Influencers need to stop encouraging people to get off hormonal birth control, say critics of an upsurge of TikToks (of varying levels of scientific accuracy) that discuss the contraception’s downsides and promote using “natural birth control” methods instead. After all, an unwanted pregnancy, which might be more likely depending on the contraception method, is a risk in the United States, where abortion rights are tenuous and there’s a maternal mortality crisis. Some say women disparaging hormonal birth control on TikTok are “fearmongering”; they’re “playing into the hands of the right.” The timing of viral videos about the downsides of birth control is simply not ideal. Don’t these creators understand the danger?

The opportunity to capitalize on this moment, propelled by the sometimes shady ethics of social media, doesn’t help. There is money to be made from all the uncertainty; influencers with promo codes, for example, endorse alternative contraception options without discussing the downsides. And the false familiarity derived from the parasocial relationships that make social media platforms so engaging can make it difficult to decipher what’s sincere and what’s a sell. With the ease of finding bad information, it’s only natural to ask how we can convince people not to use TikTok for birth control advice or content creators to fact-check their endorsements.

These concerns are fair. But what these critiques miss is the more important question of why people are turning to social media for this in the first place. Sexually active people who want to avoid pregnancy may have a healthcare provider who is transparent about the pros and cons of their contraceptive options—or they may be medically gaslit and told that the side effects aren’t a big deal and can’t be linked to birth control. The reality is that many people are pursuing answers in a system rife with implicit biases against women’s health concerns and a history of prioritizing reproductive ability over personal preferences.

That may lead people to the internet. There, they can encounter sincere testimonies that make them feel finally seen. Many of these TikTokers detail never being told about side effects and doctors uninterested in discussing other options. As a result, they express doubt over contraception choices that are, in essence, pharmaceutical interventions—these creators and their viewers seem to reject the medical establishment because they feel rejected by it. And while critics have characterized antihormonal birth control conversations as irresponsible, people will continue to encounter misinformation or make intensely personal choices based on less than altruistic framing as long as their concerns are dismissed by professionals. Distrust of hormonal birth control may be most obvious online, but it reasonably began in a doctor’s office.

The arguments against hormonal birth control that are now flooding TikTok have been around for a long time, says Kathryn Clancy, a professor at the University of Illinois Urbana-Champaign and author of Period: The Real Story of Menstruation. Birth control side effects—such as acne, weight gain, loss of libido, and mood changes—are documented in numerous studies, though there’s disagreement over the validity of some results. One complication is that the scientific understanding of the underlying mechanisms, particularly of libido and mental health, is limited. “So many life factors can alter them and often birth control takes the blame,” says Aparna Sridhar, an obstetrician-gynecologist and associate clinical professor at UCLA. At the same time, some larger studies have found, for example, a correlation between hormonal birth control and an increased risk for depression and a lower sense of well-being.

Still, side effects are one of the main reasons why people who menstruate don’t use contraception. In a 2021 study, the highest proportion of people who wanted a different method of birth control were those using hormonal birth control; people using nonhormonal methods were six times as likely to be satisfied with their contraception than the opposing group. But because hormonal birth control is considered safe and effective, there’s little effort to create new methods that circumnavigate patient concerns. Women’s contraception preferences are “simply under-studied and under-funded, and unmet needs are ignored and misunderstood by those who could work to address these issues,” reports a 2020 article published in Nature.

Despite these known potential effects, experiences with reproductive health care providers can vary drastically, and conversations in doctors’ offices about these potential side effects aren’t happening often. Providers might not have the training necessary to discuss more patient-specific questions, says Erica Sedlander, an assistant professor of social and behavioral sciences at UCSF. Or they may know the basics of side effects but are unaware about misinformation online and don’t know how to respond.

Furthermore, much of contraceptive counseling focuses on efficacy and pregnancy prevention, sometimes at the expense of other patient priorities. Research also suggests that “personal biases can impede the ability of healthcare workers to fully assess client needs and create barriers to choice.” There can also be presumptions of what a patient wants, especially if they are young, unmarried, or have never been pregnant.

It’s no surprise then that women displeased with their birth control and frustrated by their experiences with doctors found a large audience on TikTok, particularly when there’s declining trust in science. While social media has exacerbated these issues, the sentiment is also the product of a medical community that has long failed to incorporate patient concerns into research, especially when it involves women.

