Digital Contraception A Revolutionary Invention

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Female biology may not be rocket science, but keeping track of menstrual calendars is not always the easiest thing either. Raise your hand if you agree with me, or so asked the tech world before plunging itself headlong into a field now termed ‘femtech’. Femtech, in simpler words, is an assertion that the female reproductive system is often a complex, moody thing and technological assistance can go a long way in helping us understand it.

Consider exhibit A – a paid mobile application called Natural Cycles. Developed by a former CERN physicist Elina Berglund, it claims to be “highly accurate” when it comes to preventing pregnancies. App stores are flooded with several apps of this kind which track a woman’s reproductive cycle, helping them understand when they are most fertile and otherwise, to map their sexual activity accordingly. All of them together form the realm of digital contraception.

Yes, contraception is no longer limited to a pill or an external tool, but now apparently is also constituted by technology. Why I specifically mention Natural Cycles is because it is approved by the US Food and Drug Administration (FDA). It is also the only app of its kind which is certified as contraception, according to The Guardian. Earlier this year, the app was in news because several women who had been using it found themselves in that one situation they were using it to avoid – pregnancy. The international backlash against Natural Cycles took the form of medical investigation in Sweden, and a general questioning of this whole idea of femtech, an industry expecting to be a 50 billion-dollar-industry by 2025, according to this report.

How ‘Natural Cycles’ Works?

The app has a user manual available in 13 different languages. But if you’re not feeling up for going through it, here’s how it works. Every morning when you wake up, you have to enter your body temperature first thing. Along with this, you also have to regularly enter your menstrual cycle details. Based on this, the app figures out which are your most fertile days, and marks them in red, which means the chance of pregnancy is extremely high during those days.

Other days are marked in green, suggesting that you can go ahead and have unprotected sex around that time. However, the fine print of the Natural Cycles mentions that it’s accurate for only up to a 93 percent. What happens to the remaining 7 percent? You guessed it right – pregnancy. But we’ll come back to that bit later.

There is also no protection from STDs and STIs when you use Natural Cycles (or any other app of this kind). Again, this is mentioned on the site, but it’s not hard to miss in the novelty of digital contraception or an app that promises to take you off the pill. In addition to all this, there is also a questionnaire you’ve to answer before your subscription. It’s made up of questions about your body’s sexual and reproductive health and asks for a time period of a few cycles before being able to assess you in its entirety.

Menstrual cycle

You’re most likely to get pregnant a day or two before you begin to ovulate. There is actually a six day window right before ovulation, along with the ovulation day itself, which offers a good chance of pregnancy. That is not to say women can’t get pregnant otherwise. Women can get pregnant even during their period. But the timeline around ovulation is your most likely window.

The first day of your menstruation is also the first day of your menstrual cycle. The last day is the last day before the next period. Ovulation happens 14 days before your next period if you have an average 28-day cycle. However, it varies from person to person, even for women with regular menstrual cycles.

The chances of pregnancy increases by 27-33 percent in the three days leading to ovulation and decline rapidly immediately after, according to Fertility Coalition, Australia. “For many women, who have a 28-30-day cycle, the fertile period starts from the 10th day from the first day of their periods.” – Dr Monika Wadhawan, Senior Consultant, Department of Obstetrics and Gyneacology, Fortis Hospital Noida

What’s Wrong?

In January 2018, a major Swedish hospital concluded that out of the 668 abortions that took place between September and December 2017, 37 were women who had been using Natural Cycles. Following this, the Medical Products Agency of Sweden began its investigation and said that the failure rate of the app was consistent with the claims the app. They claim their failure rate to be around 6.9 percent. This roughly means that 7 out of every 100 women who use the app will get pregnant.

Along with this formal investigation, several women have come forward to talk about how the app failed them, and the toll an unplanned pregnancy took on their lives. Other than these general guidelines, the particular problem with apps like Natural Cycles and other period trackers used by women globally and posit themselves as digital contraception, overlook the fact that the consumer might not always be using the app correctly. They also do not account for women with unpredictable menstrual cycles and problems of the reproductive system.

Beyond digital contraception

Beyond digital contraception, femtech is a thriving field currently made up of about 200 startups worldwide, with several of them headed by women CEOs. Woman developers are also looking at it as a source of fighting the lack of women in similar fields, as well as taboo and stigma around issues of women’s health. While it may hold great promise, it’s also important to remember that no contraception guarantees 100 percent safety. While you can rely on age-old, tried and trusted methods of contraception, but at the end of the day, it is the female body and its internal processes which are the boss. So, don’t fall for everything you read online and always consult a doctor before trying health apps.

Is it effective?

In August this year, the US Food and Drug Administration gave the green light for a controversial mobile app to market itself as a form of digital contraception. The app, named Natural Cycles, uses an algorithm that prompts you to enter the date your period starts and record daily temperatures every morning before getting out of bed. It will tell you the ‘green’ days when you aren’t fertile, and ‘red’ days when you are fertile. You can have unprotected sex on green days, and abstain on red days. Or use additional contraception on the red days, like condoms or the emergency pill.

The creators of the app are marketing it as a contraceptive, but is it really? Clearly, it will come as a relief for those who detest pills, devices, sheaths, and all other traditional contraceptives. It is yet another algorithmic application geared towards women’s health, or ‘femtech’ in digital jargon. The app is based on what has always been labelled as ‘natural family planning’. A digital contraceptive immediately appeals to many. For starters, you can avoid synthetic hormones, and their sometimes unpleasant side effects.

Those who dislike contraceptive devices, like coils, also have an extra option. The app also helps you understand your body, by tracking your menstrual cycle and relating this to reproductive biology. In addition, the app is equally appealing to those trying to conceive. It will alert you on the most fertile period when conception is most likely, paving the way for timed intercourse. But there are concerns about the app’s ability to prevent unwanted pregnancies, when compared to modern highly effective contraceptives.

Preliminary data from early users appear to show disproportionately higher numbers of unintended pregnancies. Well, this is inherent in the way the app works, and how you respond to its prompts and alerts. Those with irregular menstrual cycles should use the app with caution. If there’s an absolute medical reason to avoid pregnancy at all costs, other long term effective contraceptives should be used instead.

Many people think of contraception as a tangible object. It can now be viewed differently, and blended into an increasingly digitised world.

Some have raised concerns about replacing proven and effective contraceptives with an app, and how that may eventually translate into increasng failure rates. But there is the desirable advantage of choice for women. Those highly attracted to digital devices, and bent on trying a different approach to their reproductive control, will find the app pretty appealing. If interested in digital contraception, all you need is to go online and download the app. You will need a period of familiarising yourself with the app, and get used to entering data and interpret prompts and alerts. The app will quickly learn your cycle over a few months, and automatically give you accurate predictions each day. Remember the app is an aid to being in control of your reproduction, it doesn’t prevent sexually transmitted infections.

Conclusion

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.

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.

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