Perceived Risk Taking and FABM Use: User’s Perspectives

The following data was collected with permission from 255 total FABM users. Select responses that are representative of the data have been included. At the end of this article, I will draw some possible conclusions from the data. The intentions data in this survey were based on this document.

For FABM instructors:  I hope this article helps you think critically about the types of intentions that people have when coming to FABMs.

For Users of FABMs: I hope this article helps you place yourself on the intention scale and make informed choices with your partner.

255 total FABM users took this survey. The questions included: what FABM method was used, how long they had been using a FABM, whether they used phase 1 and phase 3, and reasons for using barrier type methods in the fertile window.

Approximately 62% of respondents were taught by an instructor, while the remaining 38% were self taught users. 85% of people who responded were aware that Phase 1 and Phase 3 are included in the efficacy of the method. 69% used both Phase 1 and Phase 3 for unprotected sex. Out of the 15% who were not aware that Phase 1 and Phase 3 are included in efficacy studies, 76% were self taught.

40% of respondents do NOT abstain in the fertile window. This is across the board from TTA0 to TTW. 60% of respondents do abstain in the fertile window. 

Breakdown of FABM use in 255 respondents

  • Roughly 17% used a single check STM
  • 34% used a sympto hormonal method
  • 29% used a double check method
  • 10% used Billings (primarily sensation mucus method)
  • 8% used Creighton (mucus only)

How long have they used a FABM?

  • 20% less than a year
  • 15.3% one year+
  • 14.5%  two years+
  • 10.2% three years+
  • 7.8% four years+
  • 23.9% five years+
  • 8.2% ten years+

TTA 0: Not taking risks, would take all measures to end a pregnancy

Users who are TTA0 identify themselves as someone who would take all measures necessary to end a pregnancy. 25 survey takers identified themselves as TTA0. 16 of the 25 were self taught using a sympto-thermal method. Only 3 out of 25 who responded used a method other than sympto-thermal. Only 10 abstained in the fertile window. Multiple respondents replied that access to abortion or confidence in barrier method usage was why they chose not to abstain in the fertile window. 

Here is a sample of the overall responses from TTA0:

Why Barriers:

  • I do not believe that abstaining is a healthy choice for consenting adults in a committed relationship. We use a combination of femcap with contragel and “perfect withdrawal” or occasionally femcap with contragel and he completes in my anus. 🙂 We did the math on this combination and are more protected this way than we would be using the pill so we find it acceptable. 
  • Usually on the days where I am THE MOST fertile, we will not have PIV sex, but overall, I trust using condoms as we are good about using them consistently and properly, and also usually use WD as a backup alongside condoms, especially during the weeklong fertile window. 
  • I abstained in the fertile window for 1.5 years. But we’re been using condoms for 5 years and never had a break so I’m developing a trust in them.
  • Years of experience with condoms, proper and careful use of them, and some ability to check for failure/holes. I’m already a TTA0, but abstaining instead of barriers would often give only 6-7 safe days per cycle. (We often use barriers the whole time instead of FAM, technically, due to lazy or unsure charts.)
  • Personally, as TT0, I use protection in phase 1, abstain during the fertile window, UP in phase 3. If I was TT1 I would be ok with condoms in the fertile window.
  • We have excellent barrier usage, I use it with other partners as well so I need to ensure STI protection, and my partners with dicks have been given condoms 101 by me so I know they know what to do
  • I would not feel secure with barriers during the fertile window at all. We conceive far too easily. 
  • I would probably abstain if I didn’t want a pregnancy and was against aborting and also if I lived somewhere with no safe and legal access to abortions.
  • I’m confident in using barriers because my partner respects my body and our intentions. We are TTA0 right now. We don’t see any reason for abstaining because we use barrier methods responsibly. 
  • I feel comfortable using barriers, despite their failure rate being high but will only use condoms and a diaphragm together, not diaphragm alone due to the low failure rate (15% ish). I do tend to avoid intercourse more during my fertile time if possible, but will use two barriers correctly to reduce anxiety or reduce needing emergency contraception if a breakage happens. 

