Women in England and Wales are increasingly ditching the pill in favour of fertility-tracking apps, raising the risk of a rise in unplanned pregnancies, a study suggests.
Researchers concluded there had been a shift in attitudes towards contraception in the last five years, from “more reliable” hormonal options, such as the pill and the 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 to a rise in abortion rates, with wider implications for healthcare services, researchers concluded.
More women are using smartphone apps to track menstrual cycles or symptoms of ovulation. The aim of the apps is to help to estimate a woman’s fertile window, with women avoiding sex on those days to prevent pregnancy.
The researchers said “fertility awareness-based methods”, which are 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 every 100 women in the first year of use, compared with seven in 100 women for the pill or implants and fewer than one in 100 for the coil, they added.
“While the rise in abortion rates is multifactorial, one aspect that needs scrutiny is any change in contraceptive use, and particularly this surge in the use of e-health, including fertility apps, period-tracker apps, and natural family-planning apps,” experts at the University of Edinburgh said.
In the new study, published in the journal BMJ Sexual & Reproductive Health, researchers examined data from the British Pregnancy Advisory Service (Bpas) to explore which methods of contraception women who requested abortions in England and Wales were using at the time they fell pregnant.
Two periods of time were compared: January to June 2018, which included 33,495 women, and January to June 2023, which included 55,055 women.
Reported use of fertility awareness-based methods at the time of conception increased 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.
Women taking hormonal contraceptives such as the pill, the mini pill, patches and vaginal rings declined from 18.8% in 2018 to 11.3% in 2023.
Use of the contraceptive implant – a small rod placed under the skin which releases a hormone to stop the ovaries releasing an egg each month – fell from 3% to 0.6% over the period.
Those who reported using no form of contraception when they became pregnant increased from 56% in 2018 to 70% in 2023.
This was an observational study, so conclusions cannot be drawn about cause and effect. The researchers also acknowledged that abortion patients may not reflect the sexually active population in general.
They also said precise fertility awareness methods used were not recorded, so the rise in the use of smartphone app technologies in particular could only be assumed.
However, they concluded that the findings showed a “shift in contraception use from more reliable hormonal methods of contraception to less reliable fertility awareness-based methods of contraception among abortion patients”.
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They added: “There appears to have been a significant increase in the proportion of individuals attending Bpas for abortion who use fertility awareness-based methods as a form of contraception and are using no method of contraception.
“This may be a result of preference or it may be related to difficulties with access to more effective methods of contraception in the preconception and post-abortion periods.”
The study also found that the proportion of women who were seven weeks pregnant or under when they requested an abortion from Bpas services rose to 59.4% in 2023 compared with 35.6% in 2018.
Dr Patricia Lohr, director of research and innovation at Bpas, said: “This study of abortion patients showed a rise in the use of fertility awareness-based methods and a decline in hormonal contraception. This may indicate women are making different contraceptive choices or can’t get the methods they want.”
A separate Bpas survey of the general population found nearly half of women (49%) face barriers to accessing contraception, Lohr said.
“In this context, abortion remains a vital option, whether as a back-up when contraception fails or as an alternative when contraception is unavailable or unsuitable.”
She added: “At the same time, it’s vital to push for modern, innovative contraceptive methods that fit seamlessly into women’s lives and address concerns about side effects.
“Women deserve a full range of options that meet their needs without compromise.”