The pill hasn't been improved in years. No wonder women are giving up on it

The Guardian

22-02-2025

Something is changing when it comes to contraception. Lots of people aren't using it. Last week we heard that this includes a third of young Irish people. Meanwhile, there has been a significant rise in abortions in England and Wales. Prescriptions for the contraceptive pill in England dropped from 432,600 in 2014 to 188,500 in 2021. And this month data from abortion clinics found that demand is being fuelled by women coming off the pill and using natural methods instead.
When the study compared contraception used by women seeking abortions in 2018 and in 2023, it found that the proportion using smartphones to track their menstrual cycle had increased from 0.4% to 2.5%. The use of hormonal contraception among this group fell from 19% to 11%, while the group not using any form of contraception when they became pregnant increased from 50% to 70%.
Why? When it comes to the declining popularity of birth control, two factors are at play. One is a conservative backlash against it, starting in America. Alex Clark, a pro-Trump media personality, has called the birth control pill 'poison' and said it will cause 'issues with fertility' later in life. She has even suggested it can 'falsely make women feel bisexual' – claims that are all untrue. And conservative commentator Candace Owens has denounced the pill and intrauterine devices as 'unnatural'. Elon Musk has tweeted that hormonal birth control 'makes you fat, doubles risk of depression & triples risk of suicide'.
Colliding with this is the wellness movement, which has a history of advising people to treat themselves with 'natural' rather than medically proven methods. As the media landscape splinters, individual voices gain power to persuade. Videos on TikTok and Instagram, many exaggerating the side-effects of the pill, gain millions of views. Then there are individual bad experiences that may gain disproportionate attention, giving the impression that birth control is more dangerous than it is.
Public health leaders are trying to combat these forces – the NHS has warned that misinformation about the pill on social media, especially a false claim that it causes infertility, is putting women off. But there's another, underlying problem when it comes to contraception: it needs to improve.
Many are deeply dissatisfied with the contraceptives we have. Bad information aside, condoms fail, IUDs are invasive and can be painful to implant, hormonal methods have side-effects such as headaches, weight gain, acne and depression. Of women who take the contraceptive pill, about a third stop in the first year, many due to health concerns and worries about side-effects.
The cultural battle over contraception is largely focused on whether people should abandon existing methods, or whether that is irresponsible advice. But there's another question we should be asking. It's common for women to be using the same methods as their mothers – or even their grandmothers. Why aren't contraceptives getting better?
There is certainly appetite for new ideas. New products are often greeted with excitement: when Lo Loestrin, a hormonal pill with lower oestrogen, was introduced in 2011, it quickly became popular. But, oddly, there seems to be little appetite for developing it. Research has centred on small improvements to existing contraceptives. There were just 20-25 industry-funded clinical trials between 2017 and 2020, compared with 600 for cardiovascular drugs in 2019 alone. While pharmaceutical companies tend to plough 20% of their sales revenue back into research and development, for contraception it is 2%. Funding is limited, propped up by the public sector.
Why isn't more work being done to improve contraceptives? Part of the problem is that when you give a drug to a healthy population, the safety requirements and litigation risks are higher, which may put investors off. Worldwide, the contraceptive market is still growing, despite dissatisfaction; many women are just accepting the trade-offs. This means there has been no big market signal that things need to change.
But the history of contraception reflects the culture at large. While conservative forces are trying to push women off the pill by claiming it is dangerous, it was they who stymied research in the first place. Underlying this, too, is an expectation that women will put up with significant side-effects. As long as contraceptives work, unhappiness is ignored or underplayed.
There is hope on the horizon. While women's contraceptives have stagnated, a new range of imaginative treatments is on the way – for men. One, for example, is a gel that works to block fertility when smeared on the arms and shoulders, without affecting mood or libido.
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While female side-effects are considered acceptable, given they are weighed against the risks of pregnancy, researchers conducting trials do not think men would accept the same bargain. In 2011, a male contraceptive trial was halted when it emerged that side-effects included mood swings and depression – commonly experienced by women on the pill.
Nevertheless, the arrival of better contraception for men could make things easier for their female partners who don't like the options available. Innovations for men could also cross over into solutions for women, as the bar for safety and effectiveness is raised.
There is the risk, too, that, as male contraceptives suck up airtime and funding, women's will continue to fall behind: almost half of pregnancies around the world are unintended – a high proportion of them in places where birth control is accessible. The need for change is urgent.
Martha Gill is an Observer columnist