Natural Cycles’ Controversies Could Be Good for the Future of Digital Birth Control

Dogged by critics, the app’s troubles serve as a warning to other startups.

Natural Cycles’ superstar status in the birth control industry was further cemented on August 10, 2018, when it received Food and Drug Administration (FDA) approval, making it the first officially recognized birth control app by the government agency.

But the app’s critics, pointing out an array of issues with the service, aren’t too happy with the accolades it is receiving.

What is Natural Cycles and how does it work exactly?

Natural Cycles is basically a digitized version of an old, traditionally religious birth control method called fertility awareness. The natural family planning method has many types, but the app specifically mirrors the temperature method, which relies on tracking a user’s body temperature and menstrual cycle information to determine whether she can have sex without getting pregnant.

A purchase of the app includes a basal thermometer, which, according to the FDA, is a better temperature-taking instrument than a standard thermometer (you can choose to pay $9.99 a month if you provide your own basal thermometer). A user’s temperature information, taken the same time every morning, is entered into the interface, and, along with the user’s menstrual cycle information, the app determines whether the user can have pregnancy-free sex (green for yes, red for no).

It’s not exactly an innovation; multiple existing apps and websites provide similar services. But what separates Natural Cycles from the rest is an acknowledgement by the FDA, a first of its kind.

The controversies

Natural Cycles found itself in hot water after it ran a Facebook ad in the UK last year It claimed that the digital birth control method was “clinically tested” and “highly accurate,” prompting a reaction from the country’s Advertising Standards Authority (ASA) after multiple complaints.

The ad watchdog said the bold claims regarding its efficacy were exaggerated, and that the combination of the two buzz-phrases, “clinically tested” and “highly accurate,” could be interpreted as the app being an effective replacement for other tried-and-tested manual and hormonal methods of birth control. This has led to the Facebook ad being banned, reported The Verge.

Another controversy that hounded the app happened in January this year, when Natural Cycles was blamed for causing 37 unwanted pregnancies in Sweden. According to The Verge, the Södersjukhuset hospital in Stockholm, where the abortions were performed, forwarded the women’s complaints to Sweden’s Medical Product Agency.

During that time, Natural Cycles, claiming to have already been in contact with the Agency regarding each individual case, released a statement saying that the number of unwanted pregnancies reported coincides with their statistical expectations of the app’s performance.

These controversies hardly made a dent on the app’s success, it appears. Priced yearly at $79.99, Natural Cycles has 900,000 users worldwide, according to Vox, an increase of 200,000 users, or 22%, from January, when the unwanted pregnancies issue made rounds in Sweden. Its consistently strong numbers are an indication that the app isn’t about to go away.

What critics are saying

Many experts, such as Lauren Streicher, aren’t confident about the efficacy of the temperature method. Streicher is a professor of clinical obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, and she has called the process behind the app “craziness.”

“We’ve already developed good, safe, reliable methods of contraception that are available to us. This app is completely taking women back in time,” Streicher told Vox. She said she was left “infuriated” and “speechless” when the FDA gave the app its approval.

Streicher added that birth control methods that rely heavily on unfailing user behavior are bound to be less effective. “The minute you rely on action, the efficacy goes down. So take something like this and you know the failure rate is gonna be sky-high.”

And even if a user were to follow a strict routine in an effort to extract as accurate a reading as possible, multiple factors could still throw the app off. A cold, lack of sleep, or even a sip of coffee could change the outcome entirely, according to Streicher.

Natural Cycles’ response

In press statements, Natural Cycles has repeated a disclaimer common in the industry–no birth control method is 100% effective. It’s the very mantra they used to defend themselves when news of the 37 unwanted pregnancies came out in January (and which the FDA used when recognizing the app).

They also took some responsibility in the aftermath of their Facebook ad being banned in the UK. In response to Fortune’s article on their misleading ad, Natural Cycles wrote, “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.”

While these responses indicate good faith in Natural Cycles’ part, they have done little to assuage the fears of experts who are worried about the app’s methodology. Critics like Streicher stand firm on their opinion that the app’s method is simply not as solid as other more established birth control methods.

The future of digital birth control

There’s a positive takeaway from the entire Natural Cycles circus: innovation. Birth control startups will look at all of Natural Cycles’ shortcomings, everything that has dogged the app these past months, and begin to implement new ideas on their projects to prevent similar things from happening to them.

Even Natural Cycles can take this as a learning experience and fine—tune their entire operation—from improving the science behind their technology to being more careful about their marketing.

Image sources: Natural Cycles