Including fertility awareness methods in routine NHS contraceptive consultations
Funding
NHS Bristol, North Somerset and South Gloucestershire ICB Research Capability Funding.
What is the problem?
Unplanned pregnancy remains a significant public health issue in the UK, with contraceptive uptake decreasing and abortion rates increasing in recent years. These outcomes disproportionately affect people living in more disadvantaged areas, ethnic minority communities, and those with learning disabilities, reflecting wider health inequalities.
Preferences for contraception have changed. some people are moving away from hormonal methods due to concerns about side effects, or a desire for more “natural” options. Fertility awareness methods (FAMs), often supported by smartphone apps are increasingly popular. These methods involve identifying fertile days by tracking menstrual cycles and biological signs, such as body temperature and cervical mucus, and avoiding unprotected sex during these times.
While some FAMs are evidence-based and effective with education and clinical support, many apps lack validation and may give inaccurate predictions, especially after childbirth, abortion, or for irregular cycles. Without NHS guidance and support, reliance on these tools could increase unintended pregnancies and subsequent abortions, particularly among groups already experiencing inequality.
Currently, NHS contraceptive consultations do not consistently provide clear, evidence-based information on FAMs. Addressing this gap aligns with Bristol, North Somerset and South Gloucestershire (BNSSG) Integrated Care Board (ICB) priorities on reproductive health, prevention, informed choice, and reducing health inequalities.
What is the aim of the research?
RCF funding will support service-led development work to refine a fertility awareness intervention and prepare a strong future NIHR research application. Activities will include Patient and Public Involvement (PPI), stakeholder engagement, and a rapid literature review.
The rapid review will identify existing evidence on barriers and facilitators to providing FAMs within routine NHS contraceptive consultations. PPI and stakeholder engagement will. explore perceptions of usability, feasibility and acceptability, and identify preferred situations (e.., following childbirth, abortion, during routine reproductive health consultations) settings for implementation (e.g., GP practices, sexual health services, pharmacies).
To support inclusive involvement, a range of engagement approaches will be used, including small discussion groups (up to five participants), one-to-one meetings, and online or in-person options. Up to 20 members from diverse socio-demographic backgrounds across BNSSG) will be recruited, supported by community organisations (e.g., Caafi Health, Bristol Health Partners). Participants will include people eligible for contraception with varied experience of healthcare access.
Up to 10 stakeholders (e.g., clinicians, commissioners) will also be recruited to participate in one-one discussions to identify service-level and structural barriers. RCF funding will also provide dedicated time for development of the NIHR application, ensuring the proposal reflects lived experience and service priorities.
How will this be achieved?
The intended NIHR-funded project will build on learning from current service provision, patient feedback, and findings from the RCF phase. It will implement and evaluate the provision of fertility awareness methods within NHS contraceptive consultations identified as appropriate during the RCF-funded work.
The research will assess impact, acceptability, feasibility, and costs of delivering FAMs as part of routine NHS care. It will examine whether providing evidence-based FAMs and support improves informed choice and reproductive autonomy, while maintaining safety and equity.
Quantitative data will include outcomes such as unplanned pregnancy and abortion rates within BNSSG. Qualitative data will explore experiences of the intervention from service users and healthcare professionals. An economic evaluation will assess costs and potential value for money for the NHS.
The intervention will be co-produced with patients and clinicians to ensure cultural appropriateness and accessibility, particularly for CORE20PLUS populations. The overall goal is to strengthen the quality, consistency, and equity of NHS contraceptive counselling while supporting informed choice and reducing health inequalities.
Who is leading the research?
This research is led by Dr China Harrison, Research Fellow at the University of Bristol.
Further information
For more information or to get involved with this project, please email bnssg.research@nhs.net