‘Can’t you spend your time better?’, Ellen Algera heard from a GP while she was there PhD research. She looked at the growing popularity of apps that women use to track their fertile days and thus prevent pregnancy – hormone-free. The GP felt that patients were easily misled by what he saw
“Yet more and more people are using this technology in everyday life,” says Algera, now a postdoctoral researcher at Erasmus MC. Expertise center Rutgers received “signals from the field” about the increasing popularity of ‘natural’ contraceptive methods and investigated their use for the first time in early 2024. of women between the ages of 18 and 29 keep track of their fertile days with, for example, an app or ‘normal’ calendar. Only during the expected fertile days do they avoid sex or use a condom. Main reason: they don’t want hormonal contraception.
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in and the app predicts your fertile days. “They are not intended as a , but for cycle tracking,” says Algera. The most reliable fertile days method is the so-called symptothermal method. With this method, someone learns to interpret cycle patterns, such as body temperature and secretion, during a course, often together with their partner. act.” Concerns about those errors are widely shared. At the end of 2023, the Medicines Evaluation Board warned against incorrect information about contraception on social media.
Algera wanted to investigate how and why women use the apps as a contraceptive. She also looked at how healthcare professionals deal with the increasing popularity of these methods.
For her, she collected interview and diary data from the fertile days apps and spoke to general practitioners, observed contraceptive care in the consultation room and studied guidelines for contraception.
Through Facebook groups of people using such methods, Algera found herself in an online community around what she has come to call “self-tracking technologies for contraception.”
Self-care
Algera knew the need for a method without hormones from her own experience, she says via video connection. She already used an app before her. In her case, ‘self-tracking’ consisted of meticulously collecting physical data such as cycle length, temperature and changing secretions. Based on this data, Algera determined on which days the chance of fertilization is high. It became a daily activity, from the moment she woke up and immediately took her temperature.
Through Facebook groups of people who use such methods, Algera ended up in an online community around what she has come to call “self-tracking technologies for contraception.”
Ellen Algera
Photo Suzanne Blanchard
By keeping track of data on a daily basis, people collect biomedical data about themselves. “That is also knowledge,” says Algera. “Not scientifically, but .” According to her, this knowledge helps people to better understand their bodies. In her PhD research she saw tensions between what is medically recognized and what app users do and experience.
“For healthcare providers, safety is always the starting point,” she says. Doctors mainly want to minimize risks, such as unwanted pregnancy, infections or side effects. According to Algera, this is logical and essential. “Minimizing risks is part of their job.” But while doctors mainly look at what can go wrong, users look at what works for them.
‘Fearmongering’
what suits someone’s life, preferences and situation, Algera concludes in her research. In practice, when choosing between the pill, condom or IUD, for example, she saw that things usually come together. But as soon as the conversation turned to fertile days methods and apps, it disappeared into the consulting room. “Then it was actually only about risks, and never about the question: who could this suit, or how can we help people for whom this suits?”
People don’t stop using these methods by warning them even louder
She also noticed resistance in her conversations with healthcare providers when it came to patients who explicitly did not want hormones. About ‘pill fatigue’ and ‘scaremongering’ and especially wanted to emphasize that hormones are safe. “The idea that someone doesn’t want hormones because it doesn’t suit them was hardly seen as a legitimate preference,” says Algera. “Then adjusting to preferences became very difficult.”
But how reliable are such natural methods really? Algera explains that it depends on the approach and how carefully it is applied. Methods that only use the calendar are less reliable than methods that also include temperature measurements and mucus observation. How carefully someone follows the method also counts.
“Fortunately, I notice that from the mainstream,” says Algera. She sees that there is slowly becoming more awareness that these apps will not just disappear. “We can therefore take a closer look: how can we help people? People do not stop using these methods by warning them even louder.”
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