More U.K. Abortion Patients Relying on Cycle Tracking Over Hormonal Contraception

Over a 5-year period, fewer patients seeking abortion in the U.K. reported relying on hormonal contraception at the time of conception, while the use of fertility awareness-based methods increased, according to a cross-sectional study.

Use of fertility awareness-based methods around the time of conception rose from 0.4% in 2018 to 2.5% in 2023, while use of hormonal methods decreased from 18.8% to 11.3%, and use of long-acting reversible contraception (LARC) from 3% to 0.6% (P

The percentage of people not using any contraceptive methods rose by 14%, from 55.8% in 2018 to 69.6% in 2023 (Pin BMJ Sexual & Reproductive Health.

“When we compared the two groups, there was a statistically significant increase in the number of patients reporting using fertility awareness-based methods,” McNee told MedPage Today, adding that “there was also a statistically significant decrease in patients reporting using hormonal methods of contraception.”

Fertility awareness-based methods of contraception include apps where algorithms track an individual’s menstrual cycle and daily body temperature to predict fertile days, as well as period tracker apps that use calendars to predict ovulation. The paper noted that “contraception users worldwide appear to be increasingly hesitant to use hormonal methods” despite these methods being far more efficacious than fertility awareness-based methods. Simultaneously, statistics from Great Britain indicate a rise in abortion rates across all ethnic groups. While multiple factors could contribute to this rise, increased popularity of less effective contraception could play a role.

“There are studies that have qualitatively examined the decline in hormonal contraception use and the rise in fertility awareness-based methods, but this is one of the first studies, if not the first, to quantify the increase in the use of fertility awareness-based methods of contraception,” McNee said.

Data for this study came from the independent healthcare charity British Pregnancy Advisory Service (BPAS), which provides medical and surgical abortion, as well as pre- and post-abortion counseling, pregnancy testing, screening and treatment for sexually transmitted infections, and contraception and vasectomy services in England and Wales.

Contraceptive method use at conception disclosed by patients in routine abortion consultations with BPAS nurses or midwives were compared between two time periods: January-June 2018 and January-June 2023. Contraceptive methods were categorized as hormonal contraception, LARC, fertility awareness-based methods, none, or other, which included condoms, diaphragm, vasectomy, and female sterilization. In 2018, these consultations were mostly done in person, but by 2023 they were mostly done via phone. In total, there were 33,495 patients in 2018 and 55,055 in 2023.

Medical abortion was far more common than surgical abortion in both time frames, rising from 69% in 2018 to 85.6% in 2023. There were also more abortions at 7 weeks’ gestation or less in 2023 (59.4%) compared to 2018 (35.6%). Additionally, abortion patients in 2018 veered younger, with most being 25 and under (45.6%) while in 2023 most were 26 to 35 (44.1%).

Researchers pointed out that the COVID pandemic impacted patients’ ability to receive primary care and sexual healthcare, which also made accessing more effective methods of contraception more difficult. The pandemic changed birth control patterns in the U.S., too.

The authors concluded that “the possible relationship between these less effective methods of contraception and unplanned pregnancy requires further investigation.”

They also noted that in 2018, the abortion medications misoprostol and mifepristone had to be delivered in a clinic, but by 2023 both were available to patients via remote pathways. This decreased the number of appointments needed for medication abortion, so it was possible that patients were less likely to tell a healthcare provider in person that they don’t use contraception. They also noted that it wasn’t possible to determine the method of fertility awareness-based method of contraception being used, though all of these methods are less effective than hormonal methods and LARCs.

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