When Things Don’t Go As Planned with Digital Contraception.

Paper Title

When Things Don’t Go As Planned with Digital Contraception

Publication Info

• Topic area: User experiences and failures in digital contraception technologies.
• Keywords: Digital contraception, personal informatics, safety-critical systems, unplanned pregnancies, user responsibility, algorithmic trust, qualitative study, Natural Cycles, reproductive health, self-tracking.

Background and Problem

• Problem / challenge: Digital contraceptives, while offering non-hormonal alternatives, face challenges in reliability and user trust when failures occur, such as unplanned pregnancies or the need for emergency contraception. Little is known about how users experience and navigate these failures.
• Significance: Understanding these experiences is critical as digital contraceptives intersect personal informatics and safety-critical systems, where failures can have significant personal and societal consequences.
• Motivation and related work: Prior research has explored digital contraception's role in fostering bodily awareness and intimate partner collaboration. However, gaps remain in understanding user experiences of failure, responsibility attribution, and continued use after such events.

Solution

• Proposed approach: A qualitative study analyzing 27 interviews with ongoing users of the digital contraceptive Natural Cycles, focusing on their experiences with unplanned pregnancies or emergency contraception use.
• Novelty:
  1. Provides empirical insights into how users make sense of and navigate failures in digital contraception.
  2. Explores the complex attribution of responsibility between users and the technology.
  3. Highlights the ambivalence and oscillating relationships users have with digital contraceptives after failures.
  4. Proposes design sensibilities for fostering reciprocal care and repair in intimate technologies.
• Procedure and key techniques:
  • Secondary analysis of a dataset of 133 interviews, selecting 27 cases involving failure events.
  • Manifest content analysis to categorize failure types.
  • Reflexive thematic analysis to explore user sense-making, responsibility attribution, and continued use.

Results

• Concrete findings:
  • Three main failure scenarios: unplanned pregnancies leading to termination (19 participants), use of emergency contraception (several participants), and carrying out unplanned pregnancies (a subset of participants).
  • Users often debated responsibility, oscillating between blaming themselves, the technology, or contextual factors.
  • Continued use of digital contraception was influenced by trust rebuilding, partner support, and the perceived benefits of non-hormonal methods.
• Advantage over baselines: This study uniquely focuses on user experiences of failure and long-term engagement with digital contraception, unlike prior work that primarily examines adoption or effectiveness.
• Experiments / evaluation:
  • Dataset: 27 interviews from a larger corpus of 133 Natural Cycles users.
  • Methods: Manifest content analysis and reflexive thematic analysis.
  • Metrics: Qualitative themes on failure interpretation, responsibility attribution, and continued use.
• Limitations and future work:
  • Focused only on ongoing users, excluding those who discontinued use after failure.
  • Limited detail on failure experiences due to the secondary nature of the dataset.
  • Future work could explore experiences of discontinued users and expand to other digital contraceptive systems.

Summary

This study investigates user experiences with failures in the digital contraceptive Natural Cycles, focusing on unplanned pregnancies and emergency contraception use. It reveals that users navigate complex questions of responsibility, often sharing or assuming blame, and continue using the technology due to its perceived benefits and partner support. The findings challenge binary notions of failure and success, emphasizing the need for designs that acknowledge failure as part of long-term use. The study contributes to personal informatics and safety-critical systems research by proposing design sensibilities centered on reciprocal care, repair, and user agency in managing uncertainty.