Richard – Population Matters-USA

Most of us in wealthy countries know where we can go to find good family planning care. Unfortunately that is not always true in other parts of the world—unfortunately, even in the USA, 7% of women had trouble getting birth control according to a recent survey.

Alicia (name changed), the 23 year-old niece of a Kenyan friend, is an example. She had a boyfriend who took no responsibility when Alicia found she was pregnant. I helped pay for her prenatal care, then got an urgent text that she was at term and the baby was breech. I was able to pay for a cesarean at the best hospital in western Kenya. The baby weighed almost 9 pounds; I’m glad they didn’t attempt a vaginal birth!

Alicia thought she knew when she wasn’t fertile, but apparently she guessed wrong. To get effective contraception, she would have needed bus fare to travel to a city, plus the cost of the public clinic. Perhaps the clinic would have required an examination and tests (both common in some countries)—meaning more expense. These would have been insurmountable barriers to a young woman living in a subsistence economy. Perhaps the largest barrier Alicia faced was admitting that she needed birth control in her traditional society.

Here is my perception of what is needed to overcome barriers to successful use of family planning.

Start young: Sex ed starts in first grade in Finland and some other European countries. Teen sex is common there, but teen pregnancy is rare. It is interesting that the states in the US that have the least sex education have the most teen pregnancies.

Make Contraception Easily Available: Many school-based clinics can provide family planning. Colleges and universities have started stocking vending machines with condoms and emergency contraception, amongst other goodies, they are available anytime with the student’s identification card. Planned Parenthood has a very successful program. Women only need to fill out a questionnaire about their health and have their blood pressure checked to get birth control pills—and they can get up to a year’s supply at one visit.

Make Contraception Affordable: A study in Missouri has shown that when birth control is inexpensive or free, people choose the most effective methods. That has also been found true in Ceará state, Brazil and in British Columbia, Canada.

Reduce infant Mortality: “What,” you might think, “does this have to do with family planning?” Knowing that children will live to adulthood motivates people to decrease their fertility. This is especially true in countries without a social security system; children are the only security people have when they are injured and as they age.

Take away Stigma: There are many jokes about teens buying condoms—but often it is not so funny for the young man. A study done in the Midwest found that more guys would purchase “rubbers” if they knew that they would be supplied in a plain paper bag.

A small group of concerned people formed “Free the Pill” in order to get the FDA to approve an oral contraceptive available without prescription. OPill^®?. A national study found that many of the people who used OPill^®? had previously used no family planning or a less effective method.

Unfortunately, President Trump has destroyed USAID, the world’s largest funder of family planning. Although other countries and private foundations are stepping in to fill that needed aid, we can expect an increase in unintended pregnancies.

Back to Kenya. Alicia hopes for a university education. She was an excellent student in school, but her family doesn’t have the money for college. Now she has an infant to care for in addition to other challenges. Fortunately, her mother is willing to help with the baby, and I am able to help with finances.

©Richard Grossman MD, 2026

FemTech is a new word for me. It isn’t the name of a female robot, but rather describes technology for the needs of women’s reproductive health.

There are many types of FemTech. One of the earliest and most common form is various apps women use to keep track of menstrual periods. That information can be useful to help a woman know when she is most fertile and trying to conceive—or when she is least likely to conceive, if her goal is to avoid pregnancy. Unfortunately, that type of app is a good illustration of how technology can lead people astray. There are several potential problems with these simple apps.

Let’s look at the case of a woman who is trying to conceive, but her husband has a low sperm count. They have read that it is best if he saves up those precious sperm until she is ready to ovulate. She looks at her phone one morning and realizes that she is at her most fertile. Her husband is drinking his morning coffee, reading the newspaper and on his way to work. She runs up to him and says:

“Honey, today’s the day! Let’s do it!”

Under those circumstances, sex can become a chore instead of being fun. Furthermore, recently it has been found that it is more productive for a couple to have intercourse more frequently and not just when the wife is more fertile.

There are other problems for couples who are trying to avoid pregnancy. One is that the pregnancy rate is much higher than with most modern contraceptive methods. Another is problem is more pernicious: poor security. Some of the apps do not take adequate measures to keep women’s data secure. Thus, if a woman who lives in a state where abortion is illegal misses a period and might be pregnant, law enforcement might find out. Then, if she tries to go to another state to abort the pregnancy—or perhaps to just visit a friend—she can be tracked. This may seem too Orwellian to occur in the USA, but already laws have been proposed to prevent crossing a state border in order to obtain abortion care.

Natural Cycles is the only app that earned FDA approval for contraceptive purposes. It uses a combination of period information and the rise of a person’s temperature when ovulation occurs, so it is more accurate than period-tracking apps. It claims to be 93% effective with typical use—which means that as many as 7 out of 100 women will conceive in a year of using this app for birth control. This is pretty good compared to other natural family planning methods, which have a failure rate up to 25%.

FemTech gets more sophisticated than just a calendar and thermometer. High tech fertility tracking with finger rings that measure temperature and home tests for progesterone which can help tell when ovulation has occurred. There are even expensive kits that measure 4 different hormones for the same purpose. Another high tech device uses vaginal probe that notifies the user when her cervical mucus is ready to assist sperm on their journey.

For an unintended pregnancy, FemTcch can help women lower barriers to self-managed abortions. A chatbot named “Ally” uses artificial intelligence to do this. Ally provides information for safe abortions using pills. It is available in several languages and has been used by people in over 170 countries.

This is just a sample of FemTech; I’m sure that much more will be developed in the future. Unfortunately, new ways of invading our privacy will also proliferate.

PS: After posting this essay I realized that the FDA has approved another app for contraception, “Clue”.