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While Donald Trump has mostly played coy on abortion during his second term, birth control access remains firmly in his crosshairs. Last year, U.S. officials attempted to destroy at least $10 million—and possibly as much as $40 million—in contraceptives intended for aid programs in African countries, falsely suggesting that these birth control methods could cause abortion. The administration is also fighting in court to reinstate sweeping exceptions to the Affordable Care Act’s birth control mandate, which would allow most employers and universities to deny contraceptive coverage on vague moral grounds.
Meanwhile, the one-year Medicaid “defund” of large abortion providers like Planned Parenthood has decimated family planning clinics. More remain threatened because of the White House’s overhaul of federal reproductive health programs. For example, Trump transformed Title X, which covers family planning services for low-income people, from an initiative meant to prevent unwanted pregnancies into one focused on promoting pregnancy—though only after marriage. If he gets his way, the Teen Pregnancy Prevention Program will be next.
To the extent that contraception remains part of the Trump administration’s reimagined public health apparatus, only one approach has been deemed acceptable: fertility awareness-based methods (FABMs), in which users track physical signs and symptoms to determine on which days sex is more or less likely to lead to pregnancy.
FABMs are a favorite of far-right organizations like the Heritage Foundation, which promoted them both in Project 2025 and in its more recent missive, “Saving America by Saving the Family.” Conservatives want to increase the birthrate—at least among young, white women—and have become increasingly vocal in their opposition to hormonal birth control in recent years. FABMs align more with their worldview, as a nonpharmacologic alternative that can be used both to prevent pregnancy and to facilitate it. For those who want to enforce traditional gender roles, fertility awareness can also be used as a tool to frame childbearing as central to womanhood.
At the same time, social media “wellness” influencers across the political spectrum are touting FABMs as an alternative to prescription birth control like the pill, patch, ring, implant, and intrauterine device (IUD), which they falsely claim are toxic or otherwise harmful to health. This crossover makes these fertility tracking methods a perfect fit for Health Secretary Robert F. Kennedy Jr.’s Make America Healthy Again agenda.
Despite their ideologically motivated proponents, FABMs are legitimate ways to either prevent or achieve pregnancy, depending on a person’s goals. They can help users better understand their bodies and reproductive health more broadly. “The beauty of these things is, when used appropriately in the right context, they're life-changing for people,” said Rebecca Simmons, a research assistant professor at the University of Utah’s OBGYN department. “The problem with them is that, in the wrong hands, in the wrong contexts, they’re authoritarian utilizations of patriarchy.”
Another problem is that FABMS are often dismissed and even derided in mainstream health spaces. “The reproductive health and contraceptive community has ignored, sidelined, and deprioritized these methods for a long time,” said Chelsea Polis, a principal research scientist at the Guttmacher Institute, who co-leads research on FABMs alongside Simmons. “The dismissiveness and condescension that some people report [from] providers when they are interested in learning more about these methods, or report that they're using these methods … really risks pushing people away and breaking or eroding trust in the medical system.”
The antidote to the Trump administration’s disinformation about contraceptives, experts told Autonomy News, isn’t to demonize FABMs—it’s to offer accurate information and support to people who are interested in using them.
What are fertility awareness-based methods?
There are a wide variety of fertility tracking approaches. Some simply involve logging the length of the menstrual cycle on a calendar, but most also require measuring other indicators of fertility, like basal body temperature, urinary hormones, changes in cervical mucus, and the position of the cervix itself. On potentially fertile days, users who want to prevent pregnancy can either avoid sex or use another method of contraception, like condoms or emergency contraception. People who want to conceive would have sex on those days.
In a study using data from 2013 to 2015, Polis estimated that about 3 percent of women using contraceptives in the U.S. were using FABMs. However, she told Autonomy News that research has historically undercounted FABM users. “If somebody uses FABMs in conjunction with something like a condom during their fertile window, they actually get counted as a condom user, rather than as an FABM user who intermittently uses condoms,” she explained. Polis and Simmons are awaiting peer review of a new study they say better estimates the prevalence of fertility tracking as a method of birth control. While they can’t share results just yet, Polis said the numbers are “certainly higher than what they’ve been before.”
