The pill makes some women miserable. But are they really quitting it en masse?

The pill has a reputation as a reliable, if flawed, form of birth control. Photo / Eric Helgas, The New York Times

The woman in the video looks resolute, and a little sad, as she cuts up a pack of birth control pills. “These silly little pills have literally ruined me as a person,” reads the caption. The clip, which is on TikTok, has 1.1 million likes. It’s one of thousands that have proliferated on social media in recent years with virtually the same message: the pill causes terrible, sometimes irreversible side effects, and women should free themselves from it.

Anecdotal reports from news outlets have suggested that women are quitting the pill in large numbers because of this type of online post. “We’ve known for a long time that people really rely on their social circles to help them with medical decision-making as it relates to contraception,” said Dr Deborah Bartz, an obstetrician-gynecologist at Brigham and Women’s Hospital. Against a backdrop of increasingly restrictive abortion access, the idea that women might be giving up a reliable form of contraception because of social media hype has concerned researchers and doctors.

But, according to initial data, prescriptions for the birth control pill are not actually declining at all. An analysis by Trilliant Health, an analytics firm that provides healthcare companies with industry insights, found that usage has been steadily trending upward in the United States; 10 per cent of women had prescriptions in 2023, up from 7.1 per cent in 2018. The analysis looked at prescriptions for the pill that were written and picked up. Even among those ages 15-34, who would be most likely to see negative social media posts, Trilliant found prescriptions had increased.

Growing mistrust

The pill has a reputation as a reliable, if flawed, form of birth control. Its known side effects — including blood clots, weight gain, a loss of libido and mood disruptions — have in fact been the main reason that some women do eventually quit the pill, Bartz said. When patients raise those concerns with physicians, they are often dismissed, she added, which can erode people’s trust in their doctors and in healthcare institutions.

Online, that mistrust has bloomed. In two separate papers, published in 2021 and 2024, Bartz analysed the tone of birth control-related posts on Twitter. In the first study, researchers found that almost one-third of posts about the pill from 2006 to 2019 were negative. In the second study, the team found that one of the major focus points of posts about the pill was its side effects. Another analysis from 2023 found that 74 per cent of a sample of YouTube videos posted between 2019 and 2021 discussed discontinuing hormonal birth control methods because of side effects.

But the side effects of the pill don’t override its utility for many women. It is often seen as an easy point of entry for people newly considering continuous birth control because it can be started and stopped at any point, rather than requiring a painful procedure, said Dr Cherise Felix, an obstetrician and gynecologist at Planned Parenthood’s south, east and north Florida chapters.

It is also more than 90 per cent effective at preventing pregnancies and can be used to help manage a range of health conditions, like endometriosis and polycystic ovarian syndrome.

‘Better-quality discussions’

What the analysis from Trilliant also underscores is that perhaps women are not so easily swayed by what they see online, said Felix, who reviewed the findings but was not involved in the analysis. If anything, they end up discussing it with their doctors to make more informed decisions. “I have not once had a patient start a conversation with, ‘I stopped using my birth control because I saw this on TikTok,’” Felix said. “But I can tell you that just over the course of my career, I am having better-quality discussions with my patients.”

Several experts also pointed to increasingly restrictive abortion laws as a reason for the pill’s staying power in the US. Trilliant’s analysis found that nine states with some of the most restrictive abortion laws saw bigger-than-average growth in prescriptions. For example, in Alabama, where abortion is completely banned with few exceptions, and South Carolina, which restricts abortions after six weeks, prescriptions increased by almost 5 percentage points between 2018 and 2023, compared with a national increase of 3 percentage points in that same time frame.

Women began stocking up on the birth control pill after the June 2022 Supreme Court ruling that ended the constitutional right to abortion, said Julia Strasser, director of the Jacobs Institute of Women’s Health at George Washington University and co-author of a recent study looking at contraception use. In 2019, roughly 32 per cent of initial prescriptions were for more than one month; by 2022, more than half of initial prescriptions were for a greater supply of “two months, three months, six months and sometimes even 12″, Strasser said.

So if more women are relying on the pill, why does social media seem to tell a different story? One explanation, Bartz said, is what’s known as a negativity bias. Consumers are “much more inclined to complain and say, ‘Oh, my gosh, let me tell you about all this bleeding that I’m having on my pill,’ or, ‘Let me tell you about my weight gain’”, she said, and far less likely to post positive reviews.

She’s seen something very different in her clinical practice: patients valuing their birth control options more than ever. “Post-Dobbs,” Bartz said, “there has been a heightened recognition of the need to be very proactive in preventing pregnancy.”

This article originally appeared in The New York Times.

Written by: Alisha Haridasani Gupta

Photography by: Eric Halgas

©2024 THE NEW YORK TIMES