Lauren Giordano/The Atlantic

Return of the Rhythm Method

Tired of condoms and the Pill, many women are turning to new apps that help them practice one of the oldest forms of contraception.

OLGA KHAZANDEC 9 2014

Every morning when she wakes up, Becca, a college student in Pennsylvania, puts a teardrop-shaped thermometer called the Daysy under her tongue. If it lights up green, she knows that day she and her boyfriend can have sex without a condom. If it’s red or yellow, they need to use protection.

With its blinking face and patented “LadyComp algorithm,” Daysy seems newfangled, but its core technology is one septuagenarians would recognize. It relies on the basal body-temperature method of family planning, based on the fact that women’s bodies are a few degrees hotter just after ovulation. But while in past decades women who employed this method had to hand-chart their temperatures on graph paper, Daysy tracks the readings automatically and ports the data onto a companion iPhone app that lets the user see her “cycle forecast” and “temperature curve.” Because it’s personalized, it claims to predict a woman’s chance of pregnancy with an accuracy of 99.3 percent—roughly the same as that of birth-control pills.

Becca began using Daysy in June after stints on the Pill and on Nuvaring, the hormonal vaginal ring. (All of the women in this story asked me to use only their first names.) Both methods caused mood changes that she found unsettling, such as bouts of unexplained crying, and the Pill made her nauseous nearly every morning. She and her boyfriend had been together for a while, so although he was wary of “natural” contraception at first, the Pill’s nasty effects on Becca persuaded him to give it a try.

Becca has about 10 “green” days a month, and at other times, the couple uses condoms.
“At first, remembering to measure it every morning, it was hard,” she said. “But you just get in a routine.”

* * *

Count natural family planning among the ways young people these days are hearkening back to the practices of their grandparents—right there with home-pickling, beard-growing, and suspender-wearing. Of course, in this case, the underlying motive is not so much trendiness as it is a dissatisfaction with the Pill, which is still the most common form of birth control for women. In a recent CDC study of 12,000 American women, 63 percent of women who stopped using the Pill did so due to its side effects.

Meanwhile, the majority of young people live with their partners before marriage, in many cases forming pseudo-marriages that the writer Ann Friedman dubbed “the pullout generation” in New York magazine last year. With a pack of Plan B close at hand, many young women in long-term relationships are eager to prioritize sexual pleasure and to rid themselves of daily synthetic hormones. (And to be sure, many of these women also have sufficient financial resources and relational stability not to fear a mis-timed pregnancy.) The same CDC study found that the number of women whose partners sometimes rely on “withdrawal” for birth control has increased to 60 percent, from 25 percent in 1982.

As of 2010, only about 22 percent of women used “periodic abstinence," an umbrella term that includes counting days, measuring temperature, and tracking cervical mucus to predict fertility. Women with a master’s degree or higher were far more likely to use these methods than their less-educated peers. Their ranks may grow, though, as new apps and other technologies make it easier to manage the historically error-prone task of measuring, recording, and analyzing one’s cycle in order to stay baby-free.

The Rythmeter, circa 1944, came with a more complicated set of instructions. (Harvard Medical Library)

CycleBeads, for example, comes as both a string of multicolored beads and an iPhone app that allows women to track fertility based on the Standard Days Method, a system developed by Georgetown University's Institute for Reproductive Health in which specific days of each woman’s cycle are considered infertile. (The beads are geared toward women in developing countries who might not have smartphones—they can use the beads to count days.) The method only works for women who have regular cycles between 26 and 32 days long. So far the app has 30,000 users.

Kate, a woman who lives in the Washington, D.C. area, began using CycleBeads nearly three years ago after experiencing weight gain and moodiness on the Pill. These days, before she and her husband have sex, she reaches for her phone, checks the app, and "we discuss and plan accordingly.”

“At first [my husband and I] were worried,” she said, “but then we got used to it and have grown to trust it. I honestly can't imagine ever going back on the Pill.”

Other women told me the apps simplify what they would have been doing anyway. Rachel, who lives in Scottsdale, Arizona, said she’s been using fertility-awareness methods almost exclusively for 10 years. Before apps like the two she relies upon, Clue and OvuView, came along, she kept a three-ring binder full of temperature readings by her bed.

“My husband has been known to pop the thermometer in my mouth when I wake up and remind me to do cervical checks in the evening,” she said. “It's brought us closer than ever because he's so in tune with my body and my natural cycles.”

* * *

Leslie Heyer, president of Cycle Technologies, which makes CycleBeads, told me that its success rate is about 95 percent for “perfect use” and 88 percent for “typical use,” which would mean it beats condoms and falls just short of the Pill. And though women using CycleBeads have only 18 infertile days each month (14 if you deduct menstruation days), Heyer says women using the method have intercourse just as often as those on the Pill.

None of the women I contacted said they had any slip-ups or unintended pregnancies, and some said fertility awareness was just as easy to handle as the Pill or condoms. Rachel even described it as “like breathing.”

