For decades, the contraceptive pill was seen as a symbol of women’s liberation and of the ability to separate sexuality from motherhood. Its introduction gave millions of women greater control over when they wanted to have children. In recent years, however, pill use has declined in several countries, reflecting both concerns about possible side effects and changing attitudes toward contraception and the body.

In France, where the pill was legalised in 1967 and became the most widely used contraceptive method for many years, the proportion of contraceptive users aged 18 to 49 who relied on the pill fell from 55.8% in 2005 to 26.8% in 2023. In the same year, intrauterine devices (IUDs) became the most widely used method, at 27.7%. A similar trend has been observed in Germany, where pill use among women under 22 fell from 43% in 2015 to 22% in 2024.

The decline in pill use has several explanations. According to experts interviewed by RFI, a generational shift is an important factor. For earlier generations, the pill represented a major change at a time when there were fewer contraceptive options and access to abortion was much more difficult. Younger generations have grown up with a wider range of contraceptive methods and are therefore less likely to view the pill as the automatic standard choice.

Concerns about the risks associated with hormonal contraception have also affected trust in the method. In France, a controversy surrounding third- and fourth-generation pills led to a significant decline in use from 2012 onwards following reports about increased risks of thrombosis. More recently, France’s medicines safety agency warned users of desogestrel-based contraceptives about an increased risk of meningioma. Although the absolute risk remains very low, the warning has prompted some women to reconsider their contraceptive choices.

At the same time, more women say they want a different relationship with their bodies and want to reduce what some describe as the “mental burden” of taking a pill every day. Discussions on social media increasingly focus on wellbeing, mood, menstrual cycles and the desire to better understand the body.

Experts stress, however, that declining pill use does not mean that hormonal contraception has become unsuitable. For many women, hormonal contraceptives continue to have a favourable balance of benefits and risks and can provide additional medical benefits, including for heavy menstrual bleeding, endometriosis or adenomyosis. At the same time, hormone-free methods such as the copper IUD are not suitable for everyone. Contraceptive choices need to take into account each woman’s individual circumstances and preferences.

The changing perception of the pill therefore highlights the importance of contraceptive counselling based on accurate information and individual choice. No single contraceptive method is suitable for everyone. Decisions should take into account the benefits, risks, preferences and circumstances of each person. As specialists quoted by RFI point out, the best contraceptive method is ultimately the one chosen by the person using it, with adequate information and support.

Original source: RFI, https://www.rfi.fr/en/science-and-technology/20261004-the-pill-from-symbol-of-women-s-liberation-to-spread-of-mistrust