YES. I take issue with this as well.
A lot of the advertising or hype seemed to centre on the fact that it was created by a woman who is very smart in a totally unrelated field. I’m a woman, and a feminist, and a doctor. And my main criteria for someone designing new contraceptives isnt’ whether they are female, or certifiably very smart in an unrelated field, it’s what they know about O+G and fertility and can keep me from getting pregnant, as safely as possible. I have nothing against the creator, I just think her other work is irrelevant to this and shouldn’t be used as a selling point unless you can prove how your work with particles contributes to understanding fertility.
But since I’m already here, we’re going to talk about this app, because contraception is always something I’m ready to rant about.
So this app (like many ‘rhythm cycle’ methods) is billed as a natural form of contraception. It’s not new, it’s just something that has been repackaged, though I’d love to see its learning algorithms to see how it’s improved on existing ‘natural family planning’ methods that have always been unreliable. It promises to be very reliable, but UK watchdogs have found its advertising to be misleading; it can’t be said to be “highly accurate” according to the ASA, who also felt that typical use of the app led to results that fell below comparison with existing forms of contraception. Natural Cycles suggests typical-use efficacy rate of 93% and a perfect-use efficacy rate of 99%, however their initial study was found to have high dropout rates- people who didn’t get on with it may not have been included, and that can alter the numbers.
In reality, it matters much more what most people do, in everyday use. And that data can be harder to get. It’s been pointed out by the NHS that the data on these apps is limited, and comes only from the companies themselves; therefore more research is needed to ensure that these forms of contraception meet the standards we hold existing contraception to.
The ASA found that research showed that 91.7% of users did not become pregnant over the course of 13 cycles based on typical use of the app. They found that only 9.6% of cycles were considered as perfect-use, where the app had been used precisely as instructed. This is a difference in the data from the original trial; it’s possible that the population of the trial were perhaps not representative of the average user - not everyone is equally motivated to do things as prescribed. Which is why I will always go on about how typical use of a contraceptive really matters. There’s a really good breakdown of the whole Natural Cycles story on FullFact.
You might think what’s the difference between 91.7% and 99% - they both sound quite high. But if something is 99% effective, only 10 in 1000 women will become pregnant. If something is 91.7% effective, 83 out of 1000 women will become pregnant. Compare that to something like a mirena coil or implant, where only 1 out of 1000 women will become pregnant. The most commonly used Pearl Index looks at numbers out of 100, but both those methods have a higher than 99% record. The numbers matter, because each 1 is a person who then has to make decisions about what to do about this unexpected and often unwanted pregnancy.
There have been quite a few concerns in general about how reliable these methods are, and whether there is an increased number of abortions or unplanned pregnancies as a result. Some people feel that it was misrepresented to them. I’d been keeping an eye on stories about the app, because I was wary in believing any rhythm method could be that reliable, and it’s really sad to hear how much it has affected some people.
This method relieson things like charting mucus thickness, body temperature when you get up first thing in the morning and other signs that you might be ovulating, to know which days are riskiest to have sex on. However, it relies on a lot of things, like you getting up at exactly the same time every day, and having a regular cycle. There are lots of things that might affect your body temperature; workouts, being hungover, smoking, having sex, being sick, stressing etc. This kind of method is actually used pretty successfuly for couples who want to get pregnant, because the risks are a lot lower if you’re using it to choose which days you want to have more sex to make babies.
It’s worth noting that it’s still a viable contraceptive option for some people. If they have horrific side effects with hormonal forms (or just really want to avoid them), and are rigorous about taking measurements. The ideal user for this kind of method is someone who is a little older and more settled; perhaps someone in their 30s, who is rigorous about checking their measurements every morning, and who has a regimented life with the same waking times every day. It’s also probably someone who ideally doesn’t want to get pregnant right now, but who, if it did happen, would still be OK with it; the risks are mitigated if pregnancy isn’t that big of a deal to you, and you’re managing the timing of a baby, rather than trying to prevent your world from imploding. I’m really glad that it’s an option for people, but I really would like these methods to be sold as what they are; a trade off in which people have to input a lot of data (and risk user error), have to have regular cycles and routines, and really should use other protection on any days that might be borderline, so that they don’t need to use hormonal contraception.
But if pregnancy is something you really, really want to avoid, it’s always best to double up on your contraceptives and/or use a more reliable method that cuts out as much user error as possible, if you can.
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