A Tale as Old as Time: Contraception Concerns in the 21st Century

Abstract: Historical inconsistencies in contraception research have led to concerns about side effects regarding hormonal contraception. Today, concerns about the hormonal contraceptive pill are still ongoing. The side effects from hormonal contraception and prevailing socioeconomic barriers to effective contraception have heralded in the use of Mobile Health (mHealth) applications as birth control methods. These applications are set to become ubiquitous with the proliferation of wearable devices that monitor biodata. Access to modern contraceptives depends on who you are and where you live and often has cost-implications. The use of “mHealth” applications has been rising in recent years and are marketed as having maximal reward for minimal cost and perhaps could alleviate some of these concerns. While mHealth applications are flexible, accessible, and low cost, this paper suggests that we exercise caution so as not to repeat past mistakes. We provide a critical review of the history of research into contraception. We may have come far, but we still have a long way to go for equitable access to contraceptive healthcare. Plain Language Summary: We provide an in-depth commentary on the history of contraceptive research. We summarise a journey from the early experimental studies on the hormonal contraceptive pill to the present situation and current challenges. We suggest where we hope contraception research will progress in the future, with a word of caution to not repeat past mistakes. We discuss more broadly how we need to uphold women’s rights to have control over their own bodies and their decision whether or not to have children. The rise of mobile health applications (apps) may help with some of the difficulties in accessing traditional contraceptives (eg, the associated costs and environmental concerns). The implications for mobile health application use for Low- and Middle-Income Countries have the potential to be very positive. However, if they are not carefully reviewed before approval, it often ends up being the most disadvantaged people that suffer from using apps that are not rigorously tested or may not be fit for purpose. We may seem to have come a long way, but we may not yet be at the stage where women are making fully informed contraceptive choices. Keywords: mHealth, contraception, wearable device, ethics, reproductive justice