Study finds rise in abortion patients using fertility tracking methods

A growing share of women who seek abortions were using period-tracking apps or other fertility awareness methods when they got pregnant, according to a new study from England and Wales.

Fertility awareness methods help women recognise bodily signs that indicate they are more likely to become pregnant, either through apps that track menstruation and ovulation or traditional strategies like the rhythm or calendar method.

Women may opt for these methods over other contraceptives – like birth control pills, intrauterine devices (IUDs), or implants – for several reasons, including religious objections and concerns about the side effects of hormonal contraceptives. 

Yet fertility awareness methods may not be as reliable as users believe, which could lead to a rise in unwanted pregnancies, according to the study, which was published in the journal BMJ Sexual & Reproductive Health.

UK researchers analysed which birth control methods were used by more than 88,500 abortion patients in England and Wales in 2018 and 2023.

They found a shift over time, with the use of hormonal contraceptives falling from about 19 per cent to 11 per cent and the use of fertility awareness methods rising from 0.4 per cent to 2.5 per cent.

The overall numbers were small: 129 women who sought abortions were using fertility tracking in 2018, compared with 1,364 in 2023.

Younger women drove the shift toward fertility awareness methods among patients who wound up seeking abortions, with their average age falling from about 30 to 27, the study found.

Meanwhile, the share who weren’t using any contraception when they got pregnant rose from 56 per cent to nearly 70 per cent over those five years.

Fertility awareness and no contraception at all “are the two methods that are more likely to fail, and therefore you’re more likely to require the services of an abortion clinic if you don’t want to keep that pregnancy,” Dr Rosie McNee, a public health registrar at the National Health Service (NHS) Forth Valley branch in Scotland and the study’s lead author, told Euronews Health.

Can fertility monitoring prevent pregnancy?

According to the UK NHS, fertility awareness methods are between 91 per cent and 99 per cent effective at preventing pregnancy if they are used correctly all the time – which is still less reliable than methods such as IUDs.

However, if the awareness methods are not followed with exact precision, their effectiveness falls to 76 per cent.

This means that over the course of a year, 24 per cent of women who rely on fertility tracking will get pregnant, the NHS said.

The findings come amid a surge in popularity for apps like Natural Cycles, Flo, and Clue, which track women’s menstrual cycles to help identify fertile windows.

While research suggests these apps can be more precise than traditional awareness methods, women’s health experts have warned that a lack of regulation for fertility apps can have negative consequences on family planning and health.

In 2018, for example, the UK’s advertising standards authority banned what it said was a misleading Facebook advertisement for Natural Cycles claiming the app was “highly accurate” and “provided a clinically tested alternative to other birth control methods”.

How are contraceptive trends changing?

Beyond these apps’ popularity online, McNee said women could be turning to fertility awareness methods after the pandemic because of a lack of access to hormonal birth control.

That could include backlogs at primary care clinics where patients could normally get contraceptives, or disruptions to teenagers’ reproductive health education.

“The big driving shift that we’ve seen was COVID,” she said, and “social media is one aspect of this”.

The study looked only at women who sought abortions, not all sexually active women. While McNee said the findings likely apply more broadly, she added that more research is needed on exactly how many women are opting for fertility awareness methods – and why.

Doctors, too, need to be aware that more women are using these tools, McNee said.

While they can counsel patients on the pros and cons of prescription contraceptives, women who use apps or ad hoc methods may not always have reliable information.

Healthcare conversations on birth control strategies should also include the possibility of abortion if the patient’s preferred method fails, McNee said.

It’s important to “get that information out so that people can weigh up the information and make their own choice about what method of contraception they want to use in a fact-based way,” she said.