Are Women Ditching Birth Control for Fertility Awareness?

Episode 597

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-M -L -I -V -E. This is the Fertility Friday podcast, episode number 597.
In today’s episode, I’m tackling a really interesting and important question.
So the topic of Today’s episode is our women ditching birth control for fertility
awareness. And so in this brand new episode of our FAMM research series, we are
diving into a study that was conducted in the UK. And the title of the study is
self -reported contraceptive method use at conception among patients presenting for
abortion in England, a cross -sectional analysis comparing 2018 and 2023.
So this study is really interesting. We’re going to dive into the different points
of it. I’m really excited to dive into it. I have a really interesting perspective
on it, and I think so to the researchers, but unsurprisingly, they don’t necessarily
match my opinion to their opinion. So let’s go ahead and dive into the data.
So as I’ve been covering on the podcast,
contraceptive methods in favor of fertility awareness -based methods. And of course,
they are often presenting this as due to social media. So I’ll give you a quote
from the study that they have kind of in their overview just to set the stage. So
quote, largely anecdotal and some qualitative data suggests that younger women are
turning towards more natural methods of contraception, including withdrawal and the use
of mobile phone apps, so -called period tracker apps, to facilitate use of the
calendar method and track fertility, hereafter, refer to as fertility awareness -based
methods, end quote. So basically, I mean, already they kind of have my antenna up,
because already they are doing the thing that I always talk about them doing. So if
you were to basically include
view of the effectiveness of the actual condom? Well, I would argue no. And so
right off the bat, they’re telling you that anybody who says they have a period app
is using a, quote, fertility awareness -based method, and they’re including that in
their analysis. And that is intellectually dishonest and just completely ridiculous if
you actually know what fertility awareness -based methods are. So first and most, no
surprise to anybody, I’m going to start with the premise that a true fertility
awareness -based method is separate from someone who just tracks their period and has
no idea about what’s going on. You can hardly call that a method, but this is
literally how they’re starting the study. So we’ll continue. Let’s talk a little bit
about the study and how they designed it and what it was all about. So basically,
what they did is they have, I’ll read here, just this first sentence here, British
Pregnancy Advisory Service, BPAS, is an independent health care charity that provides
medical and surgical abortion through a network of clinics and telemedicine hubs in
England and Wales. So this is their organization that they’re looking at,
and what they did essentially is have the nurses, midwives, who are working in this
facility, conduct interviews with women who are seeking termination of their pregnancy,
and they are asking them what types of birth control they were using and recording
them. So this study is a cross -sectional comparative analysis, and what they did is
they compared a period of time in 2018 for women seeking termination,
medical termination, from January to June 2018, and then they had another group of
women from January to June of 2023. And what they said in the study was that they
wanted to kind of eliminate some of the issues around the COVID situation.
So they wanted to have a population kind of before that and a population after
that. So they could compare these two groups and see what the trends were. They
didn’t want their results to be confounded by all the challenges related to that
period of time that we all kind of know about. All right. So that kind of sets
the stage. And then their findings are pretty interesting. So what they found and
they grouped the different methods that were reported by these women who were seeking
out these services. So they grouped them into fertility awareness methods,
hormonal contraceptives. But, you know, if someone was using a long -acting reversible
contraceptive if someone was using like an IUD or like an implant, then that was in
a separate category. So all hormonal methods weren’t necessarily together. So primarily
the hormonal contraceptives might be like the pill, the patch, that kind of thing.
And then they had users that had no method and then they had users that reported
other methods. And in other methods, they included things like condoms and they
included vasectomy sterilization, they didn’t clarify if withdrawal was included in
other methods. They just said that withdrawal was not included in the fertility
awareness -based methods. And as I previously mentioned, anybody who said they have
used an app is included in this. So what they found was that there was a
significant, statistically significant increase in users who’ve reported that they used
basically period apps or as they term fertility awareness -based methods, but we don’t
really have a clear breakdown into like what percentage of these women just track
their periods versus which percentage of these women used a symptomothermal method
that they were trained from an instructor, right? So we don’t have that information.
Anybody who used a period tracker would have been put in this category and
therefore, you know, that’s that’s and they’re calling not FABMs. So there was an
increase in 2018. So in 2018, 0 .4%. So less than 1 % of users said that they were
using period tracker apps or other FABMs. And in 2023, 2 .5 % reported that they
used period tracker apps or FABMs. So this represents a 525 % increase,
which obviously is significant, like 525 % increase. But as I mentioned,
the actual total volume of women who were using these methods, it went from less
than 1%, 0 .4 % to 2 .5%. So that means 97 .5 % of the women who are reporting to
get this procedure who had an unintended pregnancy were not using charting apps or
fertility or in space methods. Okay, so I’m going to continue. So the study also
found that the use of hormonal contraceptives decreased. And as I mentioned, they
exclude some of the longer acting, like the IUD placement or implant.
