
“Natural” birth-control app dogged by unwanted pregnancies gets FDA approval - pestkranker
https://arstechnica.com/science/2018/08/natural-birth-control-app-dogged-by-unwanted-pregnancies-gets-fda-approval/
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jessriedel
What is with scare quotes? It's a non-pharmaceutical method with only passive
intervention (i.e., measurements and abstaining). The word "natural" seems at
least as appropriate here as "organic" and "processed" foods; all of these are
oversimplifications, but they communicate something that's not meaningless
with reasonable fidelity to an unsophisticated user.

I understand most reporters are going to bring an existing set of political
beliefs to the table, but I wish they felt a higher duty to present an
objective account. (Like a judge.) This doesn't mean pretending there's no
fact of the matter and all sides must be given equal time uncritically, but
cooly assessing arguments is different than weaponizing the words on the page.

~~~
sandworm101
The quotes refer to other "natural" methods that were once pitched but are now
bunk. "Natural" also has religious connotation in the US. Rhythm method was
the church-approved means of family planning. It doesnt work, with a per-year
failure rate of at least 10%. So anyone talking of natural birth control is
eyed with sucpicion.

~~~
zeveb
> It doesnt work, with a per-year failure rate of at least 10%.

That's on par with condoms, which per Planned Parenthood have an effective
annual failure rate of 15%[0]. Oddly, folks don't eye talk of condoms with
suspicion.

0: [https://www.plannedparenthood.org/learn/birth-
control/condom...](https://www.plannedparenthood.org/learn/birth-
control/condom/how-effective-are-condoms)

~~~
syntheticnature
As your own link shows, the main problem with condoms is people failing to use
them properly (the 98% figure given for proper usage is actually one of the
lower values I've seen for effectiveness in that case). Part of it is not
putting them on right. The other part is much closer to one of the problems
this app has: people getting caught in the moment and making an impulsive
decision to proceed at least partially against the app/without a condom, then
pull out (and either stop/apply a condom).

~~~
ummonk
So why single out the app and the natural birth control method if the same
problem (people using it incorrectly) applies to condoms as well?

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mattnewport
It's unfortunate how there are not better birth control options available by
now. Condoms are intrusive and make sex significantly less pleasurable for
many people. The pill has a number of well documented side effects and many
women anecdotally report a variety of other problems and reactions that make
them unwilling to use it or other hormone based methods. IUDs are effective
but also can have side effects for some women that in my experience are under
reported / downplayed that make them not an option. All the other options I'm
aware of have issues with effectiveness, side effects and practicality that
make them not compelling options.

The temporary 'vasectomy' based on injecting a gel seems promising but needs
more study and hasn't yet been approved in the US to my knowledge.

Given all this there's a reason natural methods like the rhythm method and
withdrawal are still used despite lower than desirable effectiveness. People
often talk like contraception is a solved problem when it's really not for
many couples. Maybe this app is not as effective as would be desired but if
it's improving on the unaided rhythm method it's still valuable.

~~~
NickM
Great points. I think it's also important to consider the statistics when you
combine multiple approaches to contraception. It may not be a good idea to
solely rely on natural methods, but natural methods can be combined with other
contraceptives to yield a much, much greater effectiveness than most
contraceptives can provide by themselves.

Since failure rates are typically stated as odds of getting pregnant within an
entire year of usage, combining two methods that each have only 90%
effectiveness can potentially yield an _extremely_ high level of
effectiveness: it's already unlikely that both methods will fail in the same
year, but when you consider that both have to fail _at the same time in the
same year_ then the odds start to look pretty good, despite neither method
being that great on its own.

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WhompingWindows
This relies on ovulation timing. Technically, if there is no egg to be
released within the next few days, a woman will not be able to conceive.
However, using temperature as a surrogate end-point for ovulation does not
yield a perfect correlation, there will be statistical error and there will be
individual differences obscuring the effectiveness of the method. Then there's
the issue of people using the app imperfectly and having sex near ovulation
anyway.

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EADGBE
I saw this as a way to _help_ people get pregnant, since it'd work in either
direction. In that case, how can you _not_ approve of it? It's simply a
natural biological aide.

~~~
jhanschoo
IIRC to get pregnant most efficiently one should do it as often as possible
rather than wait for the fertility peak.

~~~
wild_preference
Yes, but many people have a dead bedroom yet still want children.

These apps are popular among certain religous groups as well where sex is
viewed as some sort of necessary evil solely for procreation. Something to be
minimized.