TTA1: Not taking risks, and would possibly give baby up for adoption if pregnancy happened

Only 9 people identified themselves as TTA1. 5 out of 9 still used barriers in the fertile window even though intentions were low.

Why Barriers:

  • Still newish (charting since Jan but stuck on nexplanon which has expired and in that time only had two ovulatory cycles) but I will use days where I’m on my period in phase one if I feel up to it, but I am more comfortable with UP in phase 3.
  • It is literally the ONLY time I have interest in my spouse or can orgasm. Unable to orgasm in Phase 3.
  • I live in a country with great accessibility to emergency contraception as well as to health care to terminate an unwanted pregnancy, so even if my intentionality was lower I would not abstain.

Why Not Barriers:

  • Because we simply can not afford a child

TTA 2: Not taking risks.  Would need some time, maybe counseling. Ultimately keeping the pregnancy.

37 people identified themselves as TTA2.

Why Barriers:

  • I use a double-check and have an abnormal CM pattern that has it almost always starting just after my period. My husband won’t have period sex so it is extremely rare for us to fit in unprotected sex. Even if I tell him we can, he might not trust it because he doesn’t have enough knowledge of FAM. I might have abstained if I used a FABM in college or may have used condoms plus withdrawal. I was a Super Zero, meaning that even having an abortion would have been a burden, as I didn’t have any of my own money or a car. I was still a zero later in life but had more resources.
  • I only use condoms on very low risk days, so if one were to fail, there’d be plenty of time for plan B and/or pregnancy would be fairly unlikely anyways. Peak mucus days I will generally abstain or use outercourse.
  • I generally don’t enjoy sex during my period but my current partner is okay with it so I’ve been doing it more. I tend to ovulate early and rarely have dry days so I generally don’t use that rule. I am planning to use Doering once I have 12 charted cycles (starting over because I’m newly PP). We generally only want to go UP in Phase 3 though.We don’t use barriers but we do use perfect withdrawal during Phase 1 and 2 and sometimes Phase 3. I do not like any barrier method which is why we don’t use them.
  • Because of the doering rule I open my fertile window really early, but most of the time I ovulate later than those early ovulations that set my doering day so I’m ok with going UP until then because it most probably will be far ahead from ovulation. If not I know I’m still safe though.Im doubling up thats what makes me confident enough, I was a TTA0 when I started doing this
  • We don’t rush and always have great communication. And we could be TTA0 and still wouldn’t abstain because we enjoy sex.

Why Not Barriers:

  • Being extra conservative to avoid pregnancy. Not confident in my BIP (yet).
  • Since I’m self taught (charted 7 cycles) I know for sure I’m safe after I confirm ovulation. But my partner and I ALWAYS use condoms anyway and abstain during fertile window. If I were to not use protection, it would only be during luteal phase

TTA3: Not taking risks. “Oh NO how did this happen?! but everything will be okay” Surprise pregnancy would eventually be welcome.

Largest percentage of responses were from this category. 90 people identified themselves as TTA 3.

Why Barriers:

  • I don’t feel safe using phase one without protection (condom) because I am not as confident with my knowledge of the rules for that time (first 5 day, dry day rules, etc) (Self Taught)
  • I would have to be 2 or lower to abstain. We use withdrawal. I’m definitely okay with an oopsie, my partner thinks we need to wait until school is done so about a year from now we can be TTW.
  • No barriers but use withdrawl IF we have sex at all during follicular phase.
  • During the fertile window, we always use condoms and withdrawal. I’m confident in this because I feel that the chances of both the condom and withdrawal failing at the same time are very low. I don’t think my intentions would ever be low enough to abstain.
  • We have never had issues with barriers before. Abstinence for us would have less to do with intentions and more with discomfort caused by barriers / less enjoyable. We’ll never be below TTA2 I think and last time we were I felt safe with condoms too.
  • I’m confident in using barriers because I use perfect withdrawal, my partner and I have very good communication, and we’re a TTA3. My intentions would need to be TTA2 or lower to abstain.

