The maker of a popular fertility awareness app says it is built on peer-reviewed research and a scientific approach to women's health, after a recent report criticized the app's developers and funders  as "anti-abortion, anti-gay Catholic campaigners."

A May 30 report in the Guardian said the FEMM app "sows doubt about birth control" and "features claims from medical advisers who are not licensed to practice in the U.S."

The app, sold by the FEMM Foundation, markets itself as a period and ovulation tracker with three options for users - to achieve pregnancy, avoid pregnancy, or track their health.

Anna Halpine, CEO of the FEMM foundation, told CNA that "FEMM is a science and evidence based program for women's health, and our app allows us to provide personalized health care information to women directly."

"We think that this knowledge is basic women's health literacy, and we think every woman has the right to know how her body works, in order to make an informed choice about how she wants to manage her fertility," Halpine added.

The app primarily serves as a tracker for various markers of fertility and health for women, with options to track periods, cervical mucus, medications, hormone levels, basal body temperature, and a host of physical and emotional symptoms.

The app has been downloaded more than 400,000 times in the past 4 years, according to the Guardian. It has 4.8 out of 5 stars in more than 1,000 reviews in the Apple store. The FEMM Foundation also offers classes on ovulation and fertility charting, as well as "medical management" training in "protocols for the management of ovarian dysfunction, menopause and infertility."

The Guardian's report said that FEMM appears to be biased against hormonal birth control.

"The FEMM app's literature sows doubt about the safety and efficacy of hormonal birth control, asserting that it may be deleterious to a woman's health and that a safer, 'natural' way for women to avoid pregnancy is to learn their cycles," The Guardian reported.

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Halpine told CNA that FEMM aims to help women understand their own bodies.

"FEMM sees reproductive endocrinology (hormones) as the unifying element in women's health. Our approach is to empower women to understand their hormones and fluctuations, and to use our, or other charting systems, to monitor their own personal hormone patterns. The critical element is their pattern; based on the observations that they make of changing biomarkers in their body (temperature, or cervical fluid or dryness) women can 'see' their own changes of estrogen and progesterone cycle to cycle."

"Ovulation is the sign that these hormones, plus many others, are at the right level at the right time. This is why we say that ovulation is a sign of health," Halpine said.

Dr. Nathaniel DeNicola, an OB-GYN with the American College of Obstetrics and Gynecology, told The Guardian that: "The birth control pill is one of the greatest health achievements of the 20th century" and is "standard" in women's health care.

The Guardian did not, however, mention risks of artificial contraception identified by scientific research.

According to a study posted on the website of the National Center for Biotechnology Information, "hormonal contraceptives and hormone replacement therapies are classified as carcinogenic to humans (group 1) by the International Agency for Research on Cancer."

According to the National Cancer Institute, the use of oral contraceptives is associated with increased risk for breast cancer, endometrial cancer and cervical cancer, while it is also associated with a decreased risk for cervical cancer.

The Guardian also reported an outdated claim on the efficacy of fertility-awareness based methods (FBAMs) of birth control, also called Natural Family Planning methods, which FEMM facilitates. The Guardian reported that the efficacy rate of FBAMs is about 75%.

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In fact there are a variety of FBAMs available, each with varying levels of efficacy, depending on the method and the real-life use. For example, the Marquette Method, an FBAM, has been reported to be 89% effective with typical use, compared with an 87% efficacy rate for real-life use of condoms as a birth control method.  

The Guardian reported that implants and IUDs are among the most effective of birth control methods. However, IUDs can also cause some of the most severe side effects, including migration of the device and the perforation of organs.

The Guardian's report noted that a financial supporter of the FEMM app is the Chiaroscuro Foundation, a non-profit whose chairman is Sean Fieler, a wealthy philanthropist and businessman who lives in Princeton, New Jersey, and who has previously backed pro-life politicians and causes in the past.

The mission of the Chiaroscuro Foundation is "to renew in our culture a deep awareness of the composite unity of our shared human nature." According to The Guardian, the foundation donated between $350,000 and $1 million to FEMM each year between 2015-2017, or the majority of its operating budget.

Halpine told The Guardian that FEMM does not comment on abortion, or advocate on political issues.

"FEMM has never commented on the abortion issue. And doesn't work in that area. FEMM is an organization committed to expanding information research and knowledge about women's reproductive health around the world," Halpine told The Guardian.

The Guardian noted that some of FEMM's medical advisors are based in Chile, and are not licensed to practice in the United States.

"The Reproductive Health Research Institute (RHRI) provides FEMM's medical assertions, research and training. The two physicians leading RHRI are listed on its website as Pilar Vigil and Patricio Contreras. Vigil is listed as the medical director of RHRI, which has two addresses, one in New York City and another in Santiago, Chile," the Guardian reported.

"Vigil is listed as an OB-GYN and Contreras as a 'medical doctor', but neither is licensed to practice medicine in the United States," The Guardian noted.

Halpine explained that "FEMM works with medical researchers and providers around the world. Our growing network of health educators and providers in the United States and other countries serves our users worldwide. Our global network is inclusive, and FEMM benefits from the diversity of experience and ideas that our health educators and providers bring to us around the world."

On its website, FEMM provides health center locators and doctor referrals, and lists licensed health centers and doctors located in the United States.