Hesperian Health Guides

Behavioral Methods of Family Planning

In this chapter:

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

  • breastfeeding (LAM)
  • fertility awareness methods (Mucus Method, Counting Days Method)
  • withdrawal
  • abstinence and sex that cannot cause pregnancy
IMPORTANT! Except for abstinence, behavioral methods of family planning do not protect against STIs, including HIV. So you will still need to think about ways to protect yourself from these infections.

Breastfeeding to prevent pregnancy

(Lactational Amenorrhea Method, LAM)

Breastfeeding can prevent the ovaries from releasing an egg, but only under certain conditions (see box below)

How to use breastfeeding to prevent pregnancy:

Breastfeeding will prevent pregnancy only when all 3 of these things are true:
1. Your baby is less than 6 months old. a small baby lying on its back 2. You have not had your period since giving birth. a pad with blood on it, with a large X drawn through it
3. Your baby is feeding only on breast milk, and is feeding whenever it is hungry, day and night, with no more than 6 hours between feedings. 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 these things are true:
a woman breastfeeding a baby
  • Your baby is more than 6 months old, or
  • Your menstrual period returns, 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.

Fertility awareness methods require your partner’s cooperation or they will not be effective.

More Information
sex without intercourse
More Information
your menstrual cycle

Fertility awareness methods

You can only get pregnant during certain days of your menstrual cycle. Fertility awareness methods help you know when those days are so you can avoid having sex that can make you pregnant during that time.

The ovaries usually release one egg each menstrual cycle, about 14 days before your next period begins. You are fertile for about 24 hours after the egg is released, but it is difficult to know exactly when this happens. To avoid pregnancy you must avoid sex that can cause pregnancy for a few “fertile days” before and after the time you think the egg will be released. Or you can use a barrier method for protection during those days.

Many people who cannot or do not want to use other methods, or have no other methods available, use fertility awareness methods. To make this most effective, try to learn about fertility from a specially trained health worker. It can take 3 to 6 months of practice to learn to use these methods without errors.

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 that can make you pregnant during this time.

How to tell when you are fertile:

a woman looking at mucus between her thumb and finger
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?
wet mucus stretched between a thumb and finger

clear, wet, slippery mucus = fertile

dry mucus on a thumb and finger

white, dry, sticky mucus = not fertile
How to use the mucus method:
  • Do not have penis-in-vagina 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 (using spermicide would change the mucus).
  • Do not have penis-in-vagina sex until 2 days after the last day of clear, slippery mucus, or use a condom.
  • Do not have unprotected penis-in-vagina sex during your period. Because bleeding changes your mucus, 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. This will wash the mucus away.
  • If you are having trouble knowing when you are fertile, or if you have a vaginal infection, use another method.

Counting Days Method

With the Counting Days Method, you do not have unprotected sex that can make you pregnant during any time that you might be fertile. This method will only work if you have a very regular cycle. The time from the first day of one period to the first day of the next must be nearly the same each time and be between 26 days and 32 days.

a woman thinking while she counts on her fingers
I started my period 8 days ago. So we cannot have sex today, or for the next 10 days.
I better go to my sister's.

If you have cycles of different lengths (or even one that’s different), you can easily get pregnant using this method. Stress or illness can cause someone’s menstrual cycle to change. So at times like that, it is best to use a different family planning method until you are well and your cycle is regular again.

How to use the Counting Days Method: For this method to work, you cannot have unprotected sex that can make you pregnant from from the 8th day of your cycle through the 19th day of your cycle. If you have sex during this time, you must use another method of family planning.

You can use beads, a chart, or some other tool to remember your fertile days. String 32 beads, of 3 different colors, into a necklace. Each color bead can represent a different part of your cycle.
illustration of the below: a string of 32 beads, with a marker on the first blue one
A red bead
marks the
first day of
your period.
13 more blue
beads show days
when sex will not
usually cause
6 blue beads show days
    when sex
       will not usually cause
         12 white beads
        show your fertile time —
     when sex can cause pregnancy.
a woman holding a string of colored beads
On the first day of your period, put a ring or string around the red bead. Each day, move the ring past one bead. When the ring is on any of the white beads, you may get pregnant if you have penis-in-vagina sex. Whenever you start your next period, move the ring back to the red bead at the start.

Withdrawal (pulling out, coitus interruptus)

With this method, the person with the penis pulls it out of the vagina and away from the partner’s genitals before ejaculation. This is better than no method, but it does not always work. Sometimes the person does not withdraw in time. Or sometimes, a little semen can leak out of the penis before ejaculation. It only takes a little to cause pregnancy at a fertile time.

Abstinence and sex that cannot cause pregnancy

Abstinence as a family planning method means avoiding all sex that can cause pregnancy, that is, all penis-in-vagina sex. This is the surest way to prevent pregnancy, although it may be difficult to do for a long time. In many communities, couples may live separately and not have sex for months or even years after the birth of a baby. Couples living separately for some time after birth has traditionally been one way to delay the next pregnancy, and also allow the person who gave birth time to recover. Now family separations are being driven more by economic need, not healthy spacing of births, though they often have a similar result.

There are also ways to have sex that cannot cause pregnancy. Oral sex (mouth on genitals) and sexual touch (touching the genitals or other parts of the body) are sexual activities that many people enjoy. They have no risk of pregnancy and very low risk of passing HIV and other STIs. Anal sex also cannot cause pregnancy, however it is even more likely to pass HIV and other STIs than penis-in-vagina sex.

Methods that do not prevent pregnancy

These are common methods some people try that do not prevent pregnancy and that may be harmful.

  • Omens and magic do not prevent pregnancy.
  • Putting grasses, leaves, pods, and dung in the vagina can cause infection and irritation.
  • Washing out the vagina (douching) with herbs, powders, cola drinks or other liquids does not prevent pregnancy. Sperm move very fast and some will reach the inside of the womb before they can be washed out.
  • Urinating after sex does not prevent pregnancy. (But it can help prevent infections of the urine system.)

This page was updated:13 Nov 2023