FABMs may also be more effective than many people believe—but they can also be very unforgiving of user error. Polis was one of the authors of a 2018 systematic review that examined the existing evidence on FABM efficacy. This data is limited, mostly coming from small and low- or moderate-quality studies. However, the evidence shows that some specific FABMs have real-world pregnancy rates low enough to be on par with methods like the birth control pill. Most are slightly less effective than that, but still comparable to the typical failure rates of barrier methods like condoms and diaphragms. (An update to this study is another one of Polis and Simmons’ current projects.)
Importantly, existing research shows that certain FABMs have a large gap between “perfect” and “typical”—or real life—usage. This gap exists with most types of contraception, but seems to be larger with some methods of fertility tracking, possibly because using them requires more effort and skill than, for example, taking a pill or replacing a patch or vaginal ring. These challenges aren’t reasons that people shouldn’t use FABMs. But they do need this information in order to make informed choices.
“The central guiding principle should be supporting people's reproductive autonomy and providing them with the information, knowledge, and support that they need to actualize that autonomy,” said Christine Dehlendorf, a family physician, researcher, and founder of the Person-Centered Reproductive Health Program at the University of California San Francisco.
“Some people will want to use FABMs when provided with the full range of options and information about all the options, and some people will want to use IUDs,” she continued. “What we want to avoid is people making decisions that are based on incomplete information and incomplete knowledge.”
Reproductive justice and FABMs
Unbiased counseling hasn’t always been the medical field’s approach to talking about birth control. The U.S. has a long and dark history of eugenics, and these efforts to reduce births among people of color, poor people, and disabled people have often involved coercing them into using certain forms of contraception, or even forcing them to be sterilized. And for much of the early 2000s and 2010s, the contraceptive counseling approach considered to be the gold standard was one many experts now see as coercive: a “tiered-effectiveness” or “LARC-first” model, in which providers first emphasize the most effective forms of birth control, including long-acting reversible contraceptives (LARCs) like IUDs and implants.
But this approach doesn’t respect the fact that people have different values and preferences, Dehlendorf said. For some patients, efficacy is the most important consideration when they’re choosing a birth control method. For others, it’s not. Some people might be most concerned about other things, like side effects, which can be positive or negative. For example, a birth control method that can stop periods completely—like a hormonal IUD, the birth control implant or shot, or pills taken without a placebo week—might be a dream come true for one patient, while another might feel reassured by having a period every month.
When providers dismiss patients’ concerns, they risk pushing them away—and right into the arms of 'wellness' influencers who may not give them accurate information.
Plus, many people have had bad experiences with prescription birth control, or the medical system more broadly. When providers dismiss patients’ concerns, they risk pushing them away—and right into the arms of “wellness” influencers who may not give them accurate information. “Perhaps they've had gaps in their sex education,” Polis said. “They never got any reproductive biology, and it feels like this information is being actively withheld, which in some cases it has been.”
Dehlendorf said that medical providers should address these issues head on in the exam room. “We need to acknowledge the validity of people's skepticism,” she said. “Both their skepticism towards what we say about methods like IUDs, implants, and hormonal contraception, and skepticism about things that we say that can be seen as unsupportive of FABMs.”
“The other thing we need to do is not have a preference,” she added. “To really, truly not have a preference, and not have an agenda for what decisions people make, other than providing people with information and support that they need to make the choice that's best for them.”
The American College of Obstetricians and Gynecologists (ACOG) endorsed a “LARC-first” approach to birth control counseling as recently as 2019, but has since changed its guidance for providers. “Patients’ needs and goals are paramount when choosing a contraceptive method,” the organization said in a statement to Autonomy News. ACOG said it recommends counseling patients using a shared decision-making framework, in which each person involved in the conversation is seen as an expert—the medical provider an expert in their field, and the patient an expert on their own values and preferences.
