By Aneela Rampersad, DO
Editor’s Note: During her time as a FACTS elective student, Aneela Rampersad, DO, reviewed the study, “Use Effectiveness of the Symptothermal Method to Ameliorate Unmet Need for Family Planning in Kisumu County, Kenya,” by Igben-Pender et al. The study found that women using the Sympto-Thermal Method experienced no unintended pregnancies over 12 months, suggesting that fertility awareness-based methods (FABMs) may help address unmet family-planning needs in resource-limited settings. Dr. Rampersad highlights the importance of educating clinicians in FABMs so they can provide comprehensive, patient-centered reproductive healthcare.
Introduction
Across the globe, there are more than 200 million reproductive-aged women in developing countries who desire to space or limit pregnancy but lack access to modern contraception or family-planning education. The number of women using the Sympto-Thermal Method as a means for family planning has been increasing since the 1970s and has been studied across Western cultures. However, there is a lack of information about the effectiveness of the Sympto-Thermal Method across developing countries. This unmet need for family planning is associated with higher rates of unplanned pregnancies and poorer maternal health outcomes, including increased maternal morbidity and mortality. The Sympto-Thermal Method is a fertility awareness-based method (FABM) that involves tracking cervical mucus observations and basal body temperature to determine fertile and infertile periods in a woman’s cycle. This study by Igben-Pender et al. in 2025 evaluates the effectiveness of the Sympto-Thermal Method among reproductive-aged women in Kisumu County, Kenya, where there is a 16.4% unmet need for family planning among reproductive-aged women.[1]
“There are more than 200 million reproductive-aged women in developing countries who desire to space or limit pregnancy but lack access to modern contraception or family planning education.”
Methodology
A quasi-experimental study design was used to conduct this study, which involved three phases. Phase 1 included recruitment of participants for the Sympto-Thermal Method interventional group and the oral contraceptive pill control group. Phase 2 involved training the interventional group on the Sympto-Thermal Method. Phase 3 involved longitudinal monitoring of participants in both groups.
The study included reproductive-aged women from ages 15 to 49 with intentions to prevent pregnancy, specifically those who had an unmet need for family planning but did not have prior exposure to the Sympto-Thermal Method were included in the interventional group. The control group included users of oral contraceptive pills. A total of 260 participants were recruited with 136 in the intervention group and 124 in the control group. The intervention group was trained on the Sympto-Thermal Method by a certified health education specialist and monitored for a total of 12 months along with the control group. The effectiveness of each method was determined by the number of women who did not have an unintended pregnancy at the end of the 12 months.
Results
Most participants in both groups were older than 25, married, had fewer than four children, and identified as Christian. Most women had completed secondary education, were housewives, and expressed a desire to space pregnancies for at least four years. The majority resided in urban areas within Kisumu County. Among women using the Sympto-Thermal Method, the median duration of menstruation was four days with a median duration of five infertile days after menstruation. The fertile phase lasted about eight days with a three-day peak fertile window, and ovulation occurring approximately on day 14.
In the Sympto-Thermal Method intervention group, no pregnancies occurred at the end of the 12 months of longitudinal observation, making the use effectiveness 100%. In the oral contraceptive pill control group, three of the women became pregnant during months 2 through 5, making the use effectiveness 97-99%. Of note, 15 participants in the intervention group and 17 participants in the control group were lost to follow-up. When comparing the effectiveness between the Sympto-Thermal Method and oral contraceptive group, there was no significant difference with a p-value of 0.058. However, the hazard ratio was found to be 0.01, which suggests that Sympto-Thermal Method users had a 99% lower risk of unintended pregnancy when compared to oral contraceptive users.
“In the Sympto-Thermal method intervention group, no pregnancies occurred at the end of the 12 months of longitudinal observation, making the use effectiveness 100%.”
Discussion
This research article provides insight into the efficacy of the Sympto-Thermal Method for family planning in a developing country, in this case Kisumu County, Kenya. There is an unmet need for family planning in developing countries, and in Kisumu County particularly, there are reproductive-aged women who do not use modern contraception due to lack of access, adverse side effects, or cultural and religious beliefs. The use of the Sympto-Thermal Method offers a low-cost, natural, and non-invasive alternative to modern contraception, while encouraging women to gain knowledge about their own fertility cycles. The result of this study gives us more knowledge about the effectiveness of the Sympto-Thermal Method to address these unmet needs in developing countries where residents may not have readily available access to modern contraception.
“The use of the Sympto-Thermal method offers a low-cost, natural, and non-invasive alternative to modern contraception, while encouraging women to gain knowledge about their own fertility cycles.”
While the difference in effectiveness rates between the intervention group and the control group was not found to be significant, it is important to highlight that there were no pregnancies at the end of the 12 months out of all the women who were in the Sympto-Thermal Method intervention group. They were trained on this method for three months, which likely contributed to the high success rate of the intervention group. Clinicians need education in fertility awareness-based methods to accurately educate patients, support informed reproductive health decisions, and incorporate these evidence-based methods into comprehensive fertility and reproductive healthcare. Educated clinicians can then encourage patients to share this information with their communities, hopefully reducing the unmet need for family planning on a broader scale.
“Clinicians need education in fertility awareness-based methods to accurately educate patients, support informed reproductive health decisions, and incorporate these evidence-based methods into comprehensive fertility and reproductive healthcare.”
Although the sample size was small and observations were based on typical use of the Sympto-Thermal Method, the results still give us insight into the effectiveness of a fertility awareness-based method in addressing the lack of modern contraception use in developing countries. This study can be used to continue researching the use of FABMs in various developing countries, as well as other populations who lack access to contraception or just those who simply would prefer a natural family-planning approach. This study is limited in that it only looked at one county in Kenya, but it can be used as a model to guide future research in other counties and countries.
References
[1] Igben-Pender, C. E., Omemo, P., & Ng’wena, G. (2025). Use effectiveness of the symptothermal method to ameliorate unmet need for family planning in Kisumu County, Kenya. International Health. https://doi.org/10.1093/inthealth/ihaf072
ABOUT THE AUTHOR
Aneela Rampersad, DO, graduated from Rowan-Virtua School of Osteopathic Medicine and is now an OB/GYN resident at Saint Peter’s University Hospital. Passionate about serving underserved minority communities, Dr. Rampersad enrolled in the FACTS elective during medical school to deepen her understanding of natural family planning methods and learn how to offer these evidence-based options to future patients, empowering them to make informed reproductive and healthcare decisions.
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