The decline of the contraceptive pill

Since the 1960s, the contraceptive pill has been hailed as the gateway to sexual liberation and female empowerment – and has prevented millions of unwanted pregnancies.

But in the UK, many women are now turning away from the pill, due to a social-media disinformation, difficulty accessing health appointments, and growing fears of potential side effects.

Female use of hormonal contraception fell from 19% in 2018 to just over 11% in 2023, according to a study of tens of thousands of women in England and Wales, published in BMJ Sexual and Reproductive Health. These findings echo NHS data showing the percentage of women using the pill as their main form of contraception fell from 47% in 2012-13 to 27% in 2022-23.

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The BMJ study not only highlights a shift away from methods like the pill but also a "significant" increase (70%, up from 56%) in women using no contraception at all. There's also been a smaller increase (from 0.4% to 2.5%) in reliance on "fertility awareness-based methods", such as fertility-tracking apps.

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Difficulty accessing health services may be a factor driving the decline, according to the study authors. More than half of England's sexual-health clinics were forced to close during the pandemic, and remaining services are now "at breaking point", thanks to understaffing and lack of funding, the Local Government Association warned in January.

Waiting lists for gynaecological appointments have more than doubled since 2020 – faster than any other NHS service. It is also increasingly difficult to access a GP, leaving many women waiting "months" for contraceptive appointments, "especially for long-acting methods like the coil and the implant", Tanya Lane, contraception lead at abortion-care provider MSI Reproductive Choices UK, told the BBC.

The sharp fall in prescriptions for the combined contraceptive pill, recorded by the NHS in 2020-21 could be explained by the progesterone-only pill (the "mini-pill") becoming available over the counter at pharmacies.

But it's clear that growing numbers of women are also coming off the pill because of misinformation on social media, the NHS warned last year. Videos spread myths that the pill "causes infertility and cancer", with influencers claiming the pill is "this generation's cigarettes", said The Times.

There is a "growing awareness of side effects of the pill", which can include mood swings, headaches, irregular bleeding, acne, a minimal increase in risk of breast cancer and, in "extremely rare cases", blood clots. But "doctors say", according to the paper, that "many TikTok claims are wildly exaggerated or simply untrue".

"Online misinformation about the pill and other forms of hormonal contraception is a real cause for concern," said Dr Sue Mann, NHS clinical director for women's health. "We're seeing a trend towards women going without contraception," she added, which might explain why the abortion rates in England and Wales are at their highest level on record.

'Back-to-nature' family planning

The increase in the use of 'natural' methods of contraception, such as relying on fertility apps to tell you when you're unlikely to get pregnant, "needs investigating", said the BMJ study authors.

"The market has exploded," lead researcher Rosie McNee told the BBC. "There are hundreds of them, and some are more reliable than others. You don't need a prescription, and so you may not get all the information you need."

NHS data also suggests that the number of women relying on "fertility awareness" as their main method of contraceptive has doubled over the past decade (although overall use remains far lower than any other method). "Natural family planning" was most popular among women aged 25-34, reported the Daily Mail.

An important caveat: the NHS figures come from NHS sexual-health and reproductive service settings, and don't include responses from women who source contraception from a GP or pharmacy, so "only represent a snapshot". But "we have seen an increase in women turning to natural family planning recently", said Janet Barter, president of the Faculty of Sexual and Reproductive Healthcare.

"Dozens of celebrities" have raved about the benefits of apps such as Natural Cycles, said the Mail, and "hailed them 'the golden ticket'". Social media is also "littered" with influencers highlighting "the supposed benefits of binning traditional contraception as part of the 'back to nature' movement".

"The numbers of women relying on apps may be increasing, but many of these tools are not supported by high-quality, evidence-based research," said Katherine O'Brien of the British Pregnancy Advisory Service. That said, the rise in interest is "an understandable consequence of the woeful lack of innovation in contraception over the last 50 years".

"Rather than criticising women for exploring new options, we should be asking ourselves why there has been so little innovation in this essential area of women's healthcare."