Dis-Information

It's going to get worse before it gets better.

And we're all going to need smarter friends and family members.

Search for birth control on TikTok or Instagram and a cascade of misleading videos vilifying hormonal contraception appear: Young women blaming their weight gain on the pill. Right-wing commentators claiming that some birth control can lead to infertility. Testimonials complaining of depression and anxiety.

Instead, many social media influencers recommend “natural” alternatives, such as timing sex to menstrual cycles — a less effective birth-control method that doctors warn could result in unwanted pregnancies in a country where abortion is now banned or restricted in nearly half the states.

Physicians say they’re seeing an explosion of birth-control misinformation online targeting a vulnerable demographic: people in their teens and early 20s who are more likely to believe what they see on their phones because of algorithms that feed them a stream of videos reinforcing messages often divorced from scientific evidence. While doctors say hormonal contraception — which includes birth-control pills and intrauterine devices (IUDs) — is safe and effective, they worry the profession’s long-standing lack of transparency about some of the serious but rare side effects has left many patients seeking information from unqualified online communities.

The backlash to birth control comes at a time of rampant misinformation about basic health tenets amid poor digital literacy and a wider political debate over reproductive rights, in which far-right conservatives argue that broad acceptance of birth control has altered traditional gender roles and weakened the family.

Physicians and researchers say little data is available about the scale of this new phenomenon, but anecdotally, more patients are coming in with misconceptions about birth control fueled by influencers and conservative commentators.

“People are putting themselves out there as experts on birth control and speaking to things that the science does not bear out,” said Michael Belmonte, an OB/GYN in D.C. and a family planning expert with the American College of Obstetricians and Gynecologists (ACOG). “I am seeing those direct failures of this misinformation.”

He says women frequently come in for abortions after believing what they see on social media about the dangers of hormonal birth control and the effectiveness of tracking periods to prevent pregnancy. Many of these patients have traveled from states that have completely or partly banned abortions, he said, including Texas, Idaho, Georgia, North Carolina and South Carolina.

Doctors stand a better chance of dispelling misinformation when they listen to patients’ concerns, said Belmonte, noting that some are more worried about the side effects of birth control than the effectiveness doctors have long been trained to emphasize. He has adopted ACOG’s recommendation that physicians candidly discuss common side effects such as nausea, headaches, breast tenderness and bleeding between periods; many of these resolve on their own or can be mitigated by switching forms of birth control.

Women of color whose communities have historically been exploited by the medical establishment may be particularly vulnerable to misinformation, given the long history of mistrust around birth control in this country, said Kimberly Baker, an assistant professor at UTHealth Houston School of Public Health. Forced sterilizations of tens of thousands of primarily Black, Latina and Indigenous women happened under U.S. government programs in the 20th century.

“That’s another huge reason why these negative videos around birth control get a lot of fanfare, because there’s already the stigma attached to it, and that’s steeped in our history,” she said.

For influencers of all political stripes seeking fame and fortune on the internet, negative content draws more clicks, allowing them to reach a wider audience to sell their products and services.

Nicole Bendayan, who has amassed more than 1 million combined followers on Instagram and TikTok for her holistic-health coaching business, shared on social media that she stopped using hormonal birth control because she was concerned about weight gain, low libido and intermittent bleeding, which she had assumed were side effects.

Bendayan’s TikTok about getting off birth control and becoming a “cycle-syncing nutritionist” who teaches women how to live “in tune” with their menstrual cycles has drawn 10.5 million views.

The 29-year-old is not a licensed medical specialist.

“I had a lot of really bad symptoms [and] went to see a bunch of different doctors. Every one of them dismissed me. Even when I asked if it had anything to do with birth control, they all said no,” Bendayan said in an interview with The Washington Post. She had used a vaginal ring for eight years and an IUD for two; she said that when she went off birth control, her symptoms went away.

“I believe that the access to birth control is important,” she said. “I don’t think that we’re given informed consent.”

Bendayan has told her followers that birth control may deplete magnesium, vitamins B, C and E, and zinc levels. She charges hundreds of dollars for a three-month virtual program that includes analyses of blood panels for what she calls hormonal imbalances.

