Natural Cycles was hailed as a stress-free, hormone-free contraceptive. Then women began reporting unwanted pregnancies

Last summer I had an abortion. Statistically unremarkable, yes, but mine wasn’t because of a split condom or a missed pill. I was four months into a tense relationship with a much-hyped Swedish” digital contraceptive “, a smartphone app announced Natural Cycles. I had invested my 20 s on the pill, but hated not knowing whether my emotional state was down to artificial hormones or not. My boyfriend and I had been together for eight months, and I was desperately endeavouring something new, something that wouldn’t realize me feel so anxious.

That’s when the adverts started following me around on social media: glowing women reclining in Scandi bedrooms, all pallid gray-headed expanses and dappled light-footed, brandishing basal thermometers and tell people how great it felt to” get to know yourself better “. Natural Cycles’ ads promised the” world’s first contraceptive app”, something” natural, hormone free& non-invasive “. I could start using it without a two-week wait for a doctor’s appointment and so, in a fug of hormones and resentment, I bought a subscription. I was sold on shiny predicts, a sleek user interface and the fact that a former Cern physicist, Elina Berglund, was at the company’s helm. But four months in, it miscarried. Berglund facilitated discover the Higgs boson; but it turns out her algorithm couldn’t map my menstrual cycle.

Femtech, or female health engineering, “ve been through” a thunder stage, with an estimated $ 1bn of investment invoked worldwide in the last three years. Apps such as Clue, Dot, Glow and Spot On are all popular age trackers, but Natural Cycles is the only one certified as contraception. In 2017, it was approved for use across the EU, getting the green light from the German inspection and certification organisation, Tuv Sud.

How does it act? It comprises an app, an annual subscription of about PS60, and a thermometer accurate to two decimal points( free in the berth ). You input your temperature as soon as you wake up, and the app clears projections about your birthrate every day: light-green for” become have unprotected copulation”, red for” not unless you require a babe”( you can also use the app to programme teenage pregnancies ). No hormones , no embed and, supposedly , no stress. It has its own language: customers are known as ” Cyclers”, and useful information is available via a “Cyclerpedia”. It seems as easy as ordering a takeaway or a taxi from your telephone; of route there’s an app for birthrate, too.

Natural Cycles has already been registered more than 700,000 users from more than 200 countries, 125,000 of them in the UK. But its certification as contraception is under review in Sweden, where the company and its married co-founders are based. In January, a major Swedish hospital reported that 37 of the 668 women who had sought an abortion there between September and December 2017 were employing Natural Cycles as their sole birth control, and the Medical Products Agency of Sweden began to investigate. Natural Cycles has responded that the increasing numbers of pregnancies is proportional to the registered number of Swedish useds and” in line with our promises “; but as someone who didn’t report my own pregnancy last year, preserving it secret even from my parents, I wonder how many more “theres been”.

It wasn’t the stigma that kept me quiet, or the sadness, though that trailed me all summertime like the sinister song of an ice-cream van. It wasn’t the fact that being 28, in a stable-seeming relationship and game for motherhood in a couple of years, I absence an explanation other than precarious investments and a relationship exactly shy of its first anniversary( those are excellent concludes ). No, my silence was because I felt colossally naive. I’d employed the app in accordance with procedures I do most of the technology in “peoples lives”: not quite knowing how it operates, but taking for granted that it does. Speaking to others who bought the app as contraception( about 75% of Natural Cycles’ total used basi, according to its CEO ), it seems that many feel the same.

I spoke to Amy, 29, who was fed up with hormones when she started use the app as her sole family planning. Three months later, she was pregnant, a” massive sicken “. Though she declares she may have made a mistake, she can’t pinpoint the error.” You’re told all you need to know is yourself. I believed in it the same way I did the pill and envisaged I did exactly what right .” Having already booked her uniting, she went ahead with the pregnancy, giving birth weeks before she went down the alley.” It’s supposed to build you feel like you have more dominance, but in fact it did the opposite: when I fell pregnant it felt like a decision was taken out of our hands. It wasn’t how we’d have contrived it, and I don’t recommend bridals two weeks postpartum, but I’m lucky it was something we wanted in the long run .”

Marie, 30, first is known about the app when she saw an Instagram post about it( sought for Natural Cycles and you will find hundreds of posts by influencers telling you how it changed their lives ).” I didn’t blot the hashtag at the very end of the caption which said that it was a sponsored post ,” she says. She had been taking Yasmin, a frequently prescribed contraceptive pill, for six years old when she made the swap, said that he hoped the app would be a reliable and easy alternative. A time into a relationship, and eight months into using Natural Cycles, Marie realised she was pregnant. She had an abortion that proved painful, contributing to the breakdown of the relationship and extending her into what she describes as” a cavity of anguish “.

