Research highlights a shift to less reliable ‘natural’ contraception methods among abortion patients

There has been a shift away from the use of more reliable hormonal methods of contraception to less reliable fertility awareness methods among women requesting abortion in England and Wales over the past five years, reveals research published online in the journal BMJ Sexual & Reproductive Health.

Use of the Pill, mini Pill, implants, patches, and vaginal rings has given way to more ‘natural’ methods, such as period tracking apps that highlight monthly peak fertility/ovulation, the findings indicate.

While further research is needed to understand the reasons driving these changes, the trends correspond to a rise in abortion rates, with wider implications for health care services, conclude the researchers.

Worldwide, women seem to be increasingly reluctant to use hormonal methods of contraception, note the researchers. In 2010, around half of women of reproductive age in the UK were using the Pill. Since then, its use has steadily declined.

Anecdotal evidence suggests that women are increasingly turning to more ‘natural’ fertility awareness methods of contraception, largely influenced by social media, say the researchers.

But the typical failure rate for these methods ranges from two to 23 in every 100 women in the first year of use compared with seven in 100 women for the Pill/implants and less than one in 100 for the coil (intrauterine devices), they explain.

To find out what contraceptive methods women requesting abortion in England and Wales were using when they fell pregnant, the researchers compared data from the British Pregnancy Advisory Service for the periods January to June 2018 (33,495 women) and January to June 2023 (55,055 women).

Fewer young women (aged 25 or below) requested an abortion from a BPAS facility in 2023 than in 2018. But the proportion of women who hadn’t had a previous abortion fell from 62% in 2018 to 59% in 2023.

The proportion of women of minority ethnicity rose between 2018 and 2023, as did the proportion of medical abortions requested. And the proportion of women who were at seven or fewer weeks of pregnancy was significantly higher in 2023 than in 2018, rising from nearly 37% to just over 59%.

A sizable shift in the methods used for contraception occurred between 2018 and 2023, the data showed.

Reported use of fertility awareness based methods around the time of conception increased from 0.4% in 2018 to 2.5% in 2023, while the age of those using these methods fell from nearly 30 to 27.

The use of hormonal methods fell from just under 19% in 2018 to just over 11% in 2023. Use of long-acting reversible contraceptive implants also fell from 3% to 0.6% over this period.

And those who said they hadn’t used any form of contraception when they fell pregnant significantly increased by 14%, rising from 56% in 2018 to nearly 70% in 2023.

This is an observational study, precluding firm conclusions to be drawn about cause and effect. And the researchers acknowledge that abortion patients may not reflect the sexually active population in general. They also highlight that the precise fertility awareness method used wasn’t recorded, so the rise in the use of app technologies can only be assumed.

“The shift in preference towards [fertility awareness methods] is coupled with reported increases in difficulty in accessing the more effective methods of contraception following the COVID-19 pandemic due to workforce changes and a reduction in primary care and sexual health care capabilities,” point out the researchers.

“The amalgamation of a shift in attitudes and difficulty in accessing certain methods has led to increasing use of less reliable methods, which, in turn, has the potential to increase unintended pregnancies,” they add.

They conclude, “While the rise in abortion rates is multifactorial, one aspect that needs scrutiny is any change in contraceptive use, and particularly this surge in the use of ehealth, including fertility apps, period tracker apps, and natural family planning apps.

“The possible relationship between these less effective methods of contraception and unplanned pregnancy requires further investigation. However, informing the public about the efficacy of such methods in order to facilitate informed contraceptive choices is needed.”