However, several of them emphasized that there’s a difference between what they do and the “rhythm method,” a different kind of days-counting technique developed in the 1930s, which doesn't use temperature readings and which has a historical association with the Roman Catholic church.

Also important is the distinction between apps like Daysy’s and CycleBeads, which are specifically designed for contraception, and those that only track ovulation for couples who are trying to get pregnant. (Clue doesn't officially bill itself as birth control, for example.) Experts don’t recommend simply repurposing a basic fertility app for contraceptive purposes.

The American College of Obstetricians and Gynecologists said in a statement that, "Natural family planning is not as effective as most other methods of birth control. One in four women who use this method become pregnant." The organization also said that women who have abnormal bleeding, vaginitis, cervicitis, frequent fevers, or who are on certain medications should not use these methods.

Nathaniel DeNicola, an OB-GYN with the University of Pennsylvania, said natural methods are “definitely not the most effective,” but can nevertheless be a good option for women who are fed up with hormonal methods, leery of copper IUDs, or have health risks that preclude taking the Pill. Because being off by even a few days can result in pregnancy, he says it’s essential women track their days and symptoms vigilantly—and if apps can help with that, so be it.

As with any contraceptive, there are downsides. Becca shelled out $300 for the Daysy; unlike the Pill, it’s not covered by health insurance. She says she still sometimes struggles to remember to take her temperature in the mornings, and a night of drinking can skew the data.

Heyer says women who have very long or short cycles shouldn’t use CycleBeads, and neither should women who have unpredictable or casual sex. And she realizes that there’s still stigma around natural family planning, especially decades after a hard-won fight by feminists for the current, widespread availability of the Pill.

“I think there’s a sense they’re less effective,” she said. “Because historically, they were less effective. You were relying on people doing their own calculations. With the Standard Days method, the tools do matter.”

For several of the women I contacted, the tools also matter as a way to quantify and analyze menstruation, traditionally a taboo subject. Several women reported feeling more in touch with their bodies or impressed by the swooping curves and technicolor data points their uteruses generate, month after month.

“I'm doing a Ph.D in cognitive science,” said Greta, a German woman who asked to be identified pseudonymously and who uses Clue, but only to track her cycle.

“I like data. I also like that Clue empowers me to keep track of my own data, and that their attitude (design, information, everything) respects the fact that I'm an intelligent human who can make scientifically-based decisions.”

There’s another, often overlooked, stylistic element that got her hooked:
“I love that it’s not pink.”

Dial Up the Magic of This Moment: Philosopher Joanna Macy on How Rilke Can Help Us Befriend Our Mortality and Be More Alive

Few people have stood at the gates of hope – through world wars and environmental crises and personal loss – with more dignity, wisdom, and optimism than Joanna Macy during her six decades as a Buddhist scholar, environmental activist, and pioneering philosopher of ecology. Macy is also the world's greatest translator-enchantress of Rainer Maria Rilke, in whose poetry she found refuge upon the sudden and devastating death of the love of her life after fifty-six years of marriage.

Indeed, our mortality, as well as ourquintessential resistance to it, is a subject Rilke unravels frequently and with deeply comforting insight in Macy's A Year with Rilke: Daily Readings from the Best of Rainer Maria Rilke (public library | IndieBound) – a sublime collection spanning from Rilke's early poems to the last sonnet he wrote days before his death from leukemia, alongside fragments of his letters, diaries, and prose. The project is reminiscent of Tolstoy's Calendar of Wisdom, but instead of an elevating thought for each day of the year culled from a different thinker, every day features a short Rilke reading.

Macy and her collaborator, Anita Barrows, explore Rilke's singular consolations in the preface:

Rilke’s grasp of the transient nature of all things is critical to his capacity to praise and to cherish... In the face of impermanence and death, it takes courage to love the things of this world and to believe that praising them is our noblest calling. Rilke’s is not a conditional courage, dependent on an afterlife. Nor is it a stoic courage, keeping a stiff upper lip when shattered by loss. It is courage born of the ever-unexpected discovery that acceptance of mortality yields an expansion of being. In naming what is doomed to disappear, naming the way it keeps streaming through our hands, we can hear the song that streaming makes.
[...]
His capacity to embrace the dark and to acknowledge loss brings comfort to the reader because nothing of life is left out. There is nothing that cannot be redeemed. No degree of hopelessness, such as that of prisoners, beggars, abandoned animals, or inmates of asylums, is outside the scope of the poet’s respectful attention. He allows us to see that the bestowal of such pure attention is in itself a triumph of the spirit.
[...]
Rilke would teach us to accept death as well as life, and in so doing to recognize that they belong together as two halves of the same circle.

In the book, Macy highlights one particularly poignant 1923 letter to the Countess Margot Sizzo-Noris-Crouy, in which 48-year-old Rilke writes:

The great secret of death, and perhaps its deepest connection with us, is this: that, in taking from us a being we have loved and venerated, death does not wound us without, at the same time, lifting us toward a more perfect understanding of this being and of ourselves.

