Kate* had been with her boyfriend for two years when she became pregnant. The couple hadn’t been using birth control - but not because they were hoping for a baby. At 23, Kate didn’t want to conceive at all. She felt so uncomfortable using the contraceptive methods available to her that she had purposefully been going without, preferring to risk getting pregnant instead.
Kate, it seems, isn’t alone; a significant number of young women in heterosexual relationships are also making the decision to stop using contraceptives. Contraceptive app Natural Cycles, which works by tracking your temperature to predict the fertile days in your cycle, has racked up over 1.8 million users worldwide (more than 250,000 in the UK) since it was founded in 2013. A report by the United Nations found that 63% of partnered, reproductive-aged women worldwide use some form of contraception – inferring that the other 37% don’t. While a large portion of this percentage will, of course, come down to lack of access, it’s also conceivable that a share of this group will comprise of women making the choice not to use contraception.
As I have discovered through anecdotal evidence, difficult side-effects, infertility worries and concerns about the safety of hormonal methods are just some of the reasons some women are abandoning contraception altogether. For Kate, it was not knowing what the hormones in certain contraceptives could be doing to her.
“You don't know how you're going to react to a certain hormone, so I just don't want to risk putting them into my body,” she tells me. “[The pill] made me more hormonal, angry and stressed. It generally made me moodier and highly strung.”
Condoms aside, one of the only non-hormonal methods currently available to women is the copper coil. Also known as the intrauterine device (IUD), the coil is a small, T-shaped device that is placed in your womb, and releases copper to prevent you getting pregnant. While uncommon, risks associated with the IUD include pelvic infections, thrush, and perforation of the womb. After hearing from some of her own friends who’d had bad experiences using it, Kate was reluctant to subject herself to this form of contraception, either.
After two years without birth control, the arguably inevitable happened: Kate discovered she was pregnant. Although the news was hard to take at the time, she knew exactly what she needed to do. “It didn’t seem real that I could actually have something growing in me,” she shares. “After finding out I was pregnant, I just wanted to get the abortion as soon as possible.”
While Kate remained emotionally detached throughout the termination – “I never hesitated or questioned it, I always knew that was the route I would take if I fell pregnant” - it wasn’t an easy process. “I kept thinking about an abortion going wrong, and the pain. Even the word ‘abortion’ felt pretty daunting in itself. Afterwards I bled quite a lot over a few weeks. It made me feel weak and lethargic.”
Feeling drained at what she'd gone through, Kate was keen to avoid another unwanted pregnancy. When she was offered the progestogen-only ‘mini pill’ as part of her abortion aftercare, it seemed like the only option, so she reluctantly accepted it. “I felt like I was doing a U-turn on my stance [on the pill], because I was ‘supposed to’. I felt like people expected me to after the abortion,” she says.
The mini-pill didn’t work for Kate either, however. After it caused constant spotting and painful periods, she decided to stop taking it, and is now using condoms with her partner.
While Kate knew a termination was the right decision for her, it’s by no means a simple solution to unwanted pregnancies, being a difficult experience both emotionally and physically. Sam*, who recently abandoned contraception for similar reasons to Kate, tells me that having an abortion simply isn’t something she’s prepared to do - if she became pregnant, she’d have to keep the baby.
Sam has been in a monogamous relationship for over a year. She’s not good with pain so is afraid the coil will hurt, and doesn’t like the idea of an implant because of its longer-term nature. She came off the pill – the only contraception she’s tried, and which she “hated” - after finding that it made her tearful and angry about minor things. “I was not the same person on the pill,” she recalls. “I felt so bad. I was not nice to be around.”
Mood swings are a side-effect commonly reported by those taking the pill. The Lowdown, launched last year, is the world’s first review platform for contraception. The website allows women to search and filter hundreds of in-depth reviews on different contraceptive methods to help them decide which ones to try - or avoid. Of the site’s 1,978 contraceptive pill reviews (at the time of writing), 61% said the pill had “somewhat to very negatively” affected the user’s mood. In fact, over half of all women who have left reviews on The Lowdown say they feel that their contraceptive method has negatively impacted their moods and emotions.
Speaking to Cosmopolitan, The Lowdown’s founder and CEO Alice Pelton explains why she set up the site: “I just realised that there wasn't enough data and information to help women navigate this minefield.” She feels that society “doesn't really take the side effects and complaints of women seriously enough,” so she was keen to create “a platform that allowed us to track data on this to help women make informed decisions.”
