【Schoolmistress 2】

Emily Pfender enjoys following health and Schoolmistress 2fitness social media influencers online. But the doctoral student, who studies health communication at the University of Delaware, couldn't help noticing that some of those influencers kept bringing up a specific subject: discontinuing their hormonal birth control.

She found that YouTube vloggers, in particular, produced content about their experiences with contraceptives and what's known as natural family planning or fertility awareness methods. With this approach, people meticulously track their menstrual cycle, sometimes using an app, in order to know when they might become pregnant. Compared to hormonal birth control, which is effective 90 to 99 percent of the time depending on the type, fertility awareness methods are effective from 77 percent to 98 percent of the time.

In other words, making the switch from hormonal contraception to fertility awareness methods can be a considerable gamble, and influencers talking about the topic didn't always include accurate or complete information.

Pfender wanted to know if more influencers were sharing similar content, so she set out to study the question. Her findings appear in a new study published in Health Communication. The results suggest that followers may be misled by influencers who are eager to share their own journey, even if their insights could lead to unwanted or unplanned pregnancy for someone else.

"What makes the influencers so persuasive is that people just find them so relatable and so authentic," says Pfender. "'If this works for them, it must work for me,' is the kind of thinking, but that's not always the case."

A big opportunity for influencers

Pfender and another researcher watched 50 YouTube vlogs posted by accounts with at least 20,000 followers between December 2019 and December 2021. The average account had nearly 400,000 subscribers. The researchers categorized vloggers' comments about birth control and found that most influencers wanted to discontinue hormonal contraception to "be more natural" and to improve their mental health. Many forms of birth control contain naturally occurring hormones that prevent ovulation. Some research indicates there's a small increased risk of depression linked to using hormonal birth control, while other studies show that's not the case.

The debate over this topic, along with the understandable urgency people feel to make choices that boost their mental health and well-being, creates a big opportunity for influencers to portray fertility awareness methods as the answer.

But Pfender found that influencers didn't always share comprehensive or accurate information. For example, some influencers mentioned using Daysy, a hormone-free fertility tracking product, and touted it as highly effective without mentioning that, in 2019, the study used to prove its efficacy was retracted because of methodological flaws.

Influencers also often omitted more detailed information about fertility awareness methods, which are less effective for women and people with irregular or unpredictable menstrual cycles and those with abnormal uterine or cervical bleeding. The practices are most effective when people strictly follow the guidelines, which include measuring basal body temperature and the viscosity of cervical fluid every day at the same time, in addition to refraining from sex or using a barrier method on their most fertile days. Pfender says influencers would acknowledge keeping a thermometer at their bedside table, for instance, but gloss over the important details of how and when to use it.

Pfender also found that only 20 percent of the influencers adopted any form of birth control after discontinuing hormonal contraception, suggesting they were comfortable with the possibility of an unplanned pregnancy. Since many of the influencers were financially stable and married or in committed relationships, this risk might make sense for them, but perhaps not for younger followers who might lack job, housing, or relationship stability.

"It can be problematic," says Pfender.

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She recommends that followers watch this type of content with a "grain of salt" and keep in mind that birth control is "an incredibly personal choice" that depends on a person's lifestyle.

How to make the choice that's right for you

Dr. Gillian Sealy, Ph.D., chief of staff of the reproductive and sexual health nonprofit organization Power to Decide, is encouraged by the frank conversations about contraception on social media, but says Pfender's study points to the importance of getting accurate information from more than one place.

Sealy, who holds degrees in health science and public health, recommends consulting a health care professional, including those at a community health clinic or Planned Parenthood, who will listen, provide accurate and trusted information, and offer alternatives. She also suggests sites like Power to Decide's Bedsider.org, whose target audience is 18- to 29-year-olds, for comprehensive and vetted sexual and reproductive health information, including contraception.

Sealy is aware of the growing interest in non-hormonal birth control. She says that social media influencers are elevating the topic by talking about their reproductive health. Additionally, people may be more curious about it when they encounter barriers to accessing birth control as states pass laws that target certain types, including intrauterine devices and emergency contraceptives. She understands that young viewers can feel a "kinship and connection" to influencers who share their own sexual health experiences, but wants them to know that everyone's choices might look different.

"Let's be honest: People's birth control and contraception journey is different for everyone," says Sealy. "Young people especially need to understand that all methods aren't created equal. It's not a one-size-fits-all approach."