But the use of hormonal contraceptives decreased. So in 2018, about 19 % of their
patients reported that they were using hormonal contraceptives. And in 2023, about 11
% were using. So there was a 40 % decrease in the number of women reporting for
medical termination who used contraceptives. So they did see a pretty significant
decline in women who were using hormonal contraceptives. And then the long -acting
contraceptives, there was an 80 % decline. Now, if someone has an IUD placed or if
somebody has an implant, obviously those methods statistically have a lot higher of
an efficacy rate and a far lower user error margin. Because if you get an IUD
placed or an implant put in, like, you can’t really mess it up. You’re solely based
on the effectiveness of the actual method. So it’s not surprising. So in 2018, 3 %
of the women seeking termination reported that they used these long acting methods.
And then in 2020,
using no contraception at all. And then in 2023, 70 % of users,
women who had an unintended pregnancy and were asking for this procedure, 70 % used
no contraception. So there was a 25, approximately 25 % increase in the number of
women who were seeking termination because they were not using a contraceptive method
at all. So before I get into just talking a little bit about the data and what
they found, I just want to share with you from their perspective, how they presented
this. So they’re really heavily focusing on FAPMs.
This is what I find so interesting. I just finished saying that in 2023, 70 % of
the women who were seeking termination were using no method at all. Yet they found
the most significant piece of information to discuss the 2 .5 % of women in 23 who
reported using period tracker app so that they can throw FABMs under the bus because
they didn’t even assess the different types of methods and look at how many of
those women were actually using a specific method and potentially using it correctly.
So I think there’s that. And so they’re focusing on, oh my goodness, there was this
drop in the percentage of women who were using contraceptives, who reported that they
were using hormonal contraceptives. There was a drop in the women who reported using
these long acting methods. And of course, they’re looking at the increase in the
number of women who were using no method. And they’re kind of saying, well, there’s
this trend on social media for people to be using more natural methods. And so
they’re kind of like pretending like that’s the problem, I guess, because I think
it’s so interesting. If you have results like this and you see that 70 % of the
women seeking termination in 23, based on your study, had reported the use of no
method at all, then how are we hyper -focused on the fact that 2 .5 % used a period
tracker app. I would argue that a woman who uses a period tracker app is not using
birth control if she’s having unprotected sex. That would be my argument. So my
argument would be that could just go right in with the non -users. And if somebody
actually isn’t using a specific charting method, that they shouldn’t be included. So
their focus of this paper is that this is the real problem. The real problem is
that these women are hearing about these natural ineffective, according to them,
methods of birth control, and they’re turning away from more effective hormonal
contraceptive methods. And so this is the real problem. The real problem is that all
these women should be on hormonal contraceptives. And if all of them were on
contraceptives, we would have
Now, there may be, that may be a valid point. I mean, that’s certainly a
perspective that we could look at. But I think there’s a couple things that we want
to talk about. So I definitely wanted to kind of share how they presented it. So I
just want to read a quote from their conclusion. And then we’ll get into it a
little bit more. So, quote, there appears to have been a significant increase in the
proportion of individuals attending this abortion clinic who used FABM,
again, fertility awareness -based methods, that’s what they’re calling women who are
using period tracker apps as a form of contraception and are using no method of
contraception. So they’re saying like there’s an increase of women who are reporting
FABMs and no method. 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 research needs to be undertaken to
investigate this hypothesis.
So yeah, like I said, I think there’s a couple things we should be looking at. I
already mentioned, I feel like the bigger issue, to me at least, seems that there’s
such a high percentage of women reporting that they’re using no method of birth
control. And obviously, what happens if you use no method of birth control? Research
tells us over and over again that 80 % of healthy individuals who have sex for a
year are going to get pregnant if they don’t use any type of contraception. And so
that seems to be a big challenge.
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and there was one quote in the study that I thought was really interesting and the
reason I thought it was interesting is because if you really are being honest you
can’t get away from the actual data that is related to FABMs so while they’re
saying that FABMs have a high failure rate they acknowledge in their kind of
introductory summary section of the paper. They said, however, greater use of less
effective methods could lead to a higher rate of unintended pregnancy and demand for
abortion. And they say the typical use failure rate for FABM ranges from 2 to 23
in 100 in the first year of use compared with 7 in 100 for combined hormonal
methods, and it’s less than one in a hundred for uterine, intra -uterine, like IUTs.
