Originally published in Health Affairs Forefront.
If you have scrolled through wellness social media content lately, you may have encountered videos celebrating fertility tracking. The videos echo a common message: Fertility tracking has allowed people to reclaim their bodily autonomy and help them achieve their goals of getting pregnant, avoiding pregnancy, or monitoring aspects of their reproductive health. Sometimes referred to as “fertility awareness-based methods” (FABMs), these practices can help people identify the days during their menstrual cycle when they’re most likely to conceive if they have sex without contraception. And digital approaches to using an FABM suddenly seem to be everywhere—from our social media feeds to two FABM “digital contraceptive” apps approved by the Food and Drug Administration to various FemTech devices and wearables that track body temperature, hormone levels, and other fertility signs. As public interest in FABMs is growing, so is the politicization of that interest—and the latter is what concerns me.
As a research scientist that has contributed to clarifying the evidence base around FABMs, I welcome that more people are curious and interested in any contraceptive option, including FABMs. But my work has also underscored how essential it is to ground FABMs in a strong, person-centered evidence base, just the way we would with any other contraceptive option.
Many people who use FABMs do so because these methods align with their preferences and values—not necessarily as a political stance. However, as the New York Times reported on in November, there is a parallel effort by conservative influencers and policy makers who have seized on FABMs to undermine other forms of contraception and the rest of the reproductive health care spectrum. Under the guise of promoting “natural” health and “family values” and the “Make America Healthy Again” banner, they’re pushing FABMs while also promoting restrictions on reproductive health care that people need throughout their lives. This includes pushing for restrictions on contraception, abortion, fertility care, and protections for pregnant people—as well as slashing funding for Medicaid and the Supplemental Nutrition Assistance Program that will undermine people’s abilities to raise their children in safe and healthy environments.
It’s important that we first level-set about how FABMs actually work, which I have been tracking for a long time. These methods, which can involve tracking the length of one’s menstrual cycle, cervical mucus, and basal body temperature can be used to try to get pregnant, to avoid pregnancy, or monitor health. Some FABMs rely on apps, hormone-monitoring devices, or wearable devices; others can be used by tracking signs of fertility on a calendar. A study that I led using data from 2013 to 2015 found that about 3 percent of women using contraception in the US used FABMs. My colleagues and I are currently researching whether this proportion has increased since then, given the increase in availability of FABM-related apps and devices.
If someone is using FABMs to avoid pregnancy, it has advantages and disadvantages—just like any other contraceptive method. Some advantages are that FABMs may appeal to people who prefer methods without hormones or devices, may help people learn more about their bodies, and may align with some people’s religious beliefs. However, FABMs don’t protect against sexually transmitted infections (STIs), often require careful daily tracking, and—importantly—their effectiveness for pregnancy prevention can be extremely unforgiving if used incorrectly. This can be particularly daunting for those who absolutely do not want to be pregnant, given today’s patchwork of abortion bans in the US.
Estimates for the effectiveness of FABMs for pregnancy prevention are based on a small number of moderate quality studies. Currently available data suggests that with typical use (meaning under real-world use by an average person, which may include imperfect use of the method) specific FABMs such as Sensiplan and the Marquette Monitor show pregnancy rates of 2–7 per 100 users per year, comparable to the pill or patch. Most other FABMs (for example, Standard Days Method, TwoDay Method, Billings Ovulation Method, Natural Cycles, and so forth) are somewhat less effective than Sensiplan and Marquette, with rates closer to condoms or diaphragms. If higher-quality studies become available, this could modify our current understanding of FABM effectiveness.
In July 2025, the MAHA Institute and the Heritage Foundation co-sponsored a panel focusing on Body Literacy and FemTech, where speakers discussed concerns about the side effects of hormonal contraception while also praising fertility tracking and body literacy. These messages may not seem alarming on their face. But they cannot be separated from the threats in the Heritage Foundation’s major policy blueprint Project 2025. That agenda calls for restricting and even banning medication abortion, as well as undermining Title X, the nation’s only federal program dedicated to providing comprehensive family planning services to low-income individuals, and “defunding” Planned Parenthood—both of which are critical to ensuring that people’s contraceptive needs are met. Many of these policies are already working to severely limit reproductive autonomy and access to reproductive health care.