She didn’t want to tell anyone about it. She’d had an abortion once before, when a morning-after pill didn’t work, but this time she felt ashamed:” I felt like I’d behaved alone in the decision to use the app and had been overly relying. But I was also furious that I’d been treated like a consumer , not a patient .”

Like Marie, I didn’t go to my GP before I switched to the app, probably because I subconsciously knew he’d advise against it. In many ways he knows me better than any algorithm can. He gave me on the pill at 18 because I had an irregular round. I later learned I had polycystic ovary syndrome, which I now know does me a dreadful nominee for Natural Cycles, because my ovulation is erratic and erratic.

A year earlier, before I’d heard of the app, I had been to see a gynaecologist to discuss birth control, contemplating I required a non-hormonal coil matched. It was the first time a medical professional has assisted in me to truly understand the extent of my options. She outlined me a make of coordinates and plotted each alternative available( no app got a mention) to show me the benefits and impediments. Recognise v aches, feeling v upkeep, long- v short-term.

I’d speak grisly things about the hormonal vaginal resound- a widely shared article about a young, fit dame who died after a blood clot- but concurred, based on what she felt would suit me best, to try it. We laughed at how it’s impossible to experiment any birth control online without encountering horror storeys. I told myself I would trust health professionals and cease my Googling as it merely encouraged nervousnes; but after a few paranoid weeks wearing compression socks to avoid blood clots, I was done.

None of the posts on my social-media feed suggested that being a ” Cycler ” “couldve been” such a frustrating, often daunting commitment. One paid-for post I appreciated featured a still life of a puppy, a duet of on-trend headphones, a self-help book and a thermometer, with a 250 -word caption starting with” 5 things I required in the morning. Cuddles from Bee[ the dog ], tea, music, positive repeats and the first thing I do when I wake up- my Natural Cycles thermometer .” But I found that taking your temperature regularly is not so easy. The number of period I leapt out of bunked bleary-eyed and needing to pee, then realised I hadn’t first taken my temperature, signified I started waking up in the middle of the night to pre-emptively urinate, panicked about missing my evaluate space in the morning. On the pill, it didn’t matter if I’d merely woken up, was lying down or standing up when I took it. With Natural Cycles, the slightest flow seemed to count. It was comedic until it became tragic; I got pregnant when the predictions of fertile and infertile changed back and forth in one day, turning from dark-green to red, after I had unprotected sex.

I now know that the ideal Cycler is a narrow, preferably old-fashioned category of being. She’s in a stable tie-in with a stable life-style.( Shift-workers, world-travellers, the sickly, the accentuated, insomniacs and sluts be advised .) She’s about 29, and rarely ordeals fevers or hangovers. She is savvy about fertility and committed to the effort required to track hers. I could add that her phone is never lost or cracked and she’s never late to work. She wakes up at the same time every day, with a charged phone and a thermometer within reach.

” From the information supplied by Natural Cycles, I expected that my body temperature would follow a clear pattern and that I would be able to pinpoint five days in every four-week cycle that I was fruitful ,” says Lucy, 32. She swopped from the pill after becoming concerned about an increased risk of breast cancer, after one of her friends was diagnosed.” I did feel like I was getting to understand my figure better, but soon realized that I can’t pinpoint when I wake up each day. Some mornings I whisk at 5am, roll over and try to sleep for another hour or two, sometimes I toss and turn from 2am to 6am and then fall asleep, and so on .” Her learnings were erratic.” I couldn’t see a pattern and this undermined my confidence. After exploiting Natural Cycles for three full cycles/seconds, I noted I was still having eight to 10 red[ ie perhaps fertile] epoches per cycles/second .” After four months, she decided it was no better than using a docket and went back on the pill.

No form of contraception is 100% effective; most are assessed according to two metrics: usual use and perfect use. “Typical” indicates a perimeter for human error; “perfect” is when it’s used absolutely correctly. With perfect implement, Natural Cycles scores as 99% effective, with merely 1 % of women becoming pregnant. With regular apply, according to clinical studies be put into practice by the company( self-selecting, rather than randomised power trials ), that stops to 93%. This is often cited by the company as favourable compared with the pill( 91% effective with” regular implement “). But, unlike the pill, you’re not covered for every day of the month. You have to abstain or use other contraception on fruitful dates. And in the first few months, as the app “gets to know you”, these are pretty near continuous.