And so, again, one of the significant criticisms I’ve had on studies that are
looking at FABMs is that you really have to look at what they’re including. So when
we’re looking at 23 % failure rates, they’re often including these period tracker apps
that are so -called programmed with algorithms that are telling women when they’re
fertile window is. And so those calendar rhythm style options don’t fit under the
definition of modern FABMs, especially because it’s not evidence based. There’s not
really evidence on a period tracker app. There’s evidence on certain apps, few and
far between, but even those apps have been shown to, like, it’s an algorithm. So
there are issues with these algorithms. So what’s interesting, though, is that they
say, like, the typical use failure ranges from 2 to 23. And so that means that
there are fertility -witness -based methods that are effective, even with typical use,
compared to 7 in 100 for combined hormonal methods. So even that, a lot of people
don’t realize that hormonal contraceptives have a failure rate and that typical use
is not 99%. So with Combined oral contraceptives,
that means that they’re not 100 % effective or they’re not 99 % effective with
typical use. They’re, according to their data, 93 % effective, which is not 100.
And so therefore, if someone’s using hormonal contraceptives, combined contraceptives, I
mean typical use. So not like perfectly, but typical use, there will be some
unintended pregnancies. So I think that part is interesting because they actually do
acknowledge when you look at the data, they have to acknowledge that there’s this
range. And the question for me is like, well, if you’re looking at that range, why
aren’t you questioning why some methods are 2 % with typically use compared to the 7
% with typically use for hormonal contraceptives and some methods are the 23 %? Why
are we not kind of looking at that and identifying that as an issue? So Ultimately,
they’re looking at this situation, and instead of focusing on the 70 % of women who
are experiencing these unintended pregnancies and ending up in their clinics, they’re
tackling the 2 .5 % of women who are using the charting apps and saying, that’s the
real problem here. So there’s that. And ironically, if you have 70 % of women who
are using no method, they could benefit from using fertility, where to space methods,
even with their loose definition. Because according to their loose definition, there’s
a 23 % failure rate with these charting apps. And so wouldn’t that be better than
the 80 % failure rate of not using any method? So I think that there’s just
different ways of looking at this. But the first point that I’m making here is like
they’re not addressing the larger problem. So obviously, I’ve highlighted extensively
that app users
that fertility awareness -based methods, all of them are totally ineffective. All of
them are the same as calendar rhythm. And therefore, no one should use them. And I
think that is unfortunate because it’s really pushing this idea as opposed to looking
at the data and really investigating it. So they’re not, they’re misdiagnosing, as
far as I’m concerned, the real issue here. And they’re looking at this problem in a
certain way. The other thing I want to point out is that by definition,
they are looking at a population of women whose method failed them. They’re looking
at a population of women who are likely either not using a method at all, 70 % in
2023, or potentially using their methods inconsistently or incorrectly. So they’re also
looking at a specific population who has all had unintended pregnancies.
And so you’re not really looking at a general broad population of women overall.
You’re looking specifically at the individuals who had an unintended pregnancy or
otherwise, like a method failure. And interestingly, when you look at the data, most
failures are user -related, not necessarily method -related. And so, again,
it’s interesting. And that gets into like the typical use and all of those kinds of
things. But, I mean, even when we look at failure rates, like typical use versus
perfect use for the condom, for example, I even had an interesting conversation with,
I was interviewed on a podcast and the woman who interviewed me was in her 20s.
She was in her late 20s. And we were having this conversation. And I shared with
her one of the observations that I’ve made as someone now who’s in their 40s. So
in my generation, The sex education, so some of you will remember this and relate
to this, the sex education in my generation was like, if you have sex, you’ll get
AIDS and die. And so therefore, you should use condoms all the time. And they
really stressed STIs, and obviously they really stressed HIV and AIDS. And so they
told us to wear condoms. And they said, condoms are 98 % effective in preventing
pregnancy. You should wear them. And I remember learning how to use condoms. Like I
actually learned how to use them. I’m not saying that the education system was so
great. I think there was different opportunities to learn how to use them. I
remember in university, I remember going to this thing where this woman like put the
condom over her arm and like she rubbed oil on it and it snapped. So I don’t know
what was going on. Maybe it was just my university. There was different programs on
the television. I remember if any Canadians are out there, Degrassi High. I remember
seeing this. It was like snake. She put like, was that her name, Spike.
That was her name. She put like a condom over a banana or something. So I
remember, and then we had Sue Johansen the Sunday night section. So many Canadians
might be remembering some of the stuff. But I just remember that even though the
education system in the school wasn’t so great, and we didn’t necessarily learn about
all of how to use condoms, I learned how to use condoms because there was a whole
discussion around that. And even the programs that I was watching as a teenager had
some information that was sort of educational and things like that. So I just feel
like for whatever reason, in my generation.