Project 2025 even calls for the Centers for Disease Control and Prevention (CDC) to message about the “unsurpassed effectiveness of modern fertility awareness-based methods.” This is untrue and misleading: Some other contraceptive methods are more highly effective at preventing pregnancy than any FABM. It’s important to be clear about that, even though effectiveness is one of many factors that impact people’s contraceptive decision making.
Nothing about FABMs is inherently harmful, but what is harmful is the way that coercive policy championed by conservative influencers with direct ties to the Trump administration could push FABMs as a substitute for the full range of reproductive care people need and deserve. We’re already seeing hints of this approach. A recent Department of Health and Human Services grant, slated to come out of Title X funding, would create centers to “combat infertility” through menstrual education and other FABM adjacent strategies. The move has heightened fears that the administration will exclusively promote FABM-related approaches to addressing infertility, while failing to also protect or expand access to in vitro fertilization. While FABM-related approaches may support some people’s needs, it’s impossible to view this as a good-faith effort to broaden access to FABM-adjacent care when it likely means that our other reproductive health care access will be stripped away. People’s preferences and needs should never be constrained by coercive policy.
The conservative movement’s politicization of FABMs has been made possible because many in favor of reproductive rights, such as providers and researchers, have historically ignored these methods. FABMs have long been sidelined by reproductive health researchers, so evidence on FABMs is more limited than other methods. Providers in Title X clinics often lack training or resources to counsel on FABMs, and many underestimate their effectiveness or write them off as not being appropriate for their patients.
For patients concerned with the side effects of hormonal contraception and interested in FABMs, encountering dismissal from providers means that they may turn to advice on social media instead. Research has found that on social media, fear-based messages about hormonal contraception are popular and misinformation is rampant with a strong favor toward FABMs that often uses cherry-picked evidence about effectiveness and may distort someone’s perception about whether these methods meet their needs. On top of that, the inconsistent regulation of FemTech, which people may be using for contraceptive purposes (even when many of these technologies lack data or regulatory approval for this purpose), could also lead to potential unintended pregnancies. This is a serious concern, especially when many people face enormous barriers to abortion access in their home state.
This complex mix of sidelining FABMs, while leaving social media claims and insufficiently regulated technologies unchecked, has allowed conservative policy makers and influencers to politicize FABMs within their broader agenda. But FABMs should be incorporated within a reproductive justice framework, as conceptualized by Black women in 1994 to center the comprehensive reproductive health needs of the most marginalized communities. Reproductive justice is about meaningful access to the full spectrum of sexual and reproductive health care, including abortion, contraception, pregnancy and fertility care, STI prevention and care, as well as creating and supporting conditions for people to raise their children in safe and supportive environments. FABMs fit within that framework if people have access to accurate information, person-centered counseling, access to a variety of method options, and a well-functioning regulatory system.
Reorienting FABMs within this framework requires action at several levels. On the research side, that would mean funding rigorous, peer-reviewed research on FABMs and all contraceptive methods—and considering working with people with different viewpoints but who share a commitment to rigorous science. For example, I worked under a model of “oppositional collaboration” (that is, with researchers across the ideological spectrum on sensitive issues in reproductive health) to conduct a systematic review on the effectiveness of FABM methods for pregnancy prevention. Soon thereafter, the CDC cited our systematic review in updating how they talked about FABM effectiveness. This reflects how public health guidance should work: following the data, rather than using selective claims to advance an ideological agenda. At the provider level, we need to fund and train providers both within and outside the Title X system to counsel accurately and non-judgmentally around FABMs. As advocates, we can also push for strengthened FemTech regulation, fight social media misinformation, and oppose policies that elevate FABMs at the expense of other reproductive health care.
It is long past time for the reproductive rights movement to acknowledge that FABMs are an important option within the larger menu of pregnancy prevention and fertility management methods. Rather than allow the conservative MAHA movement to politicize them at the expense of other reproductive health care, we should integrate FABMs into a broader, evidence-driven vision of reproductive health care as we fight to expand access for all.