What Happens When You Swap Birth Control Pills for an App

One area that has seen some movement recently is the use of longer term contraceptive methods. Increasing numbers of women are turning to IUDs and the implant, thanks to the US introduction of the Affordable Care Act, which offers these devices free. But despite the widespread availability of these other proven and effective methods in the Western world, many women are also turning to less researched methods.

One of these methods is natural family planning, which is back in vogue thanks to a number of apps that simplify the lengthy process of tracking your menstrual cycle to predict when you are most likely to get pregnant.

One such app, called Natural Cycles, just surpassed 100,000 users. All it requires is for you to pop a thermometer in your mouth every morning, before you get out of bed or move too much, and record the results. Its algorithm uses these results to gets to know your body, so it can tell you when exactly you can expect your period and when your six-day fertile window is.

If you don't put enough data in, it will simply give you more 'red days' when you're not safe to have unprotected sex. It's joined a growing market of period trackers and fertility apps such as Eve by Glow, Kindara, and CycleBeads that tout themselves as effective, non-hormonal methods of family planning.

Beside the fact that these apps still put the lion's share—if not all—of the responsibility for contraception on women, they also highlight another huge issue in birth control: the risk of user failure.

When researchers and doctors talk about different methods of family planning, they normally use two metrics: user failure and method failure. The number one reason that contraception methods don't work is because of user failure, not method failure. Remembering to take a pill every day is one thing, but remembering to take your temperature and hoping you've recorded everything properly? That's quite another.

Laura*, 27, stopped using the pill because of anxiety, weight gain, and mood swings. She now uses Natural Cycles instead. "it isn't the most convenient thing to use," she says. "I went into it thinking it would be really easy, but now I worry that maybe I'm not following the instructions well enough. It's also very easy to forget to do. I often go to the bathroom and then realize that I should have taken my temperature before."

Fertility awareness practitioner Sarah Panzetta has used natural family planning since a pill-related pregnancy scare in 1996, and has recently started using an app too. But even she isn't completely comfortable with the rising use of these methods. "The potential is amazing but I think the reality is falling quite short of what people actually need," she says. "One thing that concerns me about some of the apps and some of the natural birth control methods is that they can be overenthusiastic about it and completely dismiss the pill and other forms of contraception."

So should we welcome these technological innovations, even if they rely on more traditional methods of birth control? Dr Philippa Kaye, an expert in pregnancy and women's health, thinks so: "Women have been doing this [natural family planning] for a long time, it might not be through an app but they've been measuring their temperature and looking at their vaginal mucus. This may help you do that, but I don't think it's the answer to contraception."

Then of course there's the small matter of lifestyle. If you're in a long term relationship and trust yourself to remember to take your temperature every morning, then natural family planning methods could be great. If you party, drink a lot, and don't think you'd remember to take your temperature the whole time, you'd find yourself with an awful lot of 'red days' when you can't have unprotected sex.

Raoul Scherwitzl, one half of the husband and wife physicist duo who developed Natural Cycles, still sees this as easier to use than the pill. "Unlike the pill, that you have to take everyday, you don't have to enter data everyday into the app—it's OK to skip these days, like on weekends for example," he says. "The cleaner the data, the more green days there will be. So if you almost never measure or party everyday, then you will have either no or very fluctuating data point, so you will only end up with red days."

Eve by Glow and Natural Cycles both undertake research and clinical trials to help improve their offering. "In a month we'll have a new clinical study that shows we have as low a failure rate as the contraceptive pill," explains Scherwitzl. He claims that their research shows that only five women in 1,000 who aren't trying to conceive will get pregnant in the space of a year, as long as they use the app correctly. That's a 0.5% chance of unwanted pregnancy. When you compare those stats to the reliability of other forms of contraception (according to the NHS condoms are 98 percent reliable and the pill 99 percent, if used correctly) there's little difference. But again, we're talking method effectiveness here—not user effectiveness.

Risks aside, anything that helps us better understand family planning and the female body is, obviously, a good thing. As these companies mine data from hundreds of thousands of women—data which, despite privacy concerns, both Eve by Glow and Natural Cycles privacy policies assure is anonymous and not passed onto third parties without user permission—we can only be getting closer to a time when women won't have to put up with contraception that don't suit them simply out of a lack of options.

If not, that long awaited male pill is always in the works.