“Birth control is this generation’s cigarettes,” says a woman on TikTok. “When women start taking the pill they get massively depressed,” says another. “It’s a class-one carcinogen,” continues the feed. “It was 99.9% effective in ruining my life.” Then there’s the meme of a woman unfolding a contraceptive pill side-effects warning leaflet, as large as a bath towel. Meanwhile those who have come off hormonal contraception and turned to fertility awareness apps give the impression of a world of joy and rainbows – and no accidents.
There’s a seismic shift going on in contraception, and health professionals are scrambling to catch up. The TikTok health claims above are wildly exaggerated and often incorrect, but that’s not stopping a generation of women, trans and non-binary people binning their pills. The latest abortion rate in England and Wales is 19 per 1,000 women and growing, the highest it has been since legalisation in 1967 – and in Scotland it is 16 per 1,000, but terminations are up 19% year on year there, with a rise among teenagers too. Some doctors have suggested that social media is to blame for the rise in abortions, as women turn away from the pill.
That’s dramatic, but it’s only part of the truth. Abortion providers such as MSI Reproductive Choices have told me that the cost of living crisis has meant more women in their 30s are having abortions, often those who already have children. Plus the public health grant to local councils used to fund sexual health services was slashed by more than £1bn – 24% – over five years up until 2021. Freedom of information requests reveal contraceptive coil-fitting waiting lists of months in the UK, and up to a year in parts of Devon and Northern Ireland.
So it’s a perfect storm – a crumbling contraceptive service, economic deprivation and growing social-media conspiracy theories around the pill. Over the last 60 years, the advent of reliable contraception has brought women into education and the workplace as never before, and rescued millions from debilitating period pain, gargantuan bleeds and other miserable conditions – as well as increasing the joy of sex.
But it is clear, as voices are amplified on TikTok and Instagram, that women feel they have been gaslighted about the side-effects and risks of hormonal contraception. They need somewhere to scream. While the medical textbooks give a fairly cursory mention to “mood swings” or “lowered libido”, a poll of 4,000 diverse women for the documentary Davina McCall’s Pill Revolution, which I produced this year, showed that 77% of pill users had experienced side-effects, 57% were worried about their mental health on hormonal contraception, and a third reported anxiety, depression or low mood on the pill – and that was the main reason for giving it up.
I’m just finishing an investigative book on contraception, and I want to weep when women tell me their stories of being “popped on the pill” for acne as an adolescent, and – like a frog slowly being boiled alive – not realising until years have passed that a particular pill has turned them into a different person: fatigued, depressed and stressed. Sometimes their relationships and libidos crash, too – 21% in our poll reported lowered sex drive on the pill, as well as pain around the vulva, thanks to the lack of natural hormones.
Most people choosing to go on the pill or have an implant or injection are schoolgirls: 64% start hormonal contraception as teenagers, and TikTok is infinitely more powerful than a one-hour sex education class. They’re watching Love Island influencers using the Natural Cycles app, measuring their basal body temperatures every morning, and staying miraculously free of synthetic hormones and pregnancies.
Jennifer Takhar at the ISG International Business School in Paris recently published a paper on the reasons behind falling pill prescription rates in western Europe, and says: “Our research shows that peers on social media are influencing young women’s choices, and reshaping perceptions of risk and side-effects, and at the same time social media is delegitimising the authority of health professionals.”
Takhar’s team interviewed women in Denmark and Germany about their growing concerns voiced on social media, and the trend towards fertility awareness methods and “green sex”. While the English hashtag is often #quittingbirthcontrol, the Germans have coined a portmanteau word: #Pillenmüdigkeit – or pill fatigue. Despite the pushback online, the German abortion rate is only six per 1,000 women – far, far less than the UK. So what are we doing wrong?
I think not listening to women’s lived experiences is a huge problem, yet as we know, doctors have no time. The received wisdom is that women should try a pill for three months “until it settles down”, but we need to be more responsive and ready to help women change brands and methods quickly. Our poll showed almost a third of women could not name the pill they were on, and most have no idea that each synthetic progestin has a different effect – some are more androgenic and masculinising, and some are more estrogenic and feminising. It’s sometimes worth asking for a different brand.
Also, the contents of the pill, implant, injection, coil, vaginal ring and patch are all synthetic progestins, and sometimes synthetic estrogens, many of which have not changed much for half a century. There are newer and apparently better-tolerated pills available that contain body-identical estrogens (but synthetic progestins); the three in the UK are Zoely, Qlaira and Drovelis. These cost the NHS around £8 a month compared to about £2 for the older pills, so the authorities are not racing to prescribe them.
We need to make our voices heard and ask for better – and more honest – medical information about hormonal contraception and side-effects, or else TikTok will continue to drown out doctors. Surprisingly, the government would like to hear more, and Prof Lesley Regan – the gynaecologist and women’s health ambassador who is targeting gender inequalities in the system – is asking women to participate in a women’s reproductive health survey that is now open for comments. We have fought for period power – now we need pill power, too.
Kate Muir’s book Everything You Need to Know About the Pill is published next year
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