JMIR Publications

ABSTRACT

Background:

People in Western countries are increasingly rejecting hormone-based birth control and expressing a preference for hormone-free methods. Digital contraceptives start to emerge as non-hormonal medical devices that make use of self-tracked data and algorithms to find a user's fertile window. However, there is little knowledge about how users experience this seemingly new form of contraception, whose failure may result in unwanted pregnancies, high risks to health, and life-changing consequences. Natural Cycles, the first digital contraceptive, has been certified in the European Union and cleared in the USA, and has a large base of users worldwide.

Objective:

We focus on users' experiences of Natural Cycles to examine the user experience offered by the first digital contraceptive, including which experiences people choose to share with other potential users, or with the company itself.

Methods:

We conducted a mixed-methods analysis of 3265 publicly available reviews written in English by users of Natural Cycles in Google Play. We combined computational and human techniques, namely topic modelling and reflexive thematic analysis.

Results:

Our analysis shows that a digital contraceptive can serve a variety of roles. For example, it can be experienced as hormone-free, as empowering, as algorithmic, as interactive, or as collaborative contraception. Our results highlight the work the user must accurately do to employ it as contraception. We show how tracking and visualisations further opportunities for self-knowledge, and how notifications and visualisations combined provide reminders and motivation to keep going. We find that perceptions of agency and timeliness open the door to reconfigurable collaborations with the technology and with others over time. We propose ‘tamed naturalness’ as key to the user experience of digital contraceptives -a naturalness that is contained and regulated by science and technology. Our analysis suggests that users of Natural Cycles do not find a contradiction in conceptualising the product as natural, even if it is co-produced by an assemblage of humans, technical systems, procedures, and institutions via medical studies, certifications, and new version releases.

Conclusions:

We conclude that the first digital contraceptive, through its application of science and technology, is experienced by users as a ‘tamed natural’ approach which is perceived as safe and trustworthy.