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 health care companies with industry insights, found that usage has been steadily trending upward in the United States; 10 percent of women had prescriptions in 2023, up from 7.1 percent in 2018. The analysis looked at prescriptions for the pill that were written and picked up. Even among those aged 15 to 34, who would be most likely to see negative social media posts, Trilliant found prescriptions had increased.
The analysis was done at the request of The New York Times, and drew on Trilliant’s database of medical and pharmacy claims. It looked at a nationally representative sample of roughly 40 million women, aged 15 to 44, who used either Medicaid or commercial insurance. It doesn’t account for people who might get their birth control from telehealth providers that don’t take insurance, but that group most likely represents a small slice of the American population, said Sanjula Jain, chief research officer at Trilliant. Several of those telehealth companies also reported double-digit increases in birth control pill purchases in the past two years. The data also doesn’t include sales of the over-the-counter birth control pill, Opill, which has been available in stores in the U.S. since March.
Ten percent of women had prescriptions for the pill in 2023, up from 7.1 percent in 2018.
Source: Trilliant Health
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, Dr. 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 health care institutions.
Online, that mistrust has bloomed. In two separate papers, published in 2021 and 2024, Dr. Bartz analyzed the tone of birth control-related posts on Twitter. In the first study, researchers found that almost a 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 percent 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 percent effective at preventing pregnancies, and can be used to help manage a range of health conditions, like endometriosis and polycystic ovarian syndrome.
What the analysis from Trilliant also underscores is that perhaps women are not so easily swayed by what they see online, said Dr. 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,’” Dr. Felix said. “But I can tell you that just over the course of my career, I am having better-quality discussions with my patients.”
Nine states with some of the most restrictive abortion laws had bigger-than-average growth in pill prescriptions.
Source: Trilliant Health
Several experts also pointed to increasingly restrictive abortion laws as a reason for the pill’s staying power. 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 percent 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,” Dr. Strasser said.
So if more women are relying on the pill, why does social media seem to tell a different story? One explanation, Dr. 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,” Dr. Bartz said, “there has been a heightened recognition of the need to be very proactive in preventing pregnancy.”
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