after fertility awareness methods are stopped: No delay Protection against sexually transmitted infections (STIs): None

Side Effects
None
Known Health Benefits
Help protect against:
• Risks of pregnancy
Known Health Risks
None

Medical Eligibility Criteria for Calendar-Based Methods

All omen can use calendar-based methods. No medical conditions prevent the use of these methods, but some conditions can make them harder to use effectively.
Caution means that additional or special counseling may be needed to ensure correct use of the method.
Delay means that use of a particular fertility awareness method should be delayed until the condition is evaluated or corrected.
Give the client another method to use until she can start the calendar-based method.

In the following situation, use caution with calendar-based methods:

•  Menstrual cycles are irregular. (For example, menstrual cycle irregularities are common in young women in the first several years after their first monthly bleeding and in older women who are approaching menopause. Identifying the fertile time may be difficult.)

In the following situations, delay starting calendar-based methods:

• Recently gave birth or is breastfeeding, (Delay until she has had at least 3 menstrual cycles and her cycles are regular again. For several months after regular cycles have returned, use with caution.)
• Recently had an abortion or miscarriage (Delay until the start of her next monthly bleeding.)
• Irregular vaginal bleeding (Delay until cycles have become more regular.)
  In the following situation, delay or use caution with calendar-based methods:
• Taking drugs that can make the menstrual cycle irregular (for example, certain antidepressants, thyroid medications, long-term use of certain antibiotics, or long-term use of any nonsteroidal anti-inflammatory drug, such as aspirin or ibuprofen).

Medical Eligibility Criteria for Symptoms-Based Methods

All women can use symptoms-based methods. No medical conditions prevent the use of these methods, but some conditions can make them harder to use effectively.
Caution means that additional or special counseling may be needed to ensure correct use of the method.
Delay means that use of a particular fertility awareness method should be delayed until the condition is evaluated or corrected. Give the client another method to use until she can start the symptoms-based method.

In the following situations, use caution with symptoms-based methods:

• Recently had an abortion or miscarriage
• Menstrual cycles have just started or have become less frequent or stopped due to older age. (Menstrual cycle irregularities are common in young women in the first several years after their first monthly bleeding and in older women who are approaching menopause. Identifying the fertile time may be difficult.)
• A chronic condition that raises her body temperature (for basal body temperature and symptothermal methods)

In the following situations, delay starting symptoms-based methods:

• Recently gave birth or is breastfeeding. (Delay until normal secretions have returned—usually at least 6 months after childbirth for breastfeeding women and at least 4 weeks after childbirth for women who are not breastfeeding. For several months after regular cycles have returned, use with caution.)
• An acute condition that raises her body temperature (for basal body temperature and symptothermal methods)
• Irregular vaginal bleeding
• Abnormal vaginal discharge
  In the following situation, delay or use caution with symptoms- based methods:
• Taking any drugs that change cervical secretions, for example, antihistimines, or drugs that raise body temperature, for example, antibiotics.

Fertility awareness methods:

• Can be effective if used consistently and correctly.
• Do not require literacy or advanced education.
• Do not harm men who abstain from sex.
• Do not work when a couple is mistaken about when the fertile time occurs, such as thinking it occurs during monthly bleeding.

• Problems With Use
• Inability to abstain from sex during the fertile time
• Cycles are outside the 26-32 day range for Standard Days Method
• Very irregular menstrual cycles among users of calendar-based methods
• Difficulty recognizing different types of secretions for the ovulation method
• Difficulty recognizing the presence of secretions for the ovulation method or the TwoDay Method

1. Can only well-educated couples use fertility awareness methods?
No. Couples with little or no formal schooling can and do use fertility awareness methods effectively. Couples must be highly motivated, well-trained in their method, and committed to avoiding unprotected sex during the fertile time.

2. Are fertility awareness methods reliable?
For many couples, these methods provide reliable information about the fertile days. If the couple avoids vaginal sex, or uses condoms or a diaphragm during the woman’s fertile time, fertility awareness methods can be effective. Using withdrawal or spermicides during the fertile time is less effective.

3. What is different about the newer fertility awareness methods, the Standard Days Method and the TwoDay Method?
These fertility awareness methods are easier to use correctly than some of the older ones. Thus, they could appeal to more couples and be more effective for some people. They are like older methods, however, in that they rely on the same ways of judging when a woman might be fertile—by keeping track of the days of the cycle for the Standard Days Method and by cervical secretions for the TwoDay Method. So far, there are few studies of these methods. A clinical trial found that, as the Standard Days Method was commonly used by women who had most cycles between 26 and 32 days long, there were 12 pregnancies per 100 women over the first year of use. In a clinical trial of the TwoDay Method as it was commonly used, there were 14 pregnancies per 100 women over the first year of use. This rate is based on those who remained in the study. Women who detected secretions on fewer than 5 days or more than 14 days in each cycle were excluded.

4. How likely is a woman to become pregnant if she has sex during monthly bleeding?
During monthly bleeding the chances of pregnancy are low but not zero. Bleeding itself does not prevent pregnancy, and it does not promote pregnancy, either. In the first several days of monthly bleeding, the chances of pregnancy are lowest. For example, on day 2 of the cycle (counting from the first day of bleeding as day 1), the chance of getting pregnant is extremely low (less than 1%). As the days pass, the chances of pregnancy increase, whether or not she is still bleeding. The risk of pregnancy rises until ovulation. The day after ovulation the chances of pregnancy begin to drop steadily. Some fertility awareness methods that depend on cervical secretions advise avoiding unprotected sex during monthly bleeding because cervical secretions cannot be detected during bleeding and there is a small risk of ovulation at this time.

5. How many days of abstinence or use of another method might be required for each of the fertility awareness methods?
The number of days varies based on the woman’s cycle length. The average number of days a woman would be considered fertile—and would need to abstain or use another method—with each method is: Standard Days Method, 12 days; TwoDay Method, 13 days; symptothermal method, 17 days; ovulation method, 18 days.

• Ask your family doctor at your health care facility in your area of residence  (see here). WARNING: if you belong to one of the socially vulnerable groups (see here) you can benefit from free contraceptives!
• Ask  Youth Friendly Health Centers
• Call the RHTC  Hotline (free and confidential call) – 0800-088-08
• Call  RHTC – 022355072 / 060903782 / 078306973
• Write to RHTC e-mail  – cidsr2012@gmail.com