Doctors warn about social media link to abortion rise

Misinformation about contraception on social media may be contributing to Scotland's record high abortion figures, doctors have told the BBC.

The number of terminations carried out in Scotland rose by almost a fifth between 2021 and 2022.

For the first time in 14 years, the number of 16 to 19-year-olds accessing abortion services also increased.

There are concerns this is being driven in part by false and misleading information on apps such as TikTok.

Videos on the platform include false claims about hormonal contraception, such as the pill, the implant, the jab and some types of the coil.

The misinformation online often focuses on side effects.

One TikTok video that has been viewed more than 600,000 times falsely claims hormonal birth control can cause infertility and brain tumours.

Another video posted by an influencer with more than 300,000 followers claims "birth control is this generation's cigarettes" and "ruins our bodies".

Meanwhile the hashtags #naturalbirthcontrol and #quittingbirthcontrol have had hundreds of millions of views.

While the reasons behind Scotland's record high abortion figures are not entirely clear, and a number of different factors are likely to have contributed, doctors have raised concerns about social media misinformation.

Dr Sinead Cook from NHS Grampian is the Scottish chair of the Faculty of Sexual and Reproductive Healthcare. She is worried this content is influencing decisions about contraception, especially among young people.

Working in a sexual health clinic in the north east of Scotland, she said she had seen patients who were "terrified of hormonal contraception" because of what they had watched on TikTok.

She told BBC Scotland News: "The biggest concern is that social media is encouraging people to either not start contraception or to stop their contraception without really understanding what their other options are.

"The risk is that we're going to just see people having unplanned pregnancies, which they really don't want, at the end of the day."

The numbers of terminations carried out in Scotland rose from 13,937 in 2021 to 16,596 in 2022.

The number of 16 to 19-year-olds accessing abortion services also increased from 1,480 in 2021 to 1,899 in 2022.

Dr Cook said the rise in abortion figures in Scotland were probably the result of a number of factors - not only a fear of hormones.

"I don't think we know why the numbers have gone up," she said. "They've gone up amongst all people of reproductive age, including amongst young people."

She said that when her team talked to patients who did not use contraception and were attending for abortions, many cited concerns about the side effects of contraceptives.

Dr Cook was speaking to a new Disclosure documentary for BBC iPlayer investigating why more women are turning their backs on hormonal birth control.

The British Pregnancy Advisory Service (BPAS), which provides help and support to women considering or going through abortions, said it was also concerned people were being put off hormonal contraception because of social media.

Lucy Grieve from the charity said that in the past year it had seen a lot of people "scared off" hormonal contraception as a result of information they had seen on apps including TikTok and Instagram.

"That undoubtedly plays a role in the rising abortion figures in Scotland," she said.

The BBC contacted TikTok about some of the videos on its platform that carry misinformation about the side effects of hormonal contraceptives.

TikTok said it had reviewed the content which had been flagged to it and taken down videos that violated its rules on medical misinformation.

While social media may be one factor, BPAS said the current cost-of-living crisis was also forcing women to make difficult choices due to financial pressures.

"People are having to make the decision to end a pregnancy that might have been wanted but they really have to ask themselves difficult questions," Ms Grieve said.

"Can they afford to pay their mortgage? Can they afford to feed their other kids?"

BPAS said waiting times for contraception and a lack of sex education for young people may also be contributing to the record number of abortions.

Condoms are the only type of contraception that can protect against STIs and prevent pregnancy.

Women are also turning to social media to share their own personal experiences of different birth control options, and there is growing conversation about the side effects many experience.

Mariya, from Paisley, had a contraceptive implant placed in her arm but said the hormones affected her mental health.

The implant is a small rod that sits under the skin on the arm and releases hormones over three years to prevent pregnancy. It is more than 99% effective, according to the NHS.

Mariya, 22, said that while she had the implant her anxiety was "spiralling out of control".

"I was scared to go outside my flat, I was scared to go to Tesco, I was calling in sick to work," she said.

"I nearly stopped eating. Looking back, that was probably one of the darkest moments I've been in."

Mariya is just one of thousands of women who say they have moved away from hormonal contraception due to side effects, but social media is awash with similar experiences.

Matilda, from Leek in Staffordshire, says her mental health was severely impacted by hormonal contraception.

After a negative experience on the Mirena coil - and having already tried the injection and various pills - Matilda wanted to do something different.

The 24-year-old found what she thought was an alternative to hormonal contraception called Natural Cycles.

It markets itself as digital contraception and the company says it has 2.5 million registered users.

The app, which is not yet recommended for use by the NHS and considered by some as more of an aid rather than birth control, is heavily advertised on social media by influencers.

Using an algorithm to track and predict ovulation, Natural Cycles indicates the fertile window during which someone may fall pregnant.

Users take their temperature every morning and input that data into the app.

Natural Cycles says the app is effective from day one and that it will only indicate "green days" - when a user can have unprotected sex - when it has enough data to do so.

Matilda was using the app and immediately started following its predictions by having unprotected sex on "green days" and avoiding sex altogether on "red days".

She said: "I just saw green and red. Most people think if you sat at a traffic light, red means stop, green means go.

"I assumed that I entered my data meant that they knew enough about my body and my cycle that I could be having unprotected sex."

Matilda fell pregnant using the app and now has a 10-month-old baby girl.

"It just wasn't something I think I was quite ready for at the age I was," she said.

"Obviously I've come to terms with it now - and I love it now - but it was definitely a massive shock."

Natural Cycles told BBC Scotland News that no method of contraception was 100% effective even when used perfectly. Its website says Natural Cycles is 93% effective with typical use and 98% effective with perfect use.

It said: "Less than one in 100 women become pregnant due to the algorithm assigning a green day when a user is fertile and the method's real-life effectiveness is the same as its published rates."

Matilda doesn't want to go back on hormonal contraception because she says her experience with the coil was so bad.

But - in the rising tide of misinformation online - are other women and girls like her getting the right information they need, to make the right choice for them?

If you have been affected by any of the issues raised in this story you can visit BBC Action Line

Should I Quit My Birth Control? Investigating the growing trend in social media influencers pushing women towards natural birth control methods.