Contraception technology isnt foolproof, but doctors must realise why we find the idea so appealing, says Guardian columnist Dawn Foster
Amid the targeted ads in my social media feeds, a war is playing out: two apps aggressively vie for my attention, stalking me from the sidebars of my browser and comprising every third photo in my Instagram feed one offering to track my ovulation and get me pregnant, the other offering to do the same, but promising I wont find myself in the family way.
The latter seems to be winning the war, with quirky gifs and videos showing young women waking up and gleefully taking their temperature, inputting digits into their colourful app, and being told they can throw barrier contraception to the wind that day. Its sold as being hyper-scientific, with the founders and developers formerly working at Cern, and without a single side-effect: unless, of course you count unintended pregnancy as a side-effect.
The novelist Olivia Sudjic, writing for the Guardian, revealed her shock at getting pregnant within months of starting to use the Natural Cycles app, and found many other women had too. In bare bones, the app is simply the Vatican-favoured rhythm method repackaged in shiny, Silicon Valley jargon and a slick interface. And the rhythm method doesnt have the greatest reputation as a diecast means of preventing pregnancy: the Catholic church recommend it for married couples both trying to plan and delay pregnancy, but with the very clear message that couples employing it should be open to the possibility of new life. Happy accidents can bring as much joy as planned babies as a Catholic, I back the churchs teaching that sex is about far more than pleasure, and also comes with responsibility and consequences for you and your family. I could use the app to try to avoid pregnancy but would have to accept pregnancy as a possible outcome of any bedroom antics.
But other women are perfectly entitled to want a contraceptive less prone to chance and failure, and deserve the truth about the app sold as super accurate. Its unreliable because our bodies are unreliable: fertility waxes and wanes with an assortment of biological factors, and tracking ovulation is never an exact science.
Its this fact that makes the marketing behind Natural Cycles so insidious: the science is pushed hard even though the founders are physicists, not gynaecologists. Id no more listen to a physicists advice on my fertility than I would let a mechanic cut my hair. To use the app correctly, women must record their temperature at the same time each morning, immediately upon waking, before sitting up . Many things can throw off the accuracy: oversleeping, having a fever, being hung over, insomnia, taking your temperature shortly after waking, irregular periods and polycystic ovary syndrome. According to these criteria I couldnt have recorded a single day accurately in the last week Ive had heat-induced insomnia, slept late, woken early, had a mild hangover, and woke one morning with a slight fever. Trying to remember all of these conditions, when the apps marketing tells you it is reliable, gives some clue as to the reason why so many women are unhappy.
But its not surprising that promises of natural birth control are so alluring. The side-effects of most forms of contraception are maddening. Friends on the pill have had their weight explode, their mental health suffer, and their skin return to teenage form, with migraines drastically worsened by daily hormones. My experiences with doctors echo those of most of myfemale friends with dysmennorrhea, endometriosis and polycystic ovary syndrome: for years my complaints were dismissed as though I werecomplaining about a mild discomfort. Only when my periods lasted three weeks out of four, I was seriously anaemic from blood loss and repeatedly lost consciousness with pain was I granted a referral to a specialist that led to an operation and a diagnosis of adenomyosis, a severe form of endometriosis. One GP told me the contraceptive implant Id had in my arm for three years had been rendered useless by the epilepsy medication I took every day.
The backlash against birth control apps is growing. Yet, women do need more readily available information about their own fertility, as well as about the side-effects of the contraceptives they are prescribed. Technology appeals because the medical profession too often dismisses and fails women, and has ignored the concerns of many women disenchanted with the side-effects of hormonal contraception. No wonder Silicon Valley steps in, seemingly offering a natural and smart solution that looks and is too good to be true.
But doctors should ask why so many women would consider trusting an app over a medical professional, and researchers should look at why so many people are unhappy with the prescribed pills, injections and implants, and work to improve them. All of us emerged blinking into the light from a uterus: fertility should be taken more seriously, and women should be trusted when reporting symptoms and anxieties, rather than be treated as unreliable witnesses and hysterics.