Can an App Address Unmet Contraceptive Needs?
When Cycle Technologies launched in 2002, one of our first products was CycleBeads, a color-coded string of beads that looks like a necklace and helps women track their menstrual cycles, identify their fertile days, and determine that their cycles are in range to use this method for pregnancy prevention or planning.
CycleBeads continue to be incredibly successful as a physical product. It was the first fertility awareness-based method based solely on tracking a woman’s period start dates that was tested in a full-scale efficacy trial. It is simple, but over 95% effective in perfect use and 88% effective in typical use* which is on par with the efficacy rates for other user-directed methods like condoms and even the pill.* It has been incorporated into the World Health Organization’s list of modern contraceptives and offered by health programs in over 60 countries around the world.
After working with CycleBeads for many years, we developed an app called CycleBeads based on the same family planning method. The app has been used widely in the U.S. since 2012 and it was clear that women in the U.S, where smartphones are ubiquitous, preferred the digital format. But in 2012, smartphone use in the developing world was non-existent.
Things have changed! Over the past few years, the developing world has seen an explosion of smartphone use and witnessed the growth of a tech-savvy generation. It’s projected that 70% of all people on the planet will use smartphones by 2020 with a huge increase coming from the developing world.*
We wanted to understand how the CycleBeads app worked in low resource settings. We began working with researchers in 2016 to find out. Could we reach women directly and circumvent the challenging health systems? Would they use the app correctly? Did the app have any advantages or disadvantages as compared to the physical CycleBeads product?
How an app can meet unmet contraceptive needs
Approximately 25% of women in the developing world have unmet contraceptive need. This means that a quarter of women who don't want to become pregnant, are not using a contraceptive method. In many of these countries, there is limited access to healthcare or commodities and women are often concerned about the potential side effects of those methods which they can access.*
A possible solution?
We have been working to get the CycleBeads Android app into women’s hands in a number of countries including Ghana, Kenya, India, Nigeria, Jordan, Egypt, and Senegal. The app had already been tested in extensive usability studies in Kenya and India to ensure that women understood how it worked, were able to use it, and used it correctly.* But we wanted to understand on a larger scale, how this app could address unmet contraceptive need and how users experienced it over time.
With this goal, we worked with researchers at Georgetown University’s Institute for Reproductive Health to develop an in-app survey. We implemented these surveys in the app over time so that users in certain countries were asked for their feedback on a variety of questions.
We chose the countries in which we worked for a variety of reasons:
The unmet contraceptive need in these countries ranged from 11% (Egypt) to nearly 30% (Ghana) of women. This means that they all had moderate to high numbers of women who didn’t want to become pregnant, were at risk of pregnancy, and didn’t have access to a contraceptive method that worked for them.
These countries are diverse in terms of culture and language. We wanted to understand how the CycleBeads app would work in multiple contexts, not just specific localized areas.
Here’s what we found out
We found that how women choose to use the CycleBeads app varied by country. Ghana and Kenya had the highest percentages of women using the app for pregnancy prevention (53% and 51% respectively), while India and Jordan had the highest percentages of women using the app for pregnancy planning (49% and 53% respectively).
In each country we surveyed, we found that the majority of people using the CycleBeads app for pregnancy prevention, had not been using any other form of contraception in the three months before they started using the app.
We found that we could reach women efficiently and that they were able to use it correctly and consistently even though they were learning about the app through direct marketing as well as word of mouth from friends and family.
Numbers, numbers, but what does it all mean?
There are a few key takeaways here.
First, there are still large numbers of women who need contraceptive options.
The CycleBeads app can reach women with unmet contraceptive need directly by providing them with a contraceptive solution that they can access entirely through their smartphones.
The CycleBeads app is filling a gap for hundreds of thousands of women who for whatever reason - concern over side effects, access to healthcare, cultural ideas around birth control - don’t use contraception.
The CycleBeads app, and our newest app Dot, may eventually be the best ways for women to access simple, effective fertility awareness method. These apps proactively educate women about their fertile windows, they remind them to enter their period dates, and they can efficiently provide women with contraceptive solutions that they can access directly through a mobile device.
But the physical CycleBeads product still has some advantages:
- It can be used by women who don’t have access to a smartphone.
- Because it is a physical product, it can be offered more readily through traditional health services.
Regardless of how women access these fertility awareness methods, we are giving them the ability to plan when and with whom they want to start their families.
There are still more women who need birth control options and there’s so much more work to be done. In 2018, we’re looking for more ways to reach women and invest in them. We’re excited to get to work!
Arevalo M. et al., "Efficacy of a New Method of Contraception: the Standard Days Method" Contraception, 2002;65;333-338
Contraceptive Technology 18th & 20th Editions.
Sedgh, G. et al “Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method”, Guttmacher Report, June 2016.
The DHS Program, Demographic & Health Surveys
CycleBeads Impact Report, February 2018
Cycle Technologies is a socially minded consumer product company based in Washington, D.C. The company creates Brilliantly Simple™ solutions to address global health needs with particular focus on reproductive health technologies. Since 2002 the company has worked with researchers, healthcare partners, and technologists to identify, develop, and make available leading edge ideas that fit its mission. To see more about the company’s initiatives, visit http://www.CycleTechnologies.com. Follow us on Facebook, Twitter, and Instagram.