Women seeking abortions after using 'natural' contraception

A study conducted in England and Wales indicates that despite women using “natural” methods, such as fertility tracking apps, for contraception, the proportion of women seeking abortions has increased. Published in the journal *BMJ Sexual & Reproductive Health*, the study's data reveals a “shift” in contraceptive method usage over the past five years, moving away from “more reliable” hormonal contraceptives, like the pill, towards “fertility awareness-based methods.”

Researchers noted that the use of hormonal contraceptive methods, including the mini-pill, among tens of thousands of women, decreased from 19% in 2018 to 11% in 2023. Simultaneously, the use of natural methods rose from 0.4% to 2.5%, which, although still a minority, is a significant increase that “warrants investigation.”

Fertility apps help women understand when they are most fertile each month or menstrual cycle by tracking their fertile window. These apps rely on measurements like body temperature to predict ovulation (the release of an egg from the ovaries). Companies claim that if used correctly, their reliability can be up to 93%. However, they require users to take measurements and control the timing of sexual activity, avoiding intercourse when the app indicates they may be fertile. The UK's National Health Service (NHS) states that if not followed strictly, the method’s effectiveness is only 76%, meaning 24% of women using fertility tracking will become pregnant each year.

In comparison, the pill and mini-pill have a 91% effectiveness rate under “typical use” and 99% under “perfect use.” Hormonal intrauterine devices or implants, which do not rely on the user remembering to take them, have a 99% effectiveness rate. For this study, researchers at the University of Edinburgh compared data from UK pregnancy advisory services between January and June 2018 (33,495 women) and January and June 2023 (55,055 women) to see if there had been a change in the use of contraceptive methods.

In addition to the shift toward natural methods, more women reported using no contraception at all in 2023, increasing from 56% in 2018 to 70%. The study authors stated that the drivers behind these trends are currently uncertain, but difficulties accessing sexual health services during the Covid pandemic could be a factor. Lead researcher Dr. Rosie McEachan told the BBC, “What really needs to be looked at is the huge rise in e-health usage, including fertility apps and period trackers. The market has exploded, there are hundreds of apps, and some are more reliable than others. Also, you don’t need a prescription, so you may not be getting all the information you need.”

Abortion provider MSI Reproductive Choices UK also told the BBC that they have seen more women using fertility awareness methods. Tania Lane, Head of Contraception, explained, “This could be due to the increased popularity of social media platforms like TikTok, with more people sharing their experiences…and paid partnerships between content creators and fertility awareness method brands, which may influence people to choose this method. Long waiting times for appointments at GP surgeries and sexual health clinics may also be a factor.” She noted, “In some parts of the UK, people are waiting months for appointments, especially for long-acting methods like IUDs and implants.”

Lane advised that any woman considering switching to fertility tracking should consult a healthcare professional. “To dispel any myths and misconceptions and to have a discussion about the risks of failure, so that an informed decision can be made,” she advised. Paula Baraitser, Medical Director at SH:24, a free sexual health service partnered with the NHS, stated that there could be many reasons why women are switching to other methods, including concerns about future fertility and possible side effects. Risks can range from mild side effects to rare but potentially serious complications.

Baraitser told the BBC, “Many people will be using contraception for 30 years of their lives. People have very different experiences with hormonal contraception, and ultimately we need more method choice so that people can find something that works for them. There have been very few new methods of contraception in the last 50 years, which reflects a lack of investment in research in this area.” Sexual health charity Brook stated that many women use hormonal contraception not just for contraception but also to manage their menstrual health, making periods lighter and more predictable. “These benefits need to be part of a wider discussion about hormones,” said spokesperson Lisa Hallgarten.