High-Tech Fertility Awareness: Moving Beyond the Beads
Millions of women in low- and middle-income countries have used evidence-based fertility awareness methods over the past several years. Most of them have used CycleBeads®, a low-cost, easy-to-use way for a woman to track her menstrual cycles and determine whether she is on a fertile day. CycleBeads are based on the Standard Days Method®, which has been proven over 95% effective in perfect use and 88% effective in typical use. It’s designed for women with cycles between 26-32 days long. CycleBeads has been widely successful because of its ease of use (it relies only on period tracking), lack of side effects, and its acceptability in a range of cultural contexts.
But newer technologies are changing the scene! Fertility awareness methods, and particularly easy-to-use ones like the Standard Days Method, are unique among contraceptive options in that they can also reach women directly through their mobile devices. When offered via mobile apps, they can circumvent many of the traditional barriers to accessing contraception and can be made available through novel, cost-efficient approaches directly to end users. What’s more, technology is allowing us to refine fertility awareness-based methods, improving upon their efficacy.
Mobile Technology in Low-Resource Settings
Smartphone use in low- and middle-income countries is expanding rapidly. It is estimated that by 2020, 70% of adults worldwide will own a smartphone. While women’s ownership of smartphones lags behind men’s overall, young women (16-39) are catching up to their male counterparts. This represents a tremendous opportunity to reach women in novel ways with critical information about their fertility.
Fertility Apps Can Address Unmet Need
Fertility apps designed to prevent or plan pregnancy are attractive to women because they are free of side effects, help them understand their fertility, and can be accessed entirely through a mobile device – often for free. Research conducted on the CycleBeads app in several countries found that a majority of women using it to prevent pregnancy had not been using contraception in the three months prior despite being at risk for pregnancy. And many had never used contraception at all.
As one woman in Kenya reported, “Having this app on my phone is like having a friend in my pocket who tells me exactly what I need to know.”
Another user in Nigeria said, “I had tried for many years to track my cycles so I could know when I could get pregnant, but always had trouble doing it right. This makes it so easy.”
Artificial Intelligence & Fertility Apps
A few new fertility apps are actually pushing boundaries by developing algorithms to identify a user’s potential fertile days. These apps use advanced predictive models that “learn” as a user enters more data and can tailor the output on a personalized basis. These types of apps, while exciting, need rigorous testing and should be held to the same standards as other contraceptive methods in terms of evaluating their efficacy.
One app-only contraceptive method which is currently undergoing this type of research is the Dot fertility app. This research is being conducted by Georgetown University’s Institute for Reproductive Health with support from USAID. The Dot app uses data science and a statistical approach to identify a woman’s risk of pregnancy using her unique period start dates. It is designed for women with cycles between 20-40 days long. The study will be complete in September 2018, and interim results indicate that Dot’s efficacy is very high in both perfect and typical use.
Future of Fertility Apps: Moving into the Mainstream
As we continue to gather evidence, it’s important to look at how to make fertility apps part of the contraceptive method mix. Women often learn about these methods outside of traditional health systems. In the research conducted on the CycleBeads app, users found out about the app much more efficiently from social media than from health providers. Furthermore, through digital media, we were able to reach women who were not already using contraception much more readily than through traditional health programs, where clients were more likely to already have a contraceptive method in hand.
Going forward, the healthcare community will want to look at how to support correct use of evidence-based fertility awareness methods and how these methods can be used to enhance use of other user-directed methods like condoms and emergency contraception. We also want to look at how to ensure these technologies are included in surveys and other studies of contraceptive use so that their real impact can be fully understood.