And so the education around just how to use contraception at all,
how to use non -hormonal methods, there’s no education on diaphragms, like there’s no
educate, like there’s just nothing. And so it’s like hormonal contraceptive only. And
they just kind of assume that’s, I would argue that they’re not even educating about
hormonal contraceptives. I think the average person doesn’t even, couldn’t list
anything or more than a few things that could interfere with the effectiveness of
their contraception, right? So there’s just no education. So I think, and I could be
wrong, so correct me if I’m wrong, but I think, again, that this study is looking
at data and skewing it in a certain way. They’re saying that there was a decrease
in hormonal contraceptive, reported hormonal contraceptive use. What if that means that
there’s more women who are using their contraceptives correctly? And so therefore,
fewer of them are having an unintended
a lower percentage is because the method was working. And, you know,
like, what if the method was working? And that’s why you’re seeing fewer women
report that type of use. And maybe the fact that there’s like so many more women
who reported using no method. What if it’s just that the women who were using the
methods correctly were actually successfully avoiding pregnancy versus the fact that if
you use no protection, you’re far more likely to have an unintended pregnancy if
that’s not your desire. So I do think it’s so interesting because, again, this data
set is really specific. This data set is specifically people who had an unintended
pregnancy only. And so therefore, they either use no method or they use their
methods incorrectly, right? So they’re giving you this rationale. They’re saying the
reason is because you have more women turning to fertility awareness -based methods
and they’re not effective. More women reported using charting apps, therefore it’s the
social media that’s making women not want to use contraceptives. And that’s why we’re
having more unintended pregnancies while not acknowledging that 70 % of the women who
were in your study literally said that they used no protection at all. And maybe
that’s the issue. Maybe the issue is an educational issue. Maybe we need to figure
out why they’re not using a method. What’s going on? Maybe that is part of what
would have to change. We would have to have a conversation and have some sort of
education about it. Or maybe we just have to have a conversation about how to use
certain methods correctly. But the issue is presented as like, oh, well, the whole
problem is that not enough women are on birth control. So we got to get them all
on birth control. And that’s really the only solution. And FABMs, we can’t have them
using nose. We got to have them on. Everyone needs to be on birth control. So
yeah. So I think it’s so interesting. I mean, if you have this study and you’re
seeing the overall picture, we’re going to focus on the 2 .5 % instead of the 70%.
So I think that kind of brings me to the end of what I wanted to talk about
today with regards to this study. I just wanted to share some thoughts on it
because I’m seeing this trend of research, really demonizing in a space methods,
criticizing it and blaming this whole, oh, more women are coming off birth control.
And that is seen as this huge problem. Instead of them asking why. So instead of
them kind of saying, well, why are women dissatisfied with contraception? The one
great thing that we have going for us is that hormonal contraceptives, the first
pill came out in 1960. And so we have a significant amount of data on hormonal
contraceptives, which is great. We have 65 years worth of data. And so there’s no
shortage of research on birth control. And I think that’s part of their problem.
We have a lot of evidence of the side effect profile. We have a lot of evidence
in terms of how many women are dissatisfied. We have studies that show that 50 % of
women who go on a combined oral contraceptive pill come off within the first year
because they’re dissatisfied with the side effects. And so instead of blaming social
media and blaming fertility awareness -based methods, why don’t you look at your own
data and ask, why is it that 50 % of women are coming off of my product within
the first year? Maybe if you just looked at that and then actually read it and
listened to what these women were saying and tried to come up with a solution for
their problems instead of just their solution is just take it or just try another
one just keep trying try this one okay we have this brand we have this other brand
okay try the iud okay do the implant okay do the shot just try something we’ve got
all of these basically this versions of the same thing and hopefully one of them
gives you fewer side effects i mean this is literally their solution And while this
is all happening, women are now talking about it more, and a lot of women are
looking for other alternatives. And instead of looking at why that is, it’s always
this, like, demonization. So if you found this episode to be interesting and you’re
wanting to take a peek at the study, you can head over to fertility friday .com
slash 597. If you can think of somebody who would benefit from hearing this,
and I and encourage you to share this episode. That is one of the ways that we
get the word out about the podcast. And it’s really been a grassroots movement from
our listeners sharing the podcast, sharing the resources, of course, that I’ve
cultivated as well. I talk extensively about the birth control pill in the fifth
vital sign, as well as my newer book co -authored with Lily Nichols, RELFood for
Fertility. So definitely take a peek at some of those resources. ironically in both
books, the pill chapter was chapter seven. And there is some new research and
information in real food fertility that wasn’t necessarily covered in the fifth vital
sign. So with that said, I hope you have a wonderful week weekend whenever you’re
tuning into the show. And I suppose one thing that I’ll say, which is not the
typical way that I end the episode, is that when you’re looking at research,
definitely look at it critically. and always think to yourself, where are the
researchers coming from? And is this the only way that this data could be
interpreted? Is there another way that we can interpret this data?
So with that, I will leave you today and, yeah, enjoy your weekend, enjoy your
week, and I will see you soon.
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