Op-Ed | Birth Control Has a TikTok Problem

Myths about birth control are as old as the hills. But social media platforms, in particular TikTok and Instagram, are allowing false information to proliferate in new and dangerous ways.

The stakes are high. The twin forces of birth control-related misinformation, often from women sharing their personal experiences, and disinformation, typically posted by right-wing activists hiding their true agendas, is happening at a time of ever-shrinking access to abortion care in the US.

Physicians need to stay on top of what’s circulating so they know what might be influencing their patients’ views of contraception. The trend should also be a wake-up call: Women clearly feel their concerns aren’t being taken seriously by the medical establishment, and they are clamouring for more nuance in conversations about birth control. If doctors don’t step in to offer more knowledge and understanding — whether that’s in an exam room with a patient or as a trusted voice on social media — the void will be filled with potentially unreliable, biased and even downright dangerous information about contraception.

Women sharing their experiences about birth control isn’t a new phenomenon. They have always looked beyond their doctors for advice, and word of mouth, whether that’s an experience shared by a family member or friend, can be a powerful persuader.

But the women talking about it aren’t typically the ones who are happy with their birth control; it’s the ones who have had a bad experience that are more apt to share.

Social media, particularly TikTok, has amplified these anecdotes on a previously unfathomable scale. Once someone has interacted with one or two videos, the algorithm keeps pushing more, easily skewing perceptions of the risks of a particular form of birth control.

A group of family planning researchers from Harvard Medical School recently analysed the content of 700 videos tagged with some of the most popular birth control-specific search terms and found more than half touched on patients’ experience and the logistics of using a particular method of contraception. Those videos had received 1.18 billion views and had been shared 4.1 million times.

Another recent study, from researchers at Duke University Medical Center, found distrust in health care providers to be a common theme in the top 100 videos tagged with #IUD, which had 471 million views and 1 million shares. Creators often discussed the pain of having the device inserted, saying they felt gaslighted or lied to about the process, says Jonas Swartz, who led the Duke study.

The disconnect between patients’ experiences and doctors’ communication about IUD insertion is a problem. Since running the IUD study, as well as others that looked at topics like medication abortion and IVF, Swartz approaches interactions with patients differently. He asks his patients if they have seen anything on social media and how they feel about what they heard. “It really is important to start out the conversation if nothing else with an acknowledgement that a patient has some education about the device or treatment you’re going to offer,” he says.

The Duke and Harvard studies, as well as other efforts to understand how social media is influencing views of contraception, are critical to understanding the scope of the problem and crafting strategies to improve communication with patients.

When patients come in after absorbing content on social media, it’s important to “break down those walls,” says Michael Belmonte, an ob-gyn and complex family planning specialist and fellow with the American College of Obstetricians and Gynecologists. Don’t get defensive or simply spit out facts, “but really start a dialogue so we can come to the best decision for them.”

But there’s a problem: Doctors can only have those conversation with the patients they see. An unchecked narrative that hormonal contraception is “unnatural” or unsafe, or that IUDs are problematic, might dissuade women from even considering those forms of birth control, which are the most effective with typical use.

Social media trends suggest that already could be happening. In the past two years, posts on TikTok and Instagram from women abandoning IUDs and daily pills in favour of “natural” birth control have proliferated. In the worst-case scenario, “natural” means an unproven supplement, which could be not only ineffective but potentially harmful. In the best-case scenario, “natural” means using a fertility-awareness methods, tracking ovulation to avoid intercourse or use a backup method on days when a pregnancy is most likely to occur.

Women have always used cycle tracking, though the process has been modernised with a bevy of apps, including one with Food and Drug Administration clearance. But the approach requires significant rigour to get right and isn’t a good fit for everyone.

“I am unaware of a single person who has been able to use natural family planning in the long term,” meaning women either got pregnant or moved on to another contraceptive method, says Deborah Bartz, an obstetrician-gynecologist at Brigham and Women’s Hospital in Boston and lead author of the Harvard study. That’s backed up by the data: Fertility awareness has a 24 percent failure rate (put another way, that adds up to 24 pregnancies per year for every 100 users) with typical use.

One fact that family planning experts emphasised to me over and over again: Roughly half of the women who get an abortion say they had used some form of birth control during the month they got pregnant.

In other words, any drop in use of birth control increases the risk of unintended pregnancies. That’s a scary thought at a time when abortion is banned in 13 states and counting.

Birth control is a very personal decision, and identifying the method that works best for an individual can require some experimentation. That is best done when a doctor, not social media influencers, guides those choices.

Women, meanwhile, should remember to be smart consumers of social media. When fed a video about the dangers of hormonal birth control, ask whether the content comes with a hidden agenda — is it trying to sell a product or pushing a political agenda?

And even if the information is well-intentioned, women should always do their own vetting — the consequences of bad advice are too grave to put one’s health in the hands of an influencer.

By Lisa Jarvis