Why Not Barriers:

  • Phase I – Cycle history shows I ovulate later. We could utilize up to day 11, but typically only use up to day 6 or 7. Phase III – confident when confirming ovulation, many months/years of practice including postpartum. No surprise pregnancies!
  • We use a double check method and learned with an instructor, so we feel safer in the 1st phase.
  • N/A my religious views (Catholic) do not allow for using barriers.
  • Barriers don’t feel worth it for us given the added risk of conceiving and less satisfying experience. Better to wait so we can increase effectiveness of method and have a better time during infertile phases.

TTA4: Not taking risks.  Currently content with family size but a surprise pregnancy would be welcome.

59 people identified themselves in this category. On the intentions scale, this is the highest category available before “Trying to Whatever” kicks in.

Why Barriers: 

  • I am confident in using condoms plus withdrawal on fertile days, and lately only use a condom. I am okay with the possibility of the condom breaking at a 4. I would need to be a 0-2 to abstain during the fertile window.
  • Religious. Orthodox Jews abstain during period and one week after, so by that time – around cd12 – I’m usually in my fertile window.
  • I don’t use barriers but use withdrawal during the fertile window. I’m aware of the risk but we did several looks at pre-ejaculate under a microscope and there were no sperm. Partner is very controlled with ejaculating so we are comfortable with our ability to manage the risk
  • We strive for perfect condom use every time and have never had a condom break, so we trust them. If we were lower on the intentions scale, I don’t think we would abstain, but would probably opt for adding extra methods like diaphragm+spermicide and/or withdrawal in addition to condoms.
  • We use withdrawal in the fertile window. Being so high on the TTA scale, we do not worry about any pregnancies resulting from failed withdrawal. Even so, it has worked for 4 years (we did the pre-ejaculate microscope test and there were NO sperm multiple times). I would never fully abstain regardless of intentions. Non Penis in Vagina Sex is always a safe option when done correctly! 

Why Not Barriers:

  • I have a longer cycle,usually 34-36 days so feel fairly confident in using the first part of phase 1. We’re currently pregnant (totally planned) but prior to that when we were TTA, we succeeded in avoiding for 9 cycles (plus 11 months pp without cycles but testing pp with Marquette).

TTW / NTNP: Pregnancy welcome but not activity trying:

29 total responses and only one person in this category used a form of a barrier, everyone else abstained or had sex when they wanted to.

Why Barriers:

  • Haven’t had any failures using withdrawal and since I’m trying to whatever with things now, I don’t mind getting pregnant if withdrawal fails 🙂

Conclusion:

Fertility intentions are not only “I want a baby” or “I do not want a baby.” There is a ton of nuance involved in how the couple feels and decides to behave in the fertile window. Intentions directly effect how someone uses a method. Almost all FABM methods discourage genital contact in the fertile window. However, this does not mean that users will follow this advice. While many users abstain due to religious reasons, others do not abstain due to their own religious beliefs or because they are secular users. With informed choice, fertility awareness users can decide based on their specific intentions what is right for them. Maligning barrier methods as a terrible choice does a disservice to an informed user of a barrier method who has made their decision based on their unique fertility intentions.

As far as I am aware, at least three methods have included barrier method usage in their studies: the Sensiplan Study (2007), the Klaus Billings Study (1979), and at least one Marquette study. The Sensiplan study and the Billings study found that there was not a signficant difference between barrier method usage and abstaining when it comes to failures. Sensiplan found a .2% lowering of efficacy. Users should be aware that incorrect barrier method usage can lead to pregnancy; however, many people are high enough on the intentions scale that this lowering of efficacy may be okay with them.

One of the most ridiculed methods is “withdrawal” or pulling out. However, even this has a place in many people’s family planning intentions, especially those higher on the intention scale or for those who wish to increase diaphragm or condom efficacy. Some people even use withdrawal to attempt to increase efficacy in infertile times of the cycle. There is much misinformation about withdrawal, including accusations of all pre-ejaculatory fluid containing sperm. For a nuanced look at what we know about withdrawal, please read this link. For information about doubling up on barrier methods and efficacy, visit this link.

Shout out to Antonela Vuljan for helping me organize this data!

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