ABSTRACT
Introduction
Social media platforms have rapidly become key sources of contraceptive health information, shaping the beliefs and behaviors of individuals of reproductive age. Yet, it has become increasingly difficult to distinguish accurate content from misleading information, potentially leading to higher unintended pregnancy rates. Given the limited insights into the quality and reliability of contraceptive information on TikTok, this cross‐sectional study aimed to systematically evaluate popular TikTok content on contraception created by various users to identify and analyze misinformation.
Method
Between August and September 2023, we analyzed 100 videos from the top five hashtags related to contraception methods (#birthcontrol, #contraception, #thepill, #naturalbirthcontrol, and #cycletracking) to assess the characteristics of the health information presented and their quality, using the DISCERN tool.
Results
The TikTok videos collectively received 4.85 billion views. Only 10% were created by medical professionals. Overall, the content showed poor reliability and quality, indicating a prominent presence of contraceptive health misinformation. Furthermore, there was a concerning trend favoring natural contraceptive methods over hormonal options, often without appropriate risk disclosures, accompanied by a growing distrust in health professionals.
Discussion
The rise of contraceptive misinformation on social media is re‐shaping patient‐provider relationships and impacting contraceptive beliefs. TikTok offers an excellent public health opportunity to disseminate accurate contraceptive information accessible to all individuals, regardless of their background or resources. To