After witnessing so much feedback roll in to The Lowdown, Alice isn’t surprised that some women are choosing to go without contraception altogether. “In the last couple of years we’ve seen a much more critical assessment of our contraception,” she says, pointing to the lack of contraceptive advancement in recent years as one of the possible causes. Many of the most commonly used contraceptive methods have remained relatively unchanged for decades. “It's quite extraordinary, really; contraception is used by almost a billion women, so it's not a niche market - it's definitely worth innovating in.”
Concerned that certain contraceptives may affect her ability to get pregnant when she wants to start trying, 23-year-old Lorelai*, who has been with her partner for almost four years, decided to stop using it all together. “Some contraceptive methods have a ‘recovery time’ between coming off them and then trying to get pregnant,” she says. “I didn’t really like the idea of waiting for my fertility to go back to normal.”
There is some truth to what she says. However, Dr Asha Kasliwal, President of the Faculty of Sexual and Reproductive Healthcare (FSRH) explains that it's different depending on which contraceptive you're using. "There is no evidence suggesting a delay in return of fertility following discontinuation of intrauterine contraception (IUD and IUS) and oral contraceptives (the progestogen-only pill and the combined pill)," notes the doctor, adding: "Conception rates [after discontinuation] are comparable to those among women using no contraception."
Natural fertility will "return very quickly" after removal of the implant, according to Dr Kasliwal, who also says that there should be "no significant delay in return to fertility" from either the transdermal patch or the vaginal ring, either. Long-acting injectables may delay a return to fertility, however. "There may be a delay of up to one year for fertility to return when they stop taking Depo-Provera and Sayana Press," says the expert, clarifying: "Because return to fertility varies widely from woman to woman, it might happen faster to some than others."
Lorelai has concluded that abandoning contraception suits her lifestyle because she has one sexual partner who makes that work with her. She used the Natural Cycles app for a period of time, before deciding that the withdrawal method, also known as ‘pulling out’, was effective enough for them [note: it's estimated around 22 out of 100 women become pregnant each year using the pull-out method.] Although Natural Cycles is an FDA-approved form of birth control, its popularity indicates that more and more women are making the move away from contraception as we know it. According to a 2019 study by the app, 36% of women surveyed in the UK are avoiding contraception because they’re opposed to taking hormones.
While the effect of hormonal contraception on mood has been widely reported, Ellie*, 23, says not enough attention is paid to its impact on those already struggling with their mental health. As well as having an aversion to pills after taking antidepressants as a teenager, Ellie fears the weight gain sometimes caused by hormonal contraceptives could trigger disordered eating - something she has a history of.
“I think there’s a lack of appreciation around the effects of taking this kind of medication when you're dealing with depression, anxiety, or eating disorders,” she tells me. “My friends are all of the belief that the harm [becoming pregnant] would cause much outweighs the threat of the pill, but it's hard when you're working on so many other issues.” To potentially risk her progress by taking another form of medication, for Ellie, is too big a gamble to take.
Asked what their ideal contraceptive method would look like, almost every woman I spoke to said it would be one developed for and used by men. This response is unsurprising; historically it’s women who have had to shoulder the responsibility of birth control - and while trials for male contraception continue, we’re a long way off yet. Having this option is long overdue.
Experts recognise that the decision over what contraception to take – if any – is a major one, and Dr Sarah Hardman, director of the Clinical Effectiveness Unit at the FSRH, urges people not to be put off by others’ experiences. “Every woman is different, and what doesn’t suit one woman may well be fine for another,” she tells Cosmopolitan. “It’s really important to note that most users of contraception do not experience significant problems - many women hugely value the contraceptive and non-contraceptive benefits that they get from their contraception.
It's vital to remember, too, that the only contraception that provides any protection from a sexually transmitted disease is condoms, so it should be kept in mind that going without this kind of barrier protection would put you at risk of STIs.
“Some women will, of course still choose to use condoms, diaphragms or fertility awareness-based methods – and that is absolutely their choice, but they need to be given the information to allow them to understand the differences between methods and they need to be offered the full range of alternatives,” Dr Hardman adds. “Studies about contraception are happening all the time, and we are always monitoring them for robust new information that might suggest that there is a significant problem or benefit with a method of contraception, so that we can change guidance if need be.”
The fact that there are women out there who feel their only options are to risk pregnancy, or to endure a contraceptive method that causes them worry or harm, is concerning - and suggests the contraceptive offering is not fit for purpose for all. The large majority of women do manage to find a contraceptive that works for them, but in order to provide everyone with the fair choice they deserve, we need to start pushing contraceptive research much further up the agenda.
*Names have been changed
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