Photo by Getty Images
Photo by Getty Images


All I want is to not get pregnant while remaining a generally healthy person

Contraceptive apps have resulted in unwanted pregnancies, while hormonal birth control has long been associated with unpleasant side effects. It’s 2018 and we still don’t have contraception figured out, says Caroline O’Donoghue

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By Caroline O'Donoghue on

Whenever I think about contraception, I’m reminded of that Dorothy Parker verse, Resumé, where she rules out suicide options based on how inconvenient they are. I’ve amended it: Dorothy wrote about the pains of life; I write about the pains of contraception.

The coil pains you;
So does the implant;
Breakthrough bleeding stains you;
And drugs cause cramp.
The male pill isn’t lawful;
Contraceptive apps give;
Condoms feel awful;
You might as well live.

I’ve been having sex for over a decade and, while I’ve been getting better at actually enjoying it, I have still not mastered the carefully nuanced art of not getting pregnant while simultaneously not going crazy. I have been on a dozen pills over the years, starting with the coquette-ish Yasmin (abandoned for mood swings) to the matronly Dianette (abandoned for carnival-sideshow levels of boob expansion) to the misery-inducing Microgynon (abandoned for being the worst thing to ever be pushed on women since the wage gap). My implant, which causes me to bleed roughly 60% of the month, has the advantage of not driving me crazy but has virtually no other advantages. For a few months now, I’ve been thinking about going on one of those fun-looking temperature-based apps. No doubt they will have been advertised to you, too – I can’t seem to open my Instagram without seeing one. You pop in your basal thermometer every morning, which co-ordinates with an app on your phone. It gives you a literal green light if you’re OK to have sex that day, a red light if not. Science! Technology! Finally, something I need you for!

Except the dream of the contraceptive app has finished before it has even started, as several women have become pregnant since switching from their regular contraception to the thermometer-app solution. In an eye-opening piece for The Guardian, novelist Olivia Sudjic writes about how she had to schedule an abortion after four months of using Natural Cycles, one of the more popular versions of the technology. Sudjic speaks to several women who have had the same experience and also finds that the app is no more or less exact than using a calendar to figure out which days you’re fertile. Or, as the Catholic girls I knew used to describe it, “Vatican roulette”. Far from being a convenient replacement aimed at that oh-so-advertised-to “girl on the go!” we all want to be, Natural Cycles is depressingly restrictive. You have to take your temperature with the app every morning, just after waking and before sitting up. No morning wee or shuffle to the door to let the dog out. What’s more, any little thing can throw the app off – in Sudjic’s case, it was because she had undiagnosed polycystic ovaries. Inconvenient, uncertain, annoying to use – and all for the low, low price of £60 a year.

For years now, women have been forced to accept contraception that alters their emotional state, stains their underwear and puts them in physical pain

Many of the women Sudjic talks to curse themselves for their naivety at having truly believed that a contraceptive app could have worked in the first place. A child-free sex life without drugs, prophylactics or hormones? Really, queen? But it’s not hard to see why it’s such a seductive product. For years now, women have been forced to accept contraception that alters their emotional state, stains their underwear and puts them in physical pain. In a study done in April 2018, it was confirmed that, overwhelmingly, the pill does have a negative impact on a woman’s quality of life. And yet contraception remains an incredibly profitable business to get into – the global hormonal-contraceptive market size is expected to reach $26.2bn by 2025.  

“Despite the fact that an estimated 100 million women around the world use contraceptive pills, we know surprisingly little today about the pill’s effect on women’s health,” said professor Angelica Lindén Hirschberg, who helped run the 2018 study. But why? Why don’t we know more? We can clone the same Chihuahua 49 times, but we can’t figure out what’s happening to women’s bodies every time they ingest a product that we have been giving them en masse since the 1970s? What kind of shit science is that?

It comes down to, I suspect, the fact that although an overwhelming amount of health products exist for female-specific problems, there are comparatively few studies dedicated to female health. In 2016, it was revealed that erectile-dysfunction studies outnumber PMS research by five to one. Additionally, large gender gaps in medical research limit how much we know about the difference between women’s health and men’s, a fact that’s shocking when you consider only a third of subjects in cardiovascular trials are women. And it makes sense, in a gross, capitalist sort of way, that the female body is kept mysterious. We are inundated with hundreds of products that kind of work, rather than a select few that do. This pill doesn’t work? Try this new pill. Crazy from all your pills? Try the coil. On and on and on, women are expected to hopscotch from one treatment to the other, trapped in an informal subscription scheme our entire fertile lives.

As I said: The male pill isn’t lawful; Contraceptive apps give; Condoms feel awful; You might as well live.


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