‘Did you know,” says Alice Pelton, founder of the Lowdown, “that it’s actually easier for a woman to book an abortion appointment than a contraception appointment in this country?”If you want an abortion, she continues, you google your nearest abortion clinic, then head to the British Society of Abortion Care Providers website, click “book appointment” and complete an online form giving your contact details and some basic medical information. Or call them using the phone number on their website (lines are open seven days a week). You’ll typically have your first appointment within a week and the abortion within a week after that.
“If you want contraception, you have to ring your GP at 8am and stay in the calling queue for however long it takes a receptionist to answer you. You may then have to wait a further couple of weeks to be seen, or be told they can’t offer the method you want or are open only on weekdays. Or you can try to find a sexual health clinic near you that is still open” — 54 per cent of UK sexual health clinics have closed since the pandemic — “and wait for hours, or stay on a waiting list for weeks.” Pelton, 36, throws her hands up in frustration. “If we could just spend a bit of time and money fixing this, it would pay off for decades.”
She is trying to do just this. In 2019 Pelton — who studied anthropology at the London School of Economics — launched the Lowdown as an online platform for women to share their experiences of contraception methods and brands. “Women started sharing their reviews and we started building up a data set.” Today the Lowdown has more than 100,000 monthly visitors from around the world, about 80,000 of whom have left a review. Women can also use the site to book consultations with doctors and order contraceptives directly, subject to approval by a medical professional. Pelton’s bio on X describes the Lowdown as “Tripadvisor for vaginas” — and its user-generated reviews, like those on the travel platform, are a matter of opinion. But for women who are considering a contraceptive method, it can be useful to read about side-effects reported by peers. For example, one 19-year-old British woman says that since she started taking the Yasmin combined pill, her premenstrual tension has diminished, her back and chest acne has cleared up and although her sex drive vanished for the first few months, it’s now back. It is also helpful to learn that the contraceptive injection (which prevents pregnancy by releasing the hormone progestogen, and lasts for up to three months) gets 2.9 out of five stars from a total of 283 reviews from users, many of whom complain about weight gain and bad skin. “I’m not a data nerd but I love collecting qualitative and quantitative data,” Pelton says. “I think it’s really interesting.” The site also features a “health hub” of articles written by doctors covering subjects such as the potential effects of vaping on conception and whether the appetite-suppressing drug Mounjaro can help with endometriosis. Advertisement Pelton is pregnant with her second child, a baby boy due in June, and already has one 18-month-old son, Alexander. As with her contraceptive journey — which involved trying several brands of the pill as well as the copper coil — her path to motherhood has not been straightforward. She spent many months trying to conceive and has suffered both a miscarriage and an ectopic pregnancy, which she has written about in detail on the Lowdown: “Towards the end of last year I started to feel a very strange pain in my lower pelvis and had a (normally timed) period that seemed to last weeks,” she writes. “Now, as a woman with endometriosis, I knew a thing or two about pelvic pain. But this was like a pain I’d not felt before that Friday morning I did a pregnancy test and it was a faint positive. I wasn’t excited because I realised I might be having an ectopic pregnancy.” She then explains what an ectopic pregnancy is in a simple bullet-pointed list. This sort of story is what makes the Lowdown feel different. It is, Pelton says, what today’s women want. They may not remember much from biology lessons at school, don’t want to be campaigned at (see: charities) and feel alienated by dry professional healthcare services. • I swapped the pill for an app and had two abortions
On this theme Pelton has co-authored a book, Contraception, with the Lowdown’s medical directors, Dr Frances Yarlett and Dr Melanie Davis-Hall. As well as contraception, it also covers conception and fertility. There is a detailed explanation of how the pill works — including the differences between the 17 brands and the effectiveness of each. I never knew, for example, that some pills are “monophasic”, meaning they contain the same hormone concentration in every pill in the packet, and others are “multiphasic”, where concentrations of hormones vary throughout the cycle.
Pelton is also interested in the future of contraception, and whether men might one day do more than just produce a condom at the crucial moment — whether that’s taking a contraceptive injection, bathing testicles in an ultrasound “bath” or undergoing reversible vasectomies using an injectible chemical gel that blocks the flow of sperm. “I think we’re going to be very surprised at how many men are excited about having control as well,” she says.
Advertisement
The pharmaceutical industry allocates only about 2 per cent of its annual revenue from the sale of contraception products to research and development, according to the Gates Foundation, compared with about 20 per cent for non-contraceptive prescription drugs. The boom in “natural” non-hormonal forms of contraception — such as cycle-tracking apps — is a result of this stasis, Pelton says. “We haven’t had a huge next wave of technology and there aren’t many other options for people to move on to.”
Cycle tracking involves women keeping track of their periods and fertile windows. “You have to be really on the ball to use this method, and be extremely diligent about accurately logging your symptoms,” Pelton writes. “Even people who ordinarily had menstrual cycles like clockwork pre-pregnancy can have rogue months, which throw timings out the window.”
Nevertheless, in a Lowdown user survey in 2023, the fertility awareness method came out on top, with an average satisfaction rating of 4.4 out of 5. Pelton is wary of criticising those who use such methods, because “women are and should be allowed to complain that the set of options available to us isn’t good enough.”
The Lowdown’s research shows the hormonal coil to be the “best” contraception available. This is a small, T-shaped plastic device that is inserted into the womb and releases progestogen, which thickens the cervical mucus — making it harder for sperm to reach an egg — and thins the uterine lining so it is harder for a fertilised egg to implant. Pelton says: “It has a lower dose of hormone, it’s localised and it seems to cause less of the hormonal side-effects than the pill.”
• Male contraceptive gel proves effective in ‘exciting’ early trial
Advertisement
She says one of the most surprising things she learnt while working on the book is that one in five women in relationships get pregnant each year if they use the “withdrawal” method. “I’d always thought 80 per cent effectiveness sounded high, but it’s not when you frame it like that,” she says. “If I had a teenage daughter I think this book would be a good thing to give her, at the point in her life when it is awkward to have these conversations.”
I don’t have teen daughters, but I don’t disagree — especially in a world where spurious health information is peddled by social media influencers, and where medical misogyny persists.
Next Pelton plans to broaden the Lowdown’s remit into pregnancy, birth and infant care. Meanwhile, if she could wave a magic wand over how we provide contraception, she would “rip it all up and start again”, and develop “a forward-thinking digital service that delivers pills, the patch, rings, is utterly seamless and is a good user experience. Then, if you need physical help, you would go to a clinic near you. You could book an appointment and be treated like an adult.”
Contraception: Your Essential Guide to Separating the Myths from the Medicine by Alice Pelton, Dr Francis Yarlett and Dr Melanie-Davis Hall (Piatkus £30 pp384). Order from timesbookshop.co.uk. Discount for Times+ members
