The ASA has ruled that the app’s claim of being a ‘highly accurate contraceptive’ is misleading and exaggerates its effectiveness
Finding the right contraception is a nightmare. Do you opt for the convenience of the pill and pump your body full of hormones that risk turning you into a raging bitch one minute, and a weeping mess the next? Do you go for the more invasive, albeit non-hormonal, coil? Or maybe condoms, and all the fumbling in the dark that goes with them? How about the surgically-inserted implant? Or maybe you just give up altogether and put your faith in the pull-out method instead?
Whichever type of contraception you go for, you know it will come served with a side order of consequences – and as women, we have no choice in the matter. It’s a case of put up and shut up, or stop having sex completely. So when Natural Cycles, the “only certified contraceptive app” in Europe, was launched in 2016 with the promise of being a non-hormonal and non-invasive form of contraception, it’s no surprise we leapt at the chance to claw back our collective sanity.
At first glance, the app appears to be a godsend for modern women everywhere. The premise is simple: measure your temperature in the morning, input the data into the app, and receive a green or red light, depending on whether you need to use protection that day or not. The question “Can I have sex without protection?” pops up in a list of Q&As published on the app’s website. The wording of the reply is firm in its assurances that, on a “green day”, you do not need to use contraception because “you cannot get pregnant as you are not fertile”.
Except… well, except you can.
Earlier this year, the reliability of Natural Cycles was called into question after 37 women fell pregnant while using the app as contraception.
A hospital in Stockholm reported that, out of 668 women who sought an abortion between September and December 2017, 37 of them had been relying on the app to keep them safe. And this is just one hospital, in one part of Europe: the company reports that it has 600,000 active users across the world, 200,000 of which are right here in the UK.
The bad news for Natural Cycles doesn’t stop there. The UK’s Advertising Standards Authority (ASA) has now ruled that the app’s claim of being a ‘highly accurate contraceptive’ is misleading and exaggerates its effectiveness. The claim was featured in a 2017 Facebook advert for the app which stated: “Natural Cycles is a highly accurate, certified, contraceptive app that adapts to every woman’s unique menstrual cycle.”
Having received complaints about the app, the ASA launched an investigation, which has now led to the advert being banned. The ruling said: “In the context of the ad, the claim ‘highly accurate contraceptive app’ would be understood by consumers to mean that the app had a high degree of accuracy and was therefore very reliable in being able to prevent unwanted pregnancies.”
The investigation also considered a video that had run alongside the advert, and the statement continued: “We further considered that the claim ‘clinically tested alternative to birth control methods’, presented alongside the ‘highly accurate’ claim would be understood to mean that the app was a reliable method of contraception which could be used in place of other established birth control methods, including those that were highly reliable in preventing unwanted pregnancies.”
In response, Natural Cycles released a statement which read: “We respect the outcome of the investigation by the ASA into one Facebook advertisement, which ran for approximately four weeks in mid-2017. The investigation was initiated nearly 12 months ago and the advertisement was removed as soon as we were notified of the complaint.
“This investigation triggered an internal review of all our advertisements and the way that we communicate more broadly, to ensure our message is clear and provides women with the information they need to determine if Natural Cycles is right for them.”
The fact that the app had already taken the advert in question out of circulation seems fairly damning. After all, the semantics are firm enough to convince even the most sceptical person that the app can stop them from becoming pregnant; the words ‘highly accurate’ and ‘clinically tested’ leave reassuringly little room for doubt, but just what is that reassurance based on?
Speaking to Stylist, Karin O’Sullivan, a clinical consultant at sexual health charity Family Planning Association (FPA) said she would not currently recommend the app alone as a contraceptive method for women.
“There’s not enough independent evidence available about the reliability and effectiveness,” she says. And speaking about the ASA investigation, she adds, “It’s not very clear what ‘highly accurate’ means – when talking about contraceptive methods it’s much more helpful to talk about effectiveness rates and explain exactly what your chances of getting pregnant are with typical and perfect use of the method”.
Raoul Scherwitzl, who founded the app alongside his wife, Cern physicist Elina Berglund, claims the app is 93% effective with typical use. However, Business Insider reported that Natural Cycles themselves admitted ‘more research’ is needed. In comparison, condoms are 85% effective with typical use, and the pill is 91% effective with typical use.
Typical use gives an estimate of effectiveness based on the likelihood that we, as humans, probably won’t use any method of contraception perfectly, which is fair enough. And looking at those three percentages as a whole, Natural Cycles makes a compelling case for being the most reliable form of contraception – again, with the added bonus of being non-hormonal and non-invasive. However, as O’Sullivan explains, there are a huge variety of issues that can come into play when using the app as a ‘fertility awareness’ contraception.