~~~
nsxwolf
I'm not sure what religious groups there are that actually have that view of
sex. I usually hear that as an incorrect interpretation of Catholic views on
human sexuality.

The usefulness of NFP depends on your perspective. If you require a 100%
childless life, you're going to see it as useless. For faithful Catholics,
using NFP with random failures can mean 3-5 kids instead of 8-12 kids. That's
a huge difference.

~~~
wild_preference
I’m from the south and have people (christian, non-denominational) in my own
family with that view.

I’m not talking about some misinterpretation of Catholic views, but a view
that actual people hold. No need for the indirection of trying to pin this on
a label. That’s another convesation. But you are underestimating the level of
sexual repression in the States.

~~~
mrguyorama
>underestimating the level of sexual repression in the States.

Let alone the rest of the religious world, and even non-religious people can
be puritanical about sex

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syntaxing
This app caters to a lot people within my social group. Old enough to be
married but young enough to want a couple years more of freedom. This allows
couples to have sex without protection. The worse consequence is pregnancy
which isn't too determinatal since most of us are mature enough mentally and
financially to support a kid.

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dougmwne
The website right now calls the app 99% effective when used as directed. Ars
is typically high quality, so I'm going to assume this isn't a Pharma hit
piece. That FDA approval must be based off better looking data than the 1990
study, right? I hope?

~~~
0xcde4c3db
If the only inputs are daily oral temperature and menstruation dates, I have a
hard time believing that they get to 99% without essentially fudging the
number via a convenient definition. For example, total ratio of users who
do/don't get pregnant over a given time period regardless of how frequently
the user is having sex or what other contraceptive methods they might be
using.

~~~
bena
I think the fudge here is "as directed". As in if you put in all of the data
accurately, take it accurately, and don't accidentally mess it up in one of
the 700 simple ways to do so, it is 99% effective.

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kqr2
Netflix recently released a documentary called _Bleeding Edge_ which takes a
sobering look at several medical devices approved by the FDA:

[https://www.imdb.com/title/tt8106576](https://www.imdb.com/title/tt8106576)

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manicdee
There is a word for people who use the rhythm method of contraception:
“parents”

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kazinator
I'm surprised that an app _needs_ any approval of this sort.

~~~
syntheticnature
It makes claims of medical efficacy, so the FDA gets involved.

~~~
kazinator
Being fertile or not isn't "medical", though, it is biological.

Should a vocabulary memorization app require FDA approval? Memory is
biological.

~~~
azinman2
Do you see doctors for memorizing vocab? No. Do you see them for pregnancy
issues? Yes.

~~~
kazinator
> _Do you see doctors for memorizing vocab?_

Quite plausibly so; if you have unusual trouble remembering even modest
quantities of vocab, that could be a brain problem.

~~~
azinman2
But then it’s memory in general, not specifically for vocab.

~~~
kazinator
A problem that shows up as infertility could be something more general too.

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amelius
Is somebody keeping a list of all the mistakes the FDA keeps making?

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wemdyjreichert
Why must everyone debate how other people should or should not have sex? What
happens in the bedroom ought to stay in the bedroom. Unfortunately, many
people who originally preached "freedom" have moved to a position of "those
who do not are unenlightened and clinging to Bibles". As jessriedel
articulated, it seems overtly political. I probably wouldn't use it, but if
someone else wants to, so what? Besides, even 90% accuracy is better than
nothing (which some people use).

~~~
gizmo686
If you market a medical product in the US you are subject to review by the
FDA. As a general rule, we like the FDA to require efficacy.

This is in addition any normal claim of false advertising if they overstate
their abilities.

~~~
LyndsySimon
This _is_ efficacious, though - it's just not as effective as other methods.

For about a decade, my wife and I were fine with the lower effectiveness of
the rhythm method. We were smart about it and had no issues, but if she'd
gotten pregnant during that time it wouldn't have been a huge problem. In our
case we based it on the date of menstruation, and giving enough of a buffer to
feel comfortable. It worked. We've had two children, both of which were
planned, and both of which were conceived within a month of our decision to do
so.

Like most things, it's a tradeoff. We didn't want to have a child at that
particular moment, but weren't willing to completely abstain to ensure that.
It didn't make sense for us to use condoms, oral contraception, or an IUD at
the time either for various reasons. We were willing to accept the risk, so it
wasn't a problem.

