Pregnancy Planning Apps May Be Inaccurate: Expert Responses

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Many popular fertility and pregnancy planning apps may be inaccurate, suggest the results of a scoping review of the available evidence, published online in BMJ Sexual & Reproductive Health.

Period tracking apps were downloaded at least 200 million times in 2016 alone. However, the review if 18 papers reported that many apps seem to have been developed without any fertility specialist input. The authors were concerned about the marketing of these apps given the weak evidence for their effectiveness in helping women avoid an unintended pregnancy.

Earl et al. fear that women are being misled

“The ability to accurately predict the fertile window is important, but the limited research that exists seems to indicate that many of the most popular apps are not accurate, even though they might contain information that supports pregnancy planning or are marketed specifically for this purpose. [This] could be very misleading for women and couples that are trying for a baby.”

Dr Diana Mansour suggests women may want apps because of COVID-19

“The analysis shows that women’s motivations to use fertility apps are varied, may overlap and change with time. Therefore, it’s understandable that during the COVID-19 pandemic, women may choose to turn to fertility apps as a logical solution for avoiding face-to-face consultations.

If women need to start contraception or get a repeat prescription during the COVID-19 pandemic, I advise them to call their GP or contraceptive clinic to discuss their need. Most GP practices will be able to issue an electronic prescription that women can collect in their nearby pharmacy; other services can supply/post their preferred method.”

(Dr Diana Mansour, Vice President of the Faculty of Sexual and Reproductive Healthcare)

Professor Susan Bewley warns against misleading gimmicks

“Women may suffer if they use a menstrual or fertility app which is not accurate.  It’s important to think carefully about buying a fancy, modern-looking, gimmicky product that doesn’t work.  At best you could waste money.  At worst the app might mislead about how to avoid or plan a pregnancy, or how to spend money wisely on infertility treatments. Buyers should always beware of the trustworthiness!”

(Professor Susan Bewley, King’s College London)

Anna Nelson raises concerns about global fertility app use

Women’s use of Fertility Tracking Apps to prevent pregnancy is imbued with ‘official legitimacy’: the FDA has licenced ‘NaturalCycles’ as a contraceptive. Yet both inaccurate use by consumers and failures by developers raise concerns about their accuracy.

We should all be alarmed, given the severity of the consequences of failed contraception for those unable or unwilling to carry the child to term. Even for the most liberal, abortion is rarely an easy choice. Many feel personally unable to choose it for religious or other reasons. This leaves the woman to continue a pregnancy against her wishes.

Besides, a huge number of women worldwide face significant difficulty accessing abortion because of practical, legal or religious obstacles, even if they want an abortion.

This review exacerbates these concerns:

  1. The only study which focussed on low- or middle-income countries indicated that over a third (39.9%) of users were seeking to prevent pregnancy. Unsafe abortions are more common in the developing world; and those who have an unsafe abortion in a developing country are far more likely to die as a result.
  2. Seven of the eighteen studies included in the Review took place in the USA, by far the most in any single country. Meanwhile access to abortion in the USA is increasingly under threat in many states.
  3. Many studies came from countries which only permit abortion in cases where it is necessary to preserve the health of the woman (eg. South Korea and Jordan) or even only in cases where it is needed to protect her life (eg.. Nigeria and Egypt). Therefore it may not be possible to legally and safely terminate a pregnancy caused by failed contraception, so app failure forces women to choose between carrying the foetus to term or accessing an ‘underground’ illegal abortion.

Unwanted pregnancy takes a significant toll on the mental and physical health of the pregnant person, especially where abortion is difficult or impossible to obtain. Developers and regulators must be alive to the dangers of false or misleading promises regarding the contraceptive effectiveness of Fertility Tracking Apps.

Of course, these apps offer benefits.  An alternative to hormone-based contraceptives and their side-effects, this is a potentially empowering option. Medication-free contraception could particularly benefit those living in countries where access to medical care and pharmaceuticals is costly.  Contraception available without clinic visits could be especially valuable for those in controlling and abusive relationships.

However, Fertility Tracking Apps should only be considered a safe means of pregnancy prevention once stringent controls exist to ensure strong scientific basis for accuracy.

(Anna Nelson, University of Manchester)

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