The digital contraceptive Natural Cycles is less progressive than it sounds

The app continues the tradition of women bearing the burden for not getting pregnant.

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In our hyper-connected, tech-obsessed world, it’s increasingly become evident that there’s an app for every conundrum. Can’t budget? There’s at least a handful of budgeting apps that link to your bank account, and others that go the extra step by making suggested changes. Need someone to do your laundry? The app store can sort you out, at a variety of prices.

Even the tricky business of birth control isn’t immune - or so it seemed. Natural Cycles, an app that works as a “fertility monitoring device” , was created by Elina Berglund and her husband two years ago, and made headlines last year after gaining certification in the EU to be marketed as a contraceptive device like the pill or the coil.

Natural Cycles recently entered the headlines again because of controversy in Sweden, where co-founder Berglund is from. Out of 668 abortions carried out by the Södersjukhuset hospital in Stockholm, Sweden, 37 were from women who had used the Natural Cycles app to prevent pregnancy.

Midwives involved reported the numbers to the Swedish Medical Product Agency, the organisation in charge of certifying Natural Cycles as a medical device. It was hardly a good look for an app that claims to be more effective than the traditional contraceptive pill.

In response, Natural Cycles argued that the user base of Natural Cycles had swelled over the last year, which had naturally meant that there had been an expected, proportionate swell in the number of unplanned pregnancies. Most contraceptive methods do have about a 95 per cent effectiveness rate in perfect use - the common contraceptive pill, for example, is about 91 per cent effective.

To sceptics, the app seems to be a pseudo-scientific version of the Catholic Church’s contraception recommendation, the rhythm method which requires women to keep track of their menstrual cycles and estimate when they're most likely to be fertile. But the rhythm method doesn’t come with the endorsement of a former particle physicist at CERN. Berglund developed the algorithm while she was a member of the team investigating the Higgs-Boson particle.

The basis of Natural Cycles methodology is that there is a relationship between a woman’s fertility and her temperature. Users input their temperature into the app every morning. It then calculates the trajectory of the users’ menstrual cycle and informs them which days they can have unprotected sex on, which will be displayed as green in the app. Days that aren't safe will show up in red.

Accessing birth control has historically been difficult for most women, and continues to remain so for many others. ​Studies have pointed to side effects of birth control on women, such as depression, mood swings and weight gain. It’s not really that surprising that when a quick fix - an app that claims to deliver all the benefits, with none of the side effects - came onto the market, scores of women jumped at the chance to adopt it. 

The app does claim a 93 per cent effectiveness rate, which is about comparable with other kinds of birth control. But an app isn’t actual, literal birth control. It cannot actually stop you from getting pregnant like a condom can. It also can’t prevent the spread of sexually transmitted diseases.

Of course, there’s also the fact that commercialising birth control - which in the UK is offered free of charge (with the exception of the morning after pill, although that may be set to change) - feels a little...icky, for lack of a better word. In iNews, Rhiannon Williams argued out that contraception, as a serious matter, shouldn't be left to targeted Instagram ads or influencers.

Natural Cycles has used both in the past. The ads don't specify the commitment involved and the narrow range of women that use it: namely, women in steady relationships over the age of 25.  

Contraception can be divided into methods that require a one-off or irregular action, and those that need regular attention. Methods such as getting an IUD (a device implanted in the womb) are operations that occur once and have a long term effect. Others involve taking a daily pill. 

The app continues the tradition in contraception of women bearing the burden for not getting pregnant. It is women who have to change their daily routines, in this case to input data and check back with the app. Such methods of contraception are vulnerable to human error. Women on the pill often forget to take it regularly – so what’s to suggest that women won’t do the same with measuring their temperature?

Other women use birth control to cope with polycystic ovary syndrome, which can be painful and long-term, or due to debilitating period pains, even endometriosis. While Natural Cycles can go some way towards staving off pregnancy, it cannot actually change hormonal imbalances or stop painful periods in the way that other kinds of contraceptives can.

In reality, Natural Cycles – and versions of it – can only really be used by a specific kind of woman. First of all, there’s a subscription rate of £6.99 a month, making a yearly subscription £84. The average user, as Berglund herself highlighted, is about 30, and would like to get pregnant at some point in the future, but is currently frustrated with hormonal contraception. 

That specific demographic is partially due to the nature of the app. Users have to be diligent with monitoring their temperatures regularly, in order to ensure the accuracy of the app’s predictions, and temperatures cannot be taken when hungover, as alcohol can have effects on the body’s temperature. Revealingly, there's a chance on the app to switch to “trying to get pregnant" as well. The target demographic of the app is also likely to be most able to cope with an unexpected pregnancy. 

On the app store, the app boasts a very high rating, with the majority of the 1,326 reviews giving the app five stars. Many of the reviewers emphasised the non-hormonal nature of the app, as well as the fact that it gave them an opportunity to get in touch with their bodies. Some even said it was life changing.  A few other reviews, although they were relatively far between, expressed dissatisfaction after becoming pregnant, with one reviewer even saying that when she indicated she was pregnant, the app offered up a message reminding to continue to log her temperatures each day, in order to stave off the chance of miscarriage.

From a public health perspective, the age group that needs the most help with contraception – and is coincidentally the most smartphone literate – is the 16-25 crowd. This is the age group most likely to engage in risky sexual behaviour, and also, statistically, the least likely to be able to deal with an unplanned pregnancy. Policymakers have spent years trying to ensure that young women stop getting pregnant, with the side effects experienced by an age group already prone to mood swings, acne and depression somewhat overlooked. If they are due a contraceptive innovation, it would be one that addressed the side effects while making the act of not getting pregnant easy, rather than more complicated.

Speaking to Business Insider after news of the unwanted pregnancies broke, Berglund said that the Natural Cycles team was surprised at the publicity, as all that the news indicated was that unplanned pregnancies do sometimes occur, even with the best laid plans. Of course, this specific instance – of the women in Sweden – is just one example for an app that is going global. There might be countless other examples out there, as suggested by reviews on the app store, of women who didn’t report to medical authorities that they were using the app, or of women who continued with their pregnancy. While the authenticity of the reviews is difficult to verify, some of the reviews say that the app was great for a week or two – until they got pregnant.

Either way, as Natasha Lomas at TechCrunch documented, the case is far from closed. While a PR firm acting on behalf of Natural Cycles said in a statement that individual reports had been closed by the Swedish MPA, the MPA asserted that the investigation was still very much on-going and that further research had to be carried out. It's unlikely that Natural Cycles will be taken off the market or even de-certified, but there may have to be more disclaimers added to the app about unwanted pregnancies, which could dilute its message. (Hot Cherry, the UK PR firm of Natural Cycles, was contacted for this article but had not responded at time of publication). 

At the end of the day, there’s a kernel of truth in what Berglund says: abstinence aside, it’s hard to find a 100 per cent success rate contraception. But through its rose-toned ads and perfect product placements, Natural Cycles paints a distinctive picture of what it offers. That picture is an illusion –  “digital contraceptives” may have their place, but they can't, and shouldn't replace traditional contraception.

Sanjana Varghese was previously a Wellcome scholar at the New Statesman. She writes about science and technology.