‘The first and only birth control app’: How Natural Cycles uses statistics not hormones

Dr Elina Bergland tells Martin Friel how she used her statistics background to create an app that allows everyone access to birth control

Dr Elina Berglund has found a digital approach to contraception (Natural Cycles)

Hidden in amongst the deluge of problems that the Covid crisis has inflicted upon the world, lies an issue that hasn’t secured much airtime. Perhaps that’s because this particular issue is not life threatening – it is life creating.

According to a survey conducted by Marie Stopes, a UK abortion provider, one in three women in the country do not know how to access contraception because their normal means of doing so have been cut off, resulting in unwanted pregnancies.

But as we have discovered this year, there is always a digital solution to an analogue problem. So, in the absence of normal routes to contraception, it seems reasonable to assume that more and more women (and their partners) would turn to one of the increasing number of digital solutions – contraception via an app.

One such digital approach is delivered by husband and wife team, Dr Elina Berglund and Raoul Scherwitzl and their app, Natural Cycles.

Billing themselves as “the first and only birth control app”, Natural Cycles started out at the beginning of the last decade as an experiment for Berglund who was keen to come off of her traditional birth control and move on to something that was less invasive and wasn’t hormone–based.

She applied her statistical knowledge from her experience analysing cosmic ray data at Cern, to her fluctuating temperature as she went through her fertility cycle. She says she started to learn much more about her body (having come off her traditional birth control) and was able, statistically, to identify the days when she was fertile.

“The average user is similar to myself – I’m a good use case,” says Berglund.

“Often you go on hormonal contraception when you are quite young and then you start thinking about children at some point and trying to figure out how you are going to make that work.”

It was her husband’s idea to turn her experiment into an app, and a business, a business that was finally born in 2013.

When users (1.8 million according to Berglund) sign up to a subscription for the app, they are sent a thermometer to measure their basal body temperature each morning which is then fed into the app which in turn will tell the user whether or not is safe to have unprotected sex.

“In the first cycle, it is 30 per cent green days and they increases from there,” explains Berglund.

She says that with accurate data, input for long enough, green days will make up the majority of a cycle but stresses that success is entirely dependent upon proper and regular use of the app and the willingness to use other contraception, such as condoms, on red days. And, says Berglund, if there is any doubt in the data, the app will produce a red day display.

“Most of our users use condoms on the red days and you need your partner to be on board [for this to work]. It’s a joint effort,” says Berglund.

Boasting that they are the only FDA cleared and CE marked birth control app, Natural Cycles’ performance (7 per cent failure rate) compares favourably to the pill (7 per cent) and the male condom (13 per cent). So Natural Cycles is, it would seem, an “as good” alternative to existing, common contraception but with the added benefit of not relying on hormones or invasive procedures.

But that didn’t stop the app attracting a slew of negative headlines throughout 2018. At the start of that year, the company came under scrutiny by the Swedish Medical Products Agency (MPA) after it was reported that 37 of the 688 women who sought an abortion at one of Stockholm’s largest hospitals in the last four months of 2017, had been relying upon Natural Cycles for their birth control.

However, after a lengthy investigation and a recommendation that the company be clearer about instructions for use of the app and the risk of unwanted pregnancy, the MPA found that the number of pregnancies was in line with the typical, published, effectiveness rate for the app.

In between that referral and ultimate vindication, came a rebuke from the UK’s Advertising Standards Authority for being misleading in a Facebook ad where they claimed that the app was “highly accurate”.

That is the downside and there will always be pregnancies, but without it, 85 per cent of women will get pregnant within a year so you need contraception

“When it comes to contraception there is nothing that is 100 per cent effective,” says Berglund.

“That is the downside and there will always be pregnancies, but without it, 85 per cent of women will get pregnant within a year so you need contraception.”

She puts much of the blame for the scrutiny and the negative press that accompanied it down to being the new kid on the block.

“When the pill came in the 1960s, it was the same [reaction], but we have the facts on our side as we are a regulated medical contraceptive device in the US and Europe.

“We have performed clinical studies which shows the rates. Without natural cycles, there would be more unwanted pregnancies, so we know what we are doing is good and helps women. There has to be a non–hormonal, non-invasive option that is effective,” she says.

If she sounds defensive, she is a bit. But it’s understandable when you consider her fledgling business had come in for cutting and potentially devasting criticism. But they have come through that period and are busily working on expansion … with lessons learned.

“We hadn’t made enough effort preparing the healthcare professionals – educating them, explaining what it is, who is it for – and we got some backlash from midwives. But we have been working with them in the UK and US,” she explains.

And while she has global aspirations, it is in the US, where the couple have lived for the last two years (and where Berglund misses the Swedish food), that she sees the greatest opportunity. But an opportunity that comes laced with political poison.

“It is so complicated in the US,” she says with understatement.

“Women’s health here is not going in the right direction. In principle, Natural Cycles could appeal to both sides [of the ideological coin], but most of our users are women who live in the cities, on the Democrat side. It doesn’t seem like we appeal to the more Conservative side of things.”

But while they are fully aware of the political weight carried by birth control in the US, they appear to be making a good go of it with 25 per cent of their users now based there.

Berglund refuses to break down customer numbers by country or reveal the annual number of new users (her scrapes with the media have made her extremely cautious) but she does say that growth in the US is currently running at 50 per cent year on year.  

Whatever comes their way in this US adventure, Berglund doesn’t seem fazed. They’ve courted controversy before, come under attack in the media, stood their ground and maintained their belief in the science behind what they are doing.

Which is an entirely fitting approach for a genuine, bona fide particle physicist.