While politicians promote the “rhythm method” of birth control, studies indicate that younger women are practicing safe sex way less these days. And now, we have natural fertility apps to contend with.
In October alone, President Donald Trump has removed aspects of the Affordable Care Act that protect no-cost contraceptive coverage, and pledged his support for a House-supported federal 20-week abortion ban.
Last week, according to a White House memo leaked to Crooked Media, Trump participated in a meeting in which White House policymakers announced plans to cut federal funding for Title X — which helps provide family planning and prevention services for the economically disadvantaged — and instead, to the divert the funds toward “fertility awareness” methods of birth control.
Birth control via “natural family planning” might be a familiar concept to anyone who has participated in any form of religious-informed sexual education, in which condoms or other contraception aren’t allowed. Put simply, “fertility awareness-based contraception,” is also known as periodic abstinence by calendar a.k.a. the rhythm method.
It requires a woman to track her fertility daily, and it's one of the most ineffective contraceptive (and STI-prevention) options, according the Center for Disease Control. In fact, the CDC categorizes the approach as one of the most ineffective forms of reversible control.
24 percent of women using fertility awareness-based methods of contraception will experience an unintended pregnancy within the first year of typical use. And without coverage under the Affordable Care Act, other forms of contraception may already become prohibitively expensive for many women who rely on the ACA’s protection of their access.
Trump’s expressed support of fertility awareness-based methods, championed by Domestic Policy Council staffers Katy Talento and Alexandra Campau, could mean the future of women’s health is widespread unplanned pregnancy.
This doesn’t mean other contraceptive options are without their drawbacks, of course. Of the 45 million women who have ever used the pill, 30 percent discontinued use because of dissatisfaction, according to the CDC, with undesirable side effects being the most commonly cited reason for discontinuation.
So goes the modern dilemma for women and the forms of contraception available to them: Half a century after the pill was approved for contraceptive use, women are still dissatisfied with the options available to them.
And this is making way for some methods that have previously been relegated to the sidelines, including the Trump-backed rhythm method.
Enter the app generation
Enter Natural Cycles, a contraceptive app that launched in Sweden in August 2014. It has since captured more than 500,000 users in 161 countries, and used in tandem with Natural Cycles’ accompanying thermometer, it is the only app certified for the use as a contraceptive in the European Union.
One wouldn’t be remiss in assuming, however, that it’s certified in the US as well, considering targeted Instagram and Facebook ads marketing the app’s contraceptive status that appear stateside. (The Verge report that the app currently has its sights actively set on FDA certification, though timeline is uncertain.)
The question of marketing ethics aside, the “out of sight, out of mind” nature of Natural Cycles may also potentially mimic an unintended outcome of other low-intervention methods like IUDs (referred to as long-acting reversible contraceptives or LARCs). That is, a decrease in the use of condoms. Point in case:
A March 2016 study in the journal JAMA Pediatrics found that “high school girls using [LARCs] were 60 percent less likely to also be using a condom during sex than the girls who were taking oral contraceptives,” according to STAT’s summary of the report. “They were also more likely to have reported two or more recent sexual partners, which increases their risk for STDs and STIs.”
We can only infer what would happen should these same high school girls be handed a calendar and told to track their fertility using the rhythm method. As much as it’s a pain to have to take a pill every day, the act itself could be said to serve as a reminder of sorts — a way to keep safe sex front of mind.
Natural Cycles claims to be comparable to the birth control pill in terms of effectiveness, with a typical use efficacy rate of 93 percent, though the CDC places the rate of efficacy of “fertility awareness methods” at 76 percent.
In an email, Dr. Elina Berglund, co-founder of Natural Cycles,says the app’s average user is “29 years old and in a stable relationship. She has a pretty regular lifestyle, and is OK with starting the mornings with measuring her temperature. Her partner is willing to use condoms on red (fertile) days.”
Like all other forms of contraception (other than the condom), Natural Cycles does not protect against the spread of STIs, which makes the profile of an average user all the more logical.
But for politicians to proffer the rhythm method as a suggested norm, without the women’s health services to even back it up? That could be the most ludicrous choice of all.
This article was updated on November 1, 2017 to reflect an updated user base of the Natural Cycles app at 500,000 users.