He adds:

I am not saying that we should love death, but rather that we should love life so generously, without picking and choosing, that we automatically include it (life’s other half) in our love. This is what actually happens in the great expansiveness of love, which cannot be stopped or constricted. It is only because we exclude it that death becomes more and more foreign to us and, ultimately, our enemy.
It is conceivable that death is infinitely closer to us than life itself… What do we know of it?

In the same letter, he admonishes against our crippling compulsion to deny death, which only impoverishes life:

Our effort, I suggest, can be dedicated to this: to assume the unity of Life and Death and let it be progressively demonstrated to us. So long as we stand in opposition to Death we will disfigure it. Believe me, my dear Countess, Death is our friend, our closest friend, perhaps the only friend who can never be misled by our ploys and vacillations. And I do not mean that in the sentimental, romantic sense of distrusting or renouncing life. Death is our friend precisely because it brings us into absolute and passionate presence with all that is here, that is natural, that is love... Life always says Yes and No simultaneously. Death (I implore you to believe) is the true Yea-sayer. It stands before eternity and says only: Yes.

Rilke captures this even more beautifully, at once with astonishing intellectual precision and astonishing spiritual expansiveness, in his poetry. In a recent conversation with Krista Tippett on the always soul-stretchingOn Being, Macy discusses Rilke's emboldening views on mortality and reads some of his poems on death and consciousness. Here is Macy reading Rilke's "The Swan"– coincidentally, the poem that appears as the day's reading in A Year with Rilke on the date of this recording, July 13:

THE SWAN
This laboring of ours with all that remains undone,
as if still bound to it,
is like the lumbering gait of the swan.
And then our dying — releasing ourselves
from the very ground on which we stood —
is like the way he hesitantly lowers himself
into the water. It gently receives him,
and, gladly yielding, flows back beneath him,
as wave follows wave,
while he, now wholly serene and sure,
with regal composure,
allows himself to glide.

In her book In Praise of Mortality, Macy writes:

Rilke invites us to experience what mortality makes possible. It links us with life and all time. Ours is the suffering and ours is the harvest.

(Perhaps no text of Rilke's captures this essential osmosis between Life and Death, light and darkness, better than his famous line, "Let everything happen to you: beauty and terror.")

In another poem from Rilke's "Sonnets to Orpheus," found in Macy's Rilke's Book of Hours: Love Poems to God, the poet casts his luminous gaze not directly at death but at the larger world of dark emotions and suffering, which he believed were essential to the creative spirit:

But the most emboldening wisdom of all – the most sorely needed consolation amid the daily darknesses we encounter both as individuals and, increasingly, as a society – comes from Macy herself. She affirms the idea that spiritual survival isn't a matter of sheepish optimism or oferadicating our dark emotions but of simply showing up. Macy, at 81, tells Tippett:

I'm not insisting that we be brimming with hope – it's OK not to be optimistic. Buddhist teachings say, you know, feeling that you have to maintain hope can wear you out, so just be present... The biggest gift you can give is to be absolutely present, and when you're worrying about whether you're hopeful or hopeless or pessimistic or optimistic, who cares? The main thing is that you're showing up, that you're here, and that you're finding ever more capacity to love this world – because it will not be healed without that. That [is] what is going to unleash our intelligence and our ingenuity and our solidarity for the healing of our world.
[...]
How is the story going to end? And that seems almost orchestrated to bring forth from us the biggest moral strength, courage, and creativity. I feel because when things are this unstable, a person's determination, how they choose to invest their energy and their heart and mind can have much more effect on the larger picture than we're accustomed to think. So I find it a very exciting time to be alive, if somewhat wearing emotionally.

Macy goes on to discuss what Rilke's poignant 1923 letter taught her, in the wake of her husband's death, about our shared tussle with mortality. Her words and the spirit from which they spring are nothing short of breathtaking:

I'm everlastingly grateful that we were in love and stayed in love. Particularly, it was like falling in love all over again in our later years, so there was a lot of cherishing. But I found that that quote that I just read you – and it's really engraved in the inside of my head – is true. It's true and that's why we're changing all the time. He's part of my world now. You become what you love. Orpheus became the world that Rilke sang to, and my husband, Fran, is spread out in this world that he loved.
So ... you're always asked to sort of stretch a little bit more -- but actually we're made for that. There's a song that wants to sing itself through us. We just got to be available. Maybe the song that is to be sung through us is the most beautiful requiem for an irreplaceable planet or maybe it's a song of joyous rebirth as we create a new culture that doesn't destroy its world. But in any case, there's absolutely no excuse for our making our passionate love for our world dependent on what we think of its degree of health, whether we think it's going to go on forever. Those are just thoughts anyway. But this moment you're alive, so you can just dial up the magic of that at any time.

A Year with Rilke is a sublime read in its entirety, as is Macy's In Praise of Mortality. Complement Macy and Rilke's shared wisdom on death withJohn Updike's memorable insight and an unusual children's book that embodies Rilke's inclusion of death into life's embrace, then listen to the fullOn Being episode and subscribe here for a steady stream of soul-expansion.

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