When asked about the science behind why her symptoms resolved after getting off birth control, Bendayan said she did her own research and found studies that backed up what she was feeling. She doesn’t claim to be a doctor, but says she wants to help others.

"I've done the research" or "Do your own research" - that's a dead giveaway for "My condition is real, and my symptoms are real, but I really don't know what the fuck I'm talking about, so the fact that I did what I did and got better proves I'm right."

“I always make it clear in a disclaimer that I’m not a medical professional and that I would happily work with their health-care team,” said Bendayan, who lives in Valencia, Spain. “I’m an educator.”

In recent years, an entire industry has popped up around regulating hormones that experts say is often a cash grab; there is no proven science that the hormone-balancing regimes pushed by some social media influencers such as Bendayan work.

Social media companies struggle to combat misinformation as they balance free-speech protections. Meta, the parent company of Facebook and Instagram, says it works hard to protect online communities.

“Our policies are designed to give people a voice, while at the same time keeping people safe on our apps,” said Ryan Daniels, a spokesman for Meta.

TikTok recently removed at least five videos linking birth control to mental health issues and other health problems after The Post asked how the company prevents the spread of misinformation. One of the videos removed was of Bendayan saying certain forms of birth control could make users more susceptible to sexually transmitted infections, which experts say the evidence does not support. A TikTok spokeswoman said the videos violated company policies prohibiting “inaccurate, misleading or false content that may cause significant harm to individuals or society.”

Bendayan told The Post she “fully” supports “the removal of any content that may inadvertently perpetuate misinformation.” She added, “As I often remind my audience, it’s essential for individuals to conduct their own research and seek comprehensive understanding, especially considering the limitations of short-form content.”

An underlying conservative push

Prominent conservative commentators have seized upon mistrust of medical professionals, sowing misinformation as a way to discourage the use of birth control. Some commentators inaccurately depict hormonal contraception as causing abortions. Others say they’re just looking out for women’s health.

Brett Cooper, a media commentator for the conservative Daily Wire, argued in a viral TikTok clip that birth control can impact fertility, cause women to gain weight and even alter whom they are attracted to. It racked up over 219,000 “likes” before TikTok removed it following The Post’s inquiry.

In a Daily Wire video, Cooper and political commentator Candace Owens denounce birth-control pills and IUDs as “unnatural,” with Owens saying she’s a “big advocate of getting women to realize this stuff is not normal,” and claiming that viewers of her content told her copper IUDs can harm women’s fertility. Medical experts say there is no evidence birth control impacts fertility long term.

On his show, Ben Shapiro, another right-wing pundit, called discussing birth-control side effects a “political third rail,” while interviewing a guest who proclaimed that women on birth-control pills are attracted to men who are “less traditionally masculine.”

Shapiro, Cooper and Owens did not respond to requests for comment.

The online magazine Evie, described by Rolling Stone as the conservative Gen Z’s version of Cosmo, urges readers to ditch hormonal birth control with headlines such as “Why Are So Many Feminists Silent About The Very Real Dangers Of Birth Control?”

Brittany Martinez, founder of Evie Magazine, said in an email that the outlet’s work has made questioning birth control mainstream. “Women have been silenced and shamed by legacy media, the pharmaceutical industry, and, in many cases, by their own doctors who have gaslit them about their experiences with hormonal birth control,” she wrote.

Martinez co-founded a menstrual cycle tracking app called 28 that is backed by conservative billionaire and tech mogul Peter Thiel. The company, 28 Wellness, told The Post it does not disclose its investors, but Evie announced Thiel Capital’s support when the product launched. A spokesman for Thiel did not respond to requests for comment. The app’s website declares: “Hormonal birth control promised freedom but tricked our bodies into dysfunction and pain.” The “feminine fitness” app told The Post it has “never been marketed as an alternative to hormonal birth control.”