“You need to be motivated and understand the advantages and disadvantages, especially the things that can make it less effective,” she explains. She describes learning how to use fertility awareness as a “steep learning curve” because it can be affected by so many factors.
“For example, a change of routine – such as going on holiday – can affect cycle length,” she says. “Late nights out followed by a late morning lie in (particularly at weekends) or getting up early to use the bathroom will affect temperature taking. And medication can have an effect – for example paracetamol can affect temperature.” And measuring temperature is what the app relies on to work.
“We also need to think about the human factor – it can be easy to think you just fancy sex even though you know it’s a red (fertile) day and you really shouldn’t, but you’re sure it will be OK just this one time,” O’Sullivan adds.
Looking at this list, it’s so easy to see how a woman using the app could be misled into thinking she couldn’t fall pregnant – when in reality, she could. If something as common and everyday as going to bed later than usual, or getting up to use the bathroom before a normal waking time, can throw the whole app off, then why the hell should we trust it in the first place?
And this is before we even begin to look at the fact that women have varying menstrual cycles, or irregular periods, which can again confuse the app. This was the issue that Hollie, a 35-year-old author, ran into when trying to use Natural Cycles as a contraceptive. Having dealt with irregular periods for all of her life, she doesn’t have a regular menstrual cycle, meaning the app couldn’t determine a single “green” day for her.
“I bought the thermometer and got the app on a free trial. I followed the instructions to the letter, but I didn’t get a single safe day,” she tells Stylist. “I contacted them after two months and they said the app might take time to learn my body’s rhythm, and extended the trial. Another two months later, I contacted them again, and again they extended the trial. Still, I didn’t have a single safe day.”
She adds, “If I’d been in my twenties, this would have been useless. In my mid-thirties, settled, and in a pretty steady routine with my phone reminder set, it was STILL difficult to follow the rules.”
Having worked in advertising herself, Hollie says she is “not surprised” that the ASA chose to investigate the app. And would she recommend Natural Cycles as contraception? “It’s certainly not a pill alternative for the average woman,” she says.
However, contrary to Hollie’s experiences, Diana, a 36-year-old editor, has had no problems with the app. Like so many others, Diana, 36, was drawn to Natural Cycles after seeing a UK influencer promote it on Instagram in a paid post – which also raises the question of whether it is appropriate for contraceptives to be advertised in this way. Diana had previously been on the pill for eight years and her doctor had recently changed the medication she was taking, which had had a negative impact on her cycle, including stomach pain and bloating that lasted for three months. She came off the pill and has been using the app for 12 months; she has had no issues with it so far.
“I have followed the instructions very closely, including taking my temperature at the same time every day before sitting up,” she says. “It’s quite straightforward to use and I also avoid taking risks (such as having sex) if I have been unable to enter my temperature due to other factors which might impact results, such as alcohol or sickness, or if the thermometer is not at my bedside when I wake up.”
Despite being aware of the ASA investigation, she will continue using the app as her only form of contraception, because of the lack of other non-invasive forms of contraception for women.
“I’m not keen on using the implant or the coil because the thought of having to get something fitted inside me seems like too much bother,” she says. “I needed access to something quick and convenient, without any hassle and fuss.”
And this is the problem in a nutshell - contraception as a whole is not quick, or convenient, or without hassle, or fuss-free. Of course women have flocked to Natural Cycles as an alternative; we are sick of messing with the natural rhythm of our bodies, sick of having implants inserted and removed, sick of the whole lot of it. It’s obvious that we’re desperate for an alternative, and Natural Cycles came along at just the right moment to grab our attention.
Which begs the question – why, in 2018, are we not putting more resources and research into finding quicker, more convenient, simply better forms of contraception? It’s unclear whether the app has undergone the same rigorous testing as other forms of contraception available in the UK, such as the pill, the coil and condoms. Yet here it is being marketed to us on social media, or by the influencers we follow, as though it is the answer we have all been waiting for.
Still not convinced? Well, the most damning evidence against the effectiveness of Natural Cycles comes from founder Berglund herself. In a 2016 interview with The Guardian, the paper reported that Berglund described her ideal user of the app as ‘a woman in a stable relationship who is planning to have children at some point, and who would like a break from hormonal contraception ahead of trying’. In the following sentence, Gemzell Danielsson, one of Berglund’s own researchers, is reported as saying the app is ‘not a good option for women who absolutely want to avoid a pregnancy’.
Is that what you’re looking for in your contraception? Will you put your faith and trust in something that even a developer’s researcher describes as ‘not a good option’ to stop you getting pregnant? I’m pretty sure the answer to both of those questions is a big fat no. So rather than relying on flimsy technology and potentially unreliable natural methods, let’s take a step back from the app, and call for more research into contraceptive options instead. There’s no doubt in my mind that we deserve better.
Stylist has reached out to Natural Cycles for comment
Images: Natural Cycles, Unsplash