A recent study published in the BMJ Sexual & Reproductive Health journal has highlighted a noticeable shift in contraceptive practices among women seeking abortions in England and Wales over the past five years. The research reveals that women are moving away from using more reliable hormonal contraceptives like the Pill, implants, and vaginal rings, in favor of less reliable, “natural” fertility awareness methods, such as period tracking apps that identify peak fertility and ovulation times.
While the reasons behind this shift require further exploration, the study associates the increasing use of fertility awareness methods with rising abortion rates, suggesting that this trend could have significant implications for healthcare services. The researchers point out that globally, there is a growing reluctance among women to use hormonal contraceptives, which is evident in the UK, where the proportion of women using the Pill has steadily declined since 2010.
The researchers also note that social media has played a role in encouraging the adoption of fertility awareness methods, despite the fact that these methods have a relatively high failure rate compared to hormonal contraception. The failure rate for fertility awareness methods can range from 2% to 23% in the first year of use, while hormonal methods like the Pill and implants have a failure rate of around 7% or less than 1% for intrauterine devices (IUDs).
To explore the impact of this shift, the researchers analyzed data from the British Pregnancy Advisory Service (BPAS) for two periods: January to June 2018 (33,495 women) and January to June 2023 (55,055 women). The study found several notable changes in the profiles of women seeking abortions. For instance, fewer young women (aged 25 and below) sought abortions in 2023 compared to 2018, but the proportion of women who had not previously had an abortion decreased slightly. Additionally, the number of women from minority ethnic backgrounds seeking abortions increased, and there was a higher demand for medical abortions.
The study also identified a significant shift in contraceptive usage over the five-year period. The use of fertility awareness-based methods (FABMs) at the time of conception rose dramatically, from 0.4% in 2018 to 2.5% in 2023. Conversely, the use of hormonal contraceptives dropped from 19% to 11%, and the use of long-acting reversible contraceptive implants fell from 3% to 0.6%. In addition, there was a 14% increase in the number of women who reported not using any form of contraception at the time of conception, with this figure rising from 56% in 2018 to nearly 70% in 2023.
The study, which is observational in nature, acknowledges that firm conclusions about cause and effect cannot be drawn. The researchers also note that the profile of abortion patients may not reflect the wider population of sexually active women, and the specific fertility awareness methods used were not recorded. However, they suggest that the rise in the use of fertility apps can be assumed.
One of the contributing factors to this trend, according to the researchers, is the difficulty many women have experienced in accessing reliable contraceptives after the COVID-19 pandemic. The pandemic led to disruptions in workforce availability and a reduction in primary care and sexual healthcare services, making it harder for women to access more effective contraceptive methods.
The researchers caution that the increased use of less reliable contraceptive methods could contribute to a rise in unintended pregnancies. They call for further investigation into the relationship between fertility awareness methods and unplanned pregnancies, emphasizing the need for public education on the efficacy of these methods to help women make informed choices.
In conclusion, the study suggests that while the rise in abortion rates is due to multiple factors, changes in contraceptive use—particularly the shift toward fertility awareness methods—should be closely examined. The potential link between these less effective methods and unintended pregnancies warrants further research and greater public awareness to ensure that women can make informed decisions about their reproductive health.
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