We are constantly hearing about the “contraception crisis,” and how there is an alarming decline in contraception use in the UK. But to what extent is this true? To help answer this, I spoke with Dr. Rose Stevens, a Postdoctoral Research Fellow at the NIHR Policy Research Unit for Reproductive Health (RH-PRU), based at UCL’s Institute for Women’s Health.

Stevens has been interested in the field of contraception since her undergraduate dissertation, seeing it as “the perfect intersection between medicine, sex, gender, politics and history.” “It has so many angles to be able to fully understand it,” she continued, commenting on the existing problems in the study of contraception in the UK. There seems to be a long way to go, as “no one is measuring side effects very well. It’s been several years of quality interview studies of women saying they’re having a hard time getting people to take them seriously.”

“It has so many angles to be able to fully understand it”

Reflecting on contraception misconceptions, Stevens considers terms like “myth” to be harmful, as they dismiss women’s concerns without providing real reassurance. “You’re still going to be worried,” Stevens argued, emphasising that “no fear or belief is necessarily wrong,” particularly if it is negatively impacting someone’s life. Contraception impacts everyone differently, and medical research must reflect this to improve support and empower informed choices.

Stevens underlined the significant role that social media, especially TikTok, plays in influencing contraception choices. While “there is a lot of great content out there, which makes things very accessible and digestible,” “the length of the video, and the algorithms” is where social media “falls down”. There is a shock-factor which platforms try to achieve, by “promoting things that are dramatic or scary, and pushing them to the fore”.

Through her social media content analysis, Stevens discovered that the videos are “often just five or six seconds long,” and “all nuance and education are lost”. While it might “feel quite validating” for women who feel dismissed by medical professionals, there is an underlying danger to resorting to this kind of content. It can intensify someone’s existing anxiety, and lead others to question their own use of contraception. Seeing women share horror stories of their experiences leads many to wonder, “should I be worried too?“.

Yet, despite these persisting issues, Stevens remains optimistic for change. She considers there to be a “cultural movement at the moment, so hopefully the research is coming”. We can see this progressive shift in recent discourse surrounding male contraceptive methods, with Stevens arguing that “some men would probably appreciate” the ability to avoid “unintended pregnancies”. Stevens observed that, “for the last 20-30 years, all of the contraceptives that we have now are effectively variants on each other,” differing only in their “modes of delivery”. This doesn’t constitute real “innovation,” but she recognises this in pioneering initiatives, such as those taking place in Copenhagen.

“Stevens hopes ‘women will feel more supported to make the decisions that they want to make’ about their own bodies”

Here, The Index Project is developing a small gel capsule called OUI, a potential on-demand form of contraception. This would be ideal for somebody who is “not having sex often,” and could look to this alternative form of contraception which “acts locally”. With “more investment” into experimental projects, Stevens believes that “we’d be in a good place”.

Indeed, Stevens expressed her scepticism at claims of a drastic decline in contraceptive use in the UK, highlighting serious gaps in the data to support such assertions. A lot of this coverage derives from “a paper published by BPAS, a British Pregnancy Advisory Service” which is “one of the biggest abortion providers in the UK”. This charity has noticed “an increase in abortions, alongside a drop in the number of people using contraception at abortion.”

While superficially there seems to be a direct correlation between declining use of contraception and a rising number of abortions in the UK, the reality is more complex. “Abortions have become much more accessible because of COVID and telemedicine. This means that more people who were having unplanned pregnancies are now able to get abortions, but it doesn’t necessarily mean people are not using contraception.”

We currently “don’t have any data on how many people in the UK are using contraception at one time,” Stevens continued. “There isn’t routine health data collection on that, which is something we should be advocating for.” Instead, what is currently available is prescription data, which comes with severe limitations. For example, “the number of contraceptive prescriptions might be going down because more people are getting longer prescriptions,” eliminating the need for routine pharmacy visits. Alongside this, “the coil prescriptions are going down,” but this shift comes alongside “new guidance which means the coil now lasts for eight years, instead of the previous five.”

When examining this data, we must also consider Gen Z – a generation often described as embracing sobriety and turning away from the party lifestyle. With this in mind, Stevens also questioned “are people having sex? Do they need contraception?“. It’s this plethora of elements which come together and make it increasingly difficult to form a comprehensive idea of contraceptive use in the UK. This is something Stevens’ project hopes to address.

Looking to the future, the campaign aims to underline the need for routine health data collection to include contraception, and to note their side effects. It is through this project, and investing into more research, that Stevens hopes “women will feel more supported to make the decisions that they want to make” about their own bodies.

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