ACOG added that its guidance on contraception access emphasizes the reproductive justice framework as key to equitable care, and “directs clinicians to counsel individuals based on their values, preferences, goals, and beliefs, while also being prepared to address clinical misinformation and common misperceptions about contraceptives.”
However, actually giving patients specific information about fertility tracking methods can be easier said than done, said Simmons, who trains medical students and OBGYN residents on FABMs at the University of Utah. Many programs don’t include this training at all, she said, and when they do, “it’s very minimal.”
FABMs “largely exist outside of the health system,” Simmons said. “Somebody doesn't need their provider to start or stop them, which is a benefit for a lot of people. But it also means that providers aren't engaging with people about these methods very much, so they tend to think … nobody's using them.” Plus, Simmons added, training patients on effective use of FABMs requires more time than providers typically have for an appointment. Ideally, they would refer patients to a fertility tracking expert, “but those referral pathways are not good,” Simmons said. “There's not a network of evidence-based, high-quality” FABM educators, she added.
FACTS or bias?
One organization certainly presents itself as an evidence-based source of information about FABMs: FACTS About Fertility, which says its mission is to “educate current and future medical professionals about the evidence supporting fertility awareness-based methods (FABMs) and their clinical applications to restore reproductive and overall health—equipping them to deliver medical care that empowers patients and respects each person.”
However, the organization’s cofounder and executive director, family medicine physician Marguerite Duane, has troubling links to far-right groups, including the Heritage Foundation, the American Association of Pro-Life OBGYNs, and the Charlotte Lozier Institute—the dubious “research” arm of Susan B. Anthony Pro-Life America, the nation’s largest anti-abortion group.
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Duane has also cozied up to the MAHA movement: Most recently, she spoke at a three-day women’s health summit hosted by the Department of Health and Human Services, at which she said she talks to girls about what they “need to consider” in order to have children someday—starting as young as 8 years old. She’s a leading advocate for “restorative reproductive medicine,” which conservative and MAHA groups alike have presented as an alternative to in vitro fertilization. It involves using FABMs to help promote pregnancy, but sometimes includes surgical interventions and other treatments that ACOG says may actually delay conception. The American Society of Reproductive Medicine has said the approach “is simply fertility medicine minus key tools like IVF, which, for some, represents the only way to build a family.”
Because Simmons leads FABM education at a medical school, she fields questions from colleagues about where to find accurate information—and sometimes, whether FACTS is a good source. “There's some accurate information there, but there's also some information that has ideological underpinnings that they're not very straightforward about,” she said of the organization’s materials. “If you're referring patients there, or if you yourself are looking there, you may be finding information that hasn't been scientifically validated or is really aimed from a religious context.”
In fact, many FABM educators are faith-based and “really focused on married couples, on people who are willing to be abstinent during the fertile window,” Simmons said. She encourages the providers she trains to pass on some literacy tools to their patients, so they know to ask questions about whether a particular instructor will or won’t include information about the use of condoms, or emergency contraception. Another potential tell that an FABM proponent is coming from a religious perspective is the use of the term “natural family planning”—a version of FABM endorsed by the Catholic Church.
When reached for comment, Duane did not answer specific questions about whether FACTS has ideological or religious underpinnings, or her connections to right-wing groups. In a statement, she said, “FACTS equips medical professionals and students, women and men, with an evidence-based understanding of fertility … Our goal is to empower patients to make their own choices about their fertility and to educate clinicians about the female cycle as a vital sign that informs accurate diagnosis and treatment of common and serious conditions including endometriosis, PMOS, recurrent miscarriage, and infertility.”
‘Biological essentialism combined with misogyny’
Duane told the New York Times that HHS contacted her with interest in expanding fertility awareness programs in federally funded health centers during Trump’s first term. She led a webinar about FABMs in 2019, but beyond that, little came of the conversation. In Trump 2.0, however, this effort is front and center, and Duane is again involved.