Take what happened when people who menstruate experienced breakthrough bleeding and heavier-than-usual periods after they were vaccinated for Covid-19. People who took part in the vaccine trials were never asked if they experienced these side effects. In turn, when people first reported menstrual changes, they were told they were imagining it—when in reality, there was no data to look to for answers. This fostered vaccine hesitancy.

Critically, early research suggests it wasn’t the vaccine’s side effects specifically that created this apprehension, explains Clancy. It was the feeling of betrayal that emerged from not knowing what to expect. People felt angry and suspicious. “It provoked mistrust because it begged the question of—did you know and not tell us? Or did you know because you didn’t bother to look?” says Clancy.

People are now asking these same questions about their hormonal birth control. It’s important to acknowledge that it’s not wrong to prefer one contraception method over another —even if there is a greater chance of becoming pregnant through, for example, fertility awareness methods over hormonal birth control. It’s also not misinformation for a TikToker to talk about the personal benefits they’ve experienced after stopping hormonal birth control. But social media offers a cornucopia of proposed solutions—and those often come with their own biases. There, different answers are presented as equally credible regardless of scientific accuracy. “There are too many self-proclaimed experts out there on the internet who tend to make assumptions without scientific evidence to back up their claim,” says Sridhar.

For example: fertility awareness methods, which involve tracking one’s menstrual cycle with the aim of knowing when pregnancy is most likely. Fertility awareness methods have emerged as a popular alternative to hormonal birth control. Apps that help with this, like FDA-approved Natural Cycles, can be 98 percent effective with perfect use. For someone who feels that hormonal birth control is affecting their body in unwanted ways, this statistic sounds great. But what most content creators don’t mention—even those being paid to promote it—is that fertility awareness methods are generally 76 to 88 percent effective. In a Guardian article about becoming pregnant after trying Natural Cycles, writer Olivia Sudjic reflects that “I’d used the app in the way I do most of the technology in my life: not quite knowing how it works, but taking for granted that it does.”

While it’s tempting to say influencers and apps are causing unwanted pregnancies, the problem goes much deeper. People on TikTok often portray natural methods in a similar tone as any other internet “hack”—a surprise solution. This partly has to do with the way people talk online, but it’s also a result of health care professionals not having serious conversations about all contraceptive options and their potential side effects. Complete transparency from providers about side effects and clearly explaining contraception options would “solve a lot of problems,” Sridhar says. “Over the years, I have realized that thorough counseling about safety, side effects, and benefits are just as important as the instructions for usage.”

Contraception counseling would also benefit from including information that reflects social norms and concerns—there’s a clear disparity between the information people want and the information they’re given. Research also suggests intellectual humility can foster trust, so it’s critical to evaluate why there isn’t data to support a patient’s claim—has it been disproved, or has it not been tested?

Another glaring issue is the lack of funding and research into new birth control options, says Bethan Swift, a PhD candidate studying women’s and reproductive health at the University of Oxford. Many people feel failed by their options, says Swift, yet there’s little effort to examine the issue further.

Of course, these changes won’t happen overnight. In the meantime, digital health reforms, spurred by the medical community, could also help ensure that people who do go hunting online for more options encounter accurate and transparent information about contraception. Apps that “approximate healthcare without the professional competency, fiduciary duties, legal protections, and liabilities” need to be transparent about the pitfalls. The FDA could arguably provide needed pressure: Because most medical apps don’t treat disease, they aren’t FDA-regulated. But the FDA does regulate apps that pose a risk to the public, and with the downfall of Roe v. Wade, apps that could spur unwanted pregnancy could be viewed as a risk.

A birth control backlash could result in increased unplanned pregnancies, and the consequences are made more complicated by America’s political climate and unsatisfactory health care. This is also happening at a time when medical professionals are experiencing severe burnout and threats. It’s unfair to point at this group and say, “Fix this.” But at the same time, an improved approach to discussing and providing reproductive health care is necessary for people who use contraception. And earning trust can lead to better health care outcomes.

Helping people make medical choices that empower them—and that are based on unbiased, clear information—could yield lessons for how to regain trust in medicine more generally. The claim that content creators are responsible for the consequences of not being able to get an abortion echoes the mistake of making Covid-19 an issue of personal responsibility rather than a public health emergency. “The fact that hormonal birth control is an unsatisfying option for a significant portion of people is not a me problem or a you problem,” says Clancy. “It’s an us problem.”