We have had a tendency to trust in the sanctity of technology without understanding that technology is nothing without the humans who interact with it.
A couple of days ago, the Swedish app maker Natural Cycles, was reported to the Swedish Medical Products Agency by one of the countries largest hospitals, Södersjukhuset. The app, which combines the calendar method with an algorithm to track fertility, was certified under EU law last year as a contraceptive method. It has come under fire because of out of 668 abortions performed at the clinic between September and December 2017, 37 of them occurred with women who were using the app.
The hospital states that it reported the app because of the side effect of an unwanted pregnancy, and wants the agency to look into the effectiveness of the technology. But how many of the other 631 other abortions were caused by failed contraceptive use? And how many of those were reported?
Natural Cycles has never claimed to be perfect. In fact, the company is at pains to publish all its medical findings and let its users explore its effectiveness for themselves. On the website, it clearly states that it is 99% effective when used perfectly. This is then further defined as using the app daily for one year. When it comes to 'regular use' – so allowing for occasionally forgetting to measure your temperature – the statistic goes down to 93%. These stats are in line with the effectiveness of the pill, which, according to the WHO is 92% when used consistently rather than perfectly.
It seems that because the app is just that, an app, people almost have higher expectations of its efficacy.
Natural Cycles released a statement that seemed unsurprised by the headlines. 'As our user base increases, so will the number of unplanned pregnancies coming from Natural Cycles users. This is an arithmetic truth applicable to all contraceptive methods,' it stated. So what's the uproar about? It seems that because the app is just that, an app, people almost have higher expectations of its efficacy. As we have become a more digitally advanced society, we have had a tendency to trust in the sanctity of technology without understanding that technology is nothing without the humans who interact with it. The same could be said of Facebook, which had an unprecedented effect on the 2016 American elections, and yet only because its users believed in the content being posted and believed it had been vetted. It's the adage of our modern times, 'it it's online, it must be true' and the same thinking can often extend to novel innovations. We give in to the magic of an algorithm, putting our wholehearted trust in them.
We don't know yet why these unwanted pregnancies occurred, whether it was due to an app error which misdiagnosed a fertile day as non-fertile or whether it was human error, a couple having unprotected sex on a designated red, likely fertile, day, which the app advises against. But maybe there was too much faith put into the app and its algorithm, and not enough human judgment.
In an issue last year, The New Scientist questioned whether we should innovate and reshape society just because we can. I would argue that the Natural Cycles app is a valid innovation – it gives women an option to take control of their fertility without the side effects of hormonal contraception. Instead of immediately questioning it because it is a smartphone therapy, we should rethink how much autonomy we give it, and other technology like it, in terms of making decisions for us.
We will be exploring morality in the age of technology in our upcoming Trend Briefing. For more information, click here.