This is yet another priority the White House pulled straight from the pages of Project 2025: The Heritage Foundation’s guide said that the Title X family planning program ”should be reframed with a focus on better education around fertility awareness and holistic family planning,” and that clients should educated about the “importance of marriage.” Meanwhile, the Teen Pregnancy Prevention Program (TPPP), which was created under the Obama administration and designed to promote evidence-based interventions to reduce the rate of pregnancy and sexually transmitted infections among teens, should promote “risk avoidance”—in other words, abstinence.
Trump’s HHS reimagined Title X along these lines, and then went a step farther with TPPP. Early this summer, the administration abruptly canceled 53 out of 67 existing TPPP grants. It then issued new guidelines for the program that emphasize not only abstinence and the importance of marriage, but “reproductive life goals counseling” and “body literacy education.” For girls, this means learning to use FABMs and to see “ovulation as a key indicator of health.” Both programs also require grantees to be “aligned” with administration priorities, including ending diversity, equity, and inclusion programs, denying the existence of transgender people, and excluding abortion access resources.
Thanks to the sorry state of sex education in the U.S., many young people don’t know as much as they deserve to about their own bodies. And “women’s health has been neglected for so many years,” Polis said. In other words, it’s not a bad idea to teach young people more about the menstrual cycle and fertility. The problem is that, behind the Trump administration’s promotion of fertility awareness is “a broader thread of biological essentialism combined with misogyny, that is then lifting these things up as a ‘should’ rather than a ‘can,’” Dehlendorf said.
“Adolescence is such a hard time from a menstrual cycle perspective,” Simmons added, and an idealistic approach to fertility tracking could make young people feel shame over things outside their control. “What's being sold is this attunement, and alignment, and the idea that once you understand, everything is perfect. But so many people experience so many problems with menstruation,” she said. “What does that say to an adolescent … That if your cycle is hard or painful or imperfect, that somehow it's your fault, right?”
What comes next
Three lawsuits fighting changes to Title X are ongoing. A coalition including the sex education nonprofit SIECUS, a Planned Parenthood affiliate, and two county governments also sued to stop changes to TPPP. On August 19, a federal judge ruled in their favor, blocking alterations to the program while litigation continues—though his order didn’t restore any grants. (He also slammed HHS for its apparent use of AI-generated citations in grant guidelines.)
Even if the Trump administration’s attempts to promote FABMs over other birth control methods ultimately fail, the far right isn’t backing down. The Heritage Foundation’s “Saving America by Saving the Family” reiterates that Title X should emphasize fertility awareness-based approaches to infertility—a reference to the principles of restorative reproductive medicine.
"What we need to do is continue to build trustworthy healthcare systems and a supportive infosphere, so that when people are ready and able to listen, we have the resources for them to be able to get information."
Another concern for Polis and Simmons is the rise of “FemTech,” specifically apps and devices that purport to help users identify fertile days. A few years ago, Polis even faced a SLAPP suit from the maker of one such app and device, Daysy, after she criticized a flawed study claiming to show it was over 99 percent effective. The study was later retracted, and Polis ultimately prevailed in court. Currently, only one available app, Natural Cycles, has been FDA-approved for use as contraception. But many other apps show a “fertile window,” and because they’re classified as wellness devices rather than medical ones, they’re subject to less regulation, Polis said. Plus, there are significant privacy concerns with many of these apps.
“I don't want us to come across as anti-technology, or anti-app, or device,” Polis said. “But this space is rife with issues and pitfalls, especially when you have companies that may have more of a profit-driven than a person-centered motive.” Tech billionaires’ increasing embrace of pronatalism, and alignment with right-wing views on abortion and contraception, is another reason for caution.
“I think that there's always the potential for backlash and recentering,” Dehlendorf said. “What we need to do is continue to build trustworthy healthcare systems and a supportive infosphere, so that when people are ready and able to listen, we have the resources for them to be able to get information.”
This story was edited by Susan Rinkunas and copy edited and fact checked by Hannah McAlilly.
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