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5 hours ago
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For many women I know, contraception is a kind of decades-long quest. The goal: to not get pregnant unless we want to. The tools: limited, imperfect and, sometimes, rejected by our uncooperative bodies.
I have gone on the pill, come off the pill, tried to get the coil (and failed, thanks to my heart rate dropping during the procedure), and had an implant that looked like a short piece of spaghetti poked into my arm, only to have it taken out again after spending months in a fug of sadness. It took the nurse 20 minutes to find it.
But in recent years, something seems to have shifted. You might hope some new, brilliant option has emerged, disrupting a landscape largely unchanged since the 1950s. But the reality seems to be broadly the opposite.
A study based on figures from the British Pregnancy Advisory Service (Bpas) has this week gestured to a rise 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 seeking an abortion. The respondents weren’t asked about these methods in more detail, but the study’s authors point to rising interest in fertility and period-tracking apps. In a survey last year, 4% of respondents told Bpas they were using an app as their main method of contraception.
In the past decade, these apps have indeed attracted a lot of attention – and controversy. Natural Cycles, founded in 2013, was the first contraceptive app to be approved by the US’s Food and Drug Administration, and it claims a 93% success rate with typical use. Yet there have been stories of women getting pregnant while using it, and in 2018 the Advertising Standards Agency ruled that its use of the phrase “highly accurate contraceptive” in an advert was misleading. (Natural Cycles said the ad was immediately removed when the complaint was received.)
But while Bpas’s figures suggest a rise in their use, these methods only account for a tiny fraction of British contraceptive choices. More striking in the latest study – and with far wider public health consequences – is the decline of contraception full stop. They report that 70% of those seeking abortions in the 2023 group were on no contraception, up from 56% in 2018. In Bpas’s wider 2024 survey on contraception, more than a quarter of respondents were using no main method of contraception.
A big part of this trend seems to be a turn against hormonal methods amid a rise in alternative healthcare and “wellness” culture. Almost half of those surveyed by Bpas were on oral contraceptives in 2013-14; by 2022-23, that had collapsed to 27%. (From 2021, pharmacies could also prescribe them, which is not included in the statistics – but this trend was evident from 2017 onwards.) And while the dominance of Natural Cycle and other apps on social media might imply these methods are filling the gap, the figures suggest a disturbing alternative: that some women are simply giving up.
Wellness culture, suspicion around pharmaceutical companies and a distaste for “unnatural” options may be partly to blame – Natural Cycles is, after all, marketed as a natural, chemical-free alternative. Online communities allow women to share their stories of side effects – which could put off even those not experiencing those problems themselves. Social media sites will forefront the most dramatic, engaging tales, rather than stories of contraception working fine. This can understandably lead to frustration in the public health circle, as hormonal contraception is safe, and has been used for decades among huge numbers of people. As a 2021 review into the rejection of hormonal contraception found, misinformation forms part of the picture.
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, implant, cap – waiting for the appointment, reading up on the pros and cons, looking for the right fit. With the implant finally yanked from my arm, I remember walking out into the rain, arm throbbing, Googling what I could try next. More than eight in 10 of Bpas’s respondents had switched methods at least once. Social media are awash with buzzy adverts and user videos about apps and fertility tracking, but under many of the high-traffic videos is a story of someone getting pregnant – with others responding that it’s still the least worst option for them.
One creator on TikTok described her own negative experience of a fertility-awareness app. “I have learned from my mistake,” she said, blaming not the method, or the trick of nature that led to two ovulations in one month, but herself.
What could it mean for more women to abandon contraception? In public health terms, it sounds deeply concerning. The backdrop to the latest figures, after all, is a slight uptick in abortion rates, while others may be having children at a time not of their choosing, at a cost to their career or family life. Meanwhile, abortion services across the UK are still patchy and can be difficult to access. If nothing else, all this should show how urgently we need more options: the male pill, for example; or contragestives, a nonhormonal option going through clinical trials.
Bekki Burbidge, from the Family Planning Association, says that women often have worries 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 process of trial and error, which means a number of appointments are needed,” she says. “The choice shouldn’t be between using a method you’re unhappy with or risking pregnancy. That’s not good enough.”
For most (but not all), contraceptives are taken by choice, not to tackle disease – and on the understanding that contraception could be used for a very long time. So it’s no surprise that each of us would hope to find a version that doesn’t make us sad, sick or pregnant. That doesn’t seem like too much to ask.
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Barbara Speed is the deputy head of Guardian Opinion