When I talk to Raoul Scherwitzl, the CEO and co-founder of Natural Cycles, he is charming and sincere and calls at precisely the appointed hour , not a few seconds early or late.” My wife and I represent a usual user-couple ,” he says.” Elina was on hormonal family planning for 10 times and we knew we wanted progenies, but in a couple of years. We both had PhDs in physics and were working at Cern, dealing with messy, fluctuating data, trying to look for the Higgs boson, which is basically looking for a signal amid racket. We started exploiting the same statistical methods to pinpoint my wife’s ovulation amid her differ temperatures. We read up on the literature and evolving an algorithm which our colleagues started applying, more. We were leading it on the Cern servers and then use Google spreadsheets. We insured it as an unmet need. There was a lack of choice and we wanted to innovate in an important field .”

Natural
Natural Cycles founders Elina Berglund and Raoul Scherwitzl.

I tell Scherwitzl that, though the need is real, after purchasing the app, caveat after caveat exposed itself. I didn’t know it would take months to become reliable.” The algorithm is cautious by design ,” he shows.” It holds red periods unless it’s sure .” I tell him how I got pregnant, when the prophecies changed after I’d had copulation. Scherwitzl empathises (” I am sorry to hear that “) but says that as well as ” downsides”, here i am” a huge upside with all the glad customers” and that” the most important thing is to use protection on red daylights: it relies on that “.

Has the company accommodated its communication strategy to reflect the experience of users who have become pregnant?” At the core, our messaging has always been sanded on facts but we do evolve what we say. We used to state the 93% digit but without the privilege context, so there were certain expectations on the product .” The 93% figure comes from existing useds responding to the company’s calls for participates, research that has been criticised by a reproductive health expert as “inappropriate and misleading”, and more like ” marketing research” than a medical study. But Scherwitzl holds the data is robust, and preferable to a medicalised self-restraint experiment.” The authorities have pros and cons to that type of study, and in our opinion this manifests the nations of the world better .”

What about the targeted advertising? Isn’t it strange to get social-media influencers( one prominent Swedish blogger is now an investor) to promote a medical product? He doesn’t think so.” Social media allows us to control the narrative because there’s lots of misinformation out there , not just with us but with every type of birth control. We can also target the right age group .”

The investigation by Sweden’s medical watchdog is now six months in, and has started its second phase, examining commerce textile, past clinical studies and fresh used data. Reports of unwanted pregnancies have not been able to, nonetheless, had any negative effect on the business.

In a 2016 interview I please I’d read, Scherwitzl’s spouse and business partner Elina Berglund described her ideal customer as a woman who is planning to have children at some extent, and who would like a breach from hormonal contraception before trying. It’s not a good alternative for women who want to altogether avoid teenage pregnancies, she said. But somehow this meaning has got lost in Natural Cycles’ sell; this is very much not what the word “contraception” are meant to me.

Indeed, on the section of the Natural Cycles website aimed at medical professionals there is a” decision tree” for physicians considering prescribing the app as birth control. Is individual patients over 18? Is she comply with her current family planning? If the answers to those questions are yes and no, then the third largest is: would she be “devastated” to get pregnant within the next year? If the answer is yes, the doctor is told not to prescribe the app. Perhaps those questions should be compulsory when you click through on a Natural Cycle link.

An
An likenes from the Natural Cycles Instagram chronicle.

Instead, the app accepts the intimate spokesperson of a relied physician, mixed with the sort of gamified messaging you find on other apps. You might get an update saying,” Nice curves! You have a nice and smooth temperature swerve with small day-to-day fluctuations. Keep up the good work !” The company’s social media is peppered with hashtags such as # yourcyclematters and # wakeupmeasuregetup. The perkiness is grating- even the thermometer suffers the slogan “Good morning!”- and can be pressurising, too. One wife I spoke to who purchased Natural Cycles to try to strategy teenage pregnancies told the company she wanted to leave after six months, as the daily tracking was too traumatic. She emailed to ask for a escape,” for psychological wellbeing “. A customer service manager responded to say she could cancel, and reactivate when she craved, but that” I took a quick look at your data, and in terms of ovulation everything examines good !”, lending,” You do not need to worry about losing any data- we never delete anything !” Those utterance tags don’t making this reassurances any less creepy.

Perhaps this untrue feel of friendship is why it felt more like a betrayal to find myself pregnant than if the pill were at fault. After the abortion, the honeymoon period of my relation intention hurriedly. It felt like we’d begun our nostalgic hasten with a spuriou start. I stopped exploiting the thermometer and went back on the pill, but it took me a little while longer to area channels with the app. I removed it from my phone, simply to realise the direct debit was rolling and non-refundable. I have just been sent another PS60 bill, for a contraceptive app I no longer use, that got me pregnant. But it’s not just the money that bothers me – it’s the remember that I introduced so much faith in a engineering that in the end relied on something as inaccurate as my torso. What’s the hashtag for that?

* If you would like your comment to be considered for inclusion on Weekend magazine’s notes page in magazine, satisfy email weekend @theguardian. com, including your name and address( not for publication ).

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