Reliance on fertility apps is increasing in England and Wales, research shows

Women in England and Wales are increasingly ditching the pill in favor of fertility tracking apps, raising the risk of an increase in unplanned pregnancies, a study suggests.

Researchers concluded that over the past five years there has been a shift in attitudes towards contraception, from ‘more reliable’ hormonal options, such as the pill and implant, to ‘fertility awareness-based methods’.

While further research was needed to understand the reasons behind the change, the trend away from hormonal contraception corresponded with a rise in abortion rates, with broader health care implications, researchers concluded.

More and more women are using smartphone apps to track menstrual cycles or ovulation symptoms. The purpose of the apps is to help estimate a woman’s fertile window, with women avoiding sex on those days to prevent pregnancy.

The researchers said “fertility awareness-based methods”, often promoted on social media, could be less reliable, with the potential to “increase unintended pregnancies”.

The typical failure rate for these methods ranges from two to 23 in 100 women in the first year of use, compared with seven in 100 women for the pill or implants and less than one in 100 for the IUD, she added.

“Although the increase in abortions is multifactorial, one aspect that needs to be closely examined is any change in the use of contraceptives, and in particular this increase in the use of e-health, including fertility apps, menstrual tracking apps and natural family planning apps. This is what experts from the University of Edinburgh say.

In the new study published in the journal BMJ Sexual & Reproductive Health, researchers examined data from the British Pregnancy Advisory Service (Bpas) to investigate what contraceptive methods women seeking abortions in England and Wales were using at the time they became pregnant.

Two periods were compared: January to June 2018, with 33,495 women, and January to June 2023, with 55,055 women.

The reported use of fertility awareness-based methods at the time of conception rose from 0.4% in 2018 to 2.5% in 2023. The average age of women using these methods fell from almost 30 to 27, analysis showed.

The number of women using hormonal contraceptives, such as the pill, mini-pill, patches and vaginal rings, fell from 18.8% in 2018 to 11.3% in 2023.

The use of the contraceptive implant – a small rod placed under the skin that releases a hormone to prevent the ovaries from releasing an egg every month – fell from 3% to 0.6% during that period.

Those who reported not using any form of contraception when they became pregnant increased from 56% in 2018 to 70% in 2023.

This was an observational study, so no conclusions can be drawn about cause and effect. The researchers also acknowledged that abortion patients may not reflect the sexually active population at large.

They also said that the precise methods used for fertility awareness are not recorded, so the increase in the use of smartphone app technologies in particular can only be assumed.

However, they concluded that the findings showed a “shift in contraceptive use from more reliable hormonal contraceptive methods to less reliable fertility awareness-based contraceptive methods among abortion patients.”

They added: “There appears to have been a significant increase in the number of individuals attending a Bpas for abortion who are using fertility awareness-based methods as a form of contraception and not using a contraceptive method.

“This may be a result of preference or it may be related to problems with access to more effective contraceptive methods in the preconception and post-abortion periods.”

The research also found that the percentage of women who were seven weeks pregnant or younger when they requested an abortion at Bpas services increased to 59.4% in 2023, compared to 35.6% in 2018.

Dr. Patricia Lohr, director of research and innovation at Bpas, said: “This study among abortion patients showed an increase in the use of fertility awareness-based methods and a decrease in hormonal contraception. This may indicate that women are making different contraceptive choices or cannot get the methods they want.”

A separate Bpas survey of the general population found that nearly half of women (49%) face barriers to accessing contraception, Lohr said.

“In this context, abortion remains a crucial option, either as a backup when contraception fails or as an alternative when contraception is unavailable or inappropriate.”

She added: “At the same time, it is crucial to strive for modern, innovative contraceptive methods that fit seamlessly into women’s lives and eliminate concerns about side effects.

“Women deserve a full range of options that meet their needs without compromise.”