FFor many women I know, contraception is a decades-long quest. The goal: not to get pregnant unless we want to. The tools: limited, imperfect and sometimes rejected by our uncooperative bodies.
I went on the pill, came off the pill, tried to get the IUD (and failed because my heart rate dropped during the procedure), and got an implant that looked like a short piece of spaghetti stuck into my arm, only only to have it taken out again after months of being in a fit of grief. It took the nurse twenty minutes to find it.
But in recent years, something seems to have changed. One might hope that a new, brilliant option has emerged, disrupting a landscape that has remained largely unchanged since the 1950s. But the reality seems to be largely the opposite.
A study based on figures from the UK’s Pregnancy Advisory Service (Bpas) this week points to an increase in the use of “fertility awareness-based methods” as opposed to hormone-based contraceptives – from 0.4% to 2.5% between 2018 and 2023 among women who came to Bpas for an abortion. Respondents were not asked about these methods in more detail, but the study authors note the increasing interest in fertility and menstrual tracking apps. In a survey Last year, 4% of respondents told Bpas that they used an app as their main method of contraception.
Indeed, these apps have attracted a lot of attention – and controversy – over the past decade. Founded in 2013, Natural Cycles was the first birth control app approved by the U.S. Food and Drug Administration, and claims a 93% success rate with typical use. Still, there have been stories of women becoming pregnant while using it, and in 2018 the Advertising Standards Agency ruled that using the phrase “high-precision contraceptive” in an ad was misleading. (Natural Cycles said the ad was immediately removed when the complaint was received.)
But while Bpas figures indicate an increase in their use, these methods represent only a small proportion of UK contraceptive choices. More striking in the latest study – and with much broader public health implications – is the complete decline in contraception. They report that 70% of those who sought abortion in the 2023 group did not use contraception, up from 56% in 2018. In Bpas’s The broader 2024 Contraception Survey found that more than a quarter of respondents were not using any major method of contraception.
Much of this trend appears to be a turn against hormonal methods, amid a rise in alternative health care and “wellness” culture. Nearly half of those surveyed by Bpas used oral contraceptives in 2013-2014; by 2022-2023 this had fallen to 27%. (From 2021, pharmacies would also be able to prescribe them, which is not included in the statistics – but this trend was clearly visible from 2017 onwards.) And while the dominance of Natural Cycle and other social media apps might imply that these methods are filling the gap , the numbers suggest a troubling alternative: that some women simply give up.
Wellbeing culture, suspicion around pharmaceutical companies and an aversion to ‘unnatural’ options may be partly to blame – after all, Natural Cycles is marketed as a natural, chemical-free alternative. Online communities allow women to share their stories of side effects – which could deter even those who don’t experience these problems themselves. Social media sites will foreground the most dramatic, compelling stories, rather than stories about birth control working just fine. This can understandably lead to frustration in the public health community, as hormonal contraception is safe and has been used for decades among large numbers of people. A 2021 study on hormonal contraceptive rejection reveals misinformation is part of the image.
But while some may have fallen prey to conspiracy theories, others will have spent years diligently trying option after option – from the mini-pill to the injection, the implant, the cap – waiting for the appointment, reading the pros and cons, looking for the right fit. When the implant was finally pulled out of my arm, I remember walking out into the rain with my arms throbbing and Googling what I could try next. More than eight in ten Bpas respondents have switched methods at least once. Social media is flooded with buzzy ads and user videos about apps and fertility tracking, but among many of the high-traffic videos is a story of someone getting pregnant – while others respond that it’s still the least worst option for them.
One creator on TikTok described her own negative experience with a fertility awareness app. “I learned from my mistake,” she said, blaming not the method or nature’s trick that led to two ovulations in one month, but herself.
What might it mean if more women gave up birth control? In terms of public health, it sounds very worrying. After all, the background to the latest figures is a slight increase in abortion rates, while others may have children at a time they do not want, at the expense of their career or family life. Meanwhile, abortion services in the United Kingdom are still active fragmentary and can be difficult to access. If anything, all this should show how urgently we need more options: the male pill, for example; or contragestantsa non-hormonal option undergoing clinical trials.
Bekki Burbidge of the Family Planning Association says women often worry about the side effects of hormonal contraception, and that “years of underfunding” have made it harder for people to try different options. “It can be a trial and error process, requiring a number of appointments,” she says. “The choice should not be between using a method you are not happy with or risking a pregnancy. That’s not good enough.”
For most (but not all), contraceptives are used by choice, not to address disease – and with the understanding that contraception can be used for a very long time. So it’s no surprise that each of us hopes to find a version that doesn’t make us sad, sick, or pregnant. That doesn’t seem like too much to ask.