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close this bookWhere Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)
close this folderChapter 13: Family Planning
close this folderNatural Methods of Family Planning
View the document(introduction...)
View the documentBreastfeeding for the first 6 months (Lactational Amenorrhea Method, LAM)
View the documentThe mucus method and the rhythm method


There are also 3 methods to avoid pregnancy that do not require any devices or chemicals (as with barrier methods) or medicines (as with hormonal methods). The methods are:

· breastfeeding for the first 6 months
· the mucus method
· the rhythm method

Natural methods of family planning do not protect against STDs, including HIV/AIDS. If you use any of the natural methods listed in these pages, you still need to think about ways to protect yourself from these diseases.

Breastfeeding for the first 6 months (Lactational Amenorrhea Method, LAM)

Breastfeeding under certain conditions can prevent the ovaries from releasing an egg. This method does not cost anything, but it is most effective for only the first 6 months after childbirth.

How to use breastfeeding to prevent pregnancy:

Breastfeeding is not an effective method of family planning unless these 3 conditions are true:

1. Your baby is less than 6 months old.


2. You have not had your monthly bleeding since giving birth.


3. You are giving your baby only breast milk, and feeding it whenever it is hungry - with no more than 6 hours between feedings - day and night. Your baby does not sleep through the night without feeding.


Use another method of family planning that is safe with breastfeeding as soon as any of the following things happen:

· Your baby is more than 6 months old, or

· Your monthly bleeding starts, or

· Your baby starts taking other kinds of milk or other foods, or starts sleeping for more than 6 hours during the night, or

· You must be away from the baby for more than 6 hours and cannot remove milk from your breasts during that time.

The mucus method and the rhythm method

To use either of these methods, you must understand when you are fertile during your monthly cycle. This is sometimes called ‘fertility awareness’. Then, to avoid pregnancy, you and your partner must not have sex, or must use a barrier method of family planning, during your fertile days.

¨ All these methods require the man’s cooperation or they will not be effective.


Because there are no costs or side effects, these methods can be used by women who cannot or do not want to use other methods, or when other methods are not available.

To practice fertility awareness more effectively, both you and your partner should visit a specially trained health worker to learn about your bodies and about fertility. It usually takes about 3 to 6 months of practice to learn how to use these methods.

Natural family planning methods do not work as well if:

· you have little control over when you will have sex. During your fertile times, your partner must be willing to wait and not have sex or to use condoms or some other barrier method.

· your fertility signs change from month to month. You will not be able to know when you are fertile.

· you have just had a baby or miscarriage. It is hard to know when you are fertile at these times.


What you should know about a woman’s cycle of fertility:

· A woman produces one egg each month.

· The egg is released from the ovary about 14 days before the next monthly bleeding.

· The egg lives for about 24 hours (1 day and 1 night) after it has been released from the ovary.

· The man’s sperm (seed) can live up to 2 days inside the woman’s body.


To make all natural family planning methods more effective:

· Have sex only on the days between the end of the fertile time and your next monthly bleeding.

· Use both the mucus method and the rhythm method at the same time.

· Use condoms whenever you are not sure if you are fertile, or do not have sex.

Mucus Method

To use the mucus method, you must pay careful attention to the mucus (wetness) in your vagina. Your body produces wet mucus during your fertile time to help the sperm get into the womb. So if you check your mucus every day, you will know when you are becoming fertile. Then you can avoid sex during this time.

How to tell when you are fertile:

1. Wipe the outside of your vagina with your finger or a piece of paper or cloth.

2. If there is mucus there, take some between your fingers. How does it feel? Wet and slippery? Dry and sticky?

clear, wet, slippery mucus = fertile

white, dry, sticky mucus = not fertile


How to use the mucus method:

· Do not have sex on any day you see or feel wetness or mucus. Or, if you want to have sex on those days, use a condom or a diaphragm without spermicide (these are the only methods that do not change the mucus).

· Do not have sex until 4 days after the last day of clear, slippery mucus.

· Do not have sex during your monthly bleeding. There is a small possibility you could be fertile and not be able to tell.

· Do not douche or wash out your vagina at any time.

· If you are having trouble knowing when you are fertile, or if you have a vaginal infection, you should use another method.

Rhythm Method

The rhythm method teaches you to find your fertile time by counting the days in your monthly cycle. You CANNOT rely on the rhythm method if:

· you are breastfeeding and your monthly bleeding has not returned.

· you have recently been pregnant and your monthly bleeding is not yet regular.

How to use the rhythm method:

· Count the number of days in each of your monthly cycles for 6 months, from the first day of one monthly bleeding until the first day of the next.

· Pick out the longest and the shortest cycles.

· Take away or subtract 20 days from your shortest cycle and 10 days from your longest cycle. The time between these 2 days is your fertile time.

· Although you can have sex any time before or after your fertile time, the safest time is between the end of your fertile time and the beginning of your next monthly bleeding.

For example: Julia kept track of her monthly bleeding for 6 months. Her shortest cycle was 26 days and her longest cycle was 34 days:

To avoid pregnancy, Julia should not have sex, or she should use another family planning method, from day 6 after her monthly bleeding starts until day 24.

You must use another method of family planning while you are counting your 6 monthly cycles. But you should not use the pill, implants, or injections during the time you are counting, because these methods change the time when your monthly bleeding starts.