The influencers’ messaging helps drive potential legislation limiting access to hormonal birth control, said Amanda Stevenson, a sociologist, demographer and assistant professor at the University of Colorado at Boulder who is studying how antiabortion activists and lawmakers are trying to restrict birth control. Already Republican legislators in Missouri have tried, unsuccessfully, to stop the state’s Medicaid program from covering IUDs and emergency contraceptives. A panel of the U.S. Court of Appeals for the 5th Circuit this month upheld a Texas law requiring minors to obtain parental permission before accessing birth control.

Stevenson pointed to pronouncements by Lila Rose, an antiabortion activist with hundreds of thousands of followers on social media who has urged women to get off birth control, in what Stevenson called an effort to stigmatize it.

“To be anti-fertility is to be anti-woman, and the proliferation of hormonal birth control is just another way of trying to force women to be more like men, with significant consequences for our emotional and physical health,” Rose said in an email.

In a 2017-2019 federal survey, the latest available, 14 percent of women 15 to 49 years old said they were currently using oral contraceptive pills, and 10 percent said they were using long-acting reversible contraceptives such as an IUD. In a federal survey of women ages 15 to 44 who had had sex, the percentage who reported ever having used the pill dropped from 82 percent to 79 percent between 2002 and 2015, while the percentage for those ever having used an IUD more than doubled to 15 percent.

Side effects of birth control

All forms of medication, including hormonal birth control, can have side effects. Some are rare, but serious: Birth-control pills that contain estrogen can lead to blood clots and strokes. IUDs can perforate the uterine wall.

When Sabrina Grimaldi went to urgent care for chest pain last spring, the medical staff told her she had pulled a muscle and sent her home. Weeks later, when her left leg started to swell and turn purple, the 24-year-old from Arizona realized it was more than a pulled muscle. Medical providers discovered blood clots in her leg and in both of her lungs, which she said they told her were caused by her birth-control pills. Grimaldi wrote about her experience in the Zillennial Zine, an online magazine where she is editor in chief, and also shared it on TikTok.

“There’s all of those crazy things on the package that say you might have a blood clot or a heart attack or death, and you’re just like whatever. You don’t actually think that that’s going to happen,” Grimaldi said in an interview, noting that her doctor never discussed potential side effects with her.

The Food and Drug Administration points out that the risk of developing blood clots from using birth-control pills — 3 to 9 women out of 10,000 who are on the pill — remains lower than the risk of developing blood clots in pregnancy and in the postpartum period. Doctors note that Opill, the over-the-counter pill that will soon be available in stores and online, contains only progestin — meaning it does not have the blood clot risk of estrogen-containing pills.

The algorithms behind TikTok, YouTube and Instagram are designed to surface content similar to what viewers have already watched, which experts say leads viewers to believe that more people suffer complications than in reality.

Jenny Wu, an OB/GYN resident at Duke University, noticed that her Gen Z patients were turning away from IUDs at higher rates than her millennial patients — and were referencing TikToks about the pain of IUD insertion. So she analyzed the 100 most popular TikTok videos about IUDs and found that a surprisingly high proportion — almost 40 percent — were negative.

“It’s changed how I practice,” she said. She now routinely offers patients a variety of pain management options including anti-inflammatory drugs, a lidocaine injection into the cervix, or anti-anxiety medication.

Catherine Miller, a junior at the University of Wisconsin at Stout, had never wanted to be on hormonal birth control after going down a rabbit hole of TikTok videos that listed negative side effects without context.

“It created this sense of fear that if I ever needed to be put on birth control, I would become a completely different person, I would gain a bunch of weight, and my life would be over,” the 20-year-old said. “I was like, well, obviously, this is true. This applies to everybody, because it’s the only thing I’m seeing.”

But in the fall, Miller took a human sexual biology class taught by a family physician who had spent decades counseling women on how to choose the right birth control. The professor walked the class through scientific research to dispel some of the misconceptions they had encountered.

After learning that her understanding of the risks was skewed by social media, Miller said she worries about her generation of women facing a lack of accurate information — and choices. Abortion is banned in Wisconsin after 22 weeks of pregnancy.

“It’s terrifying to think about our options being taken away, and misinformation about the things that we still have access to,” she said. “That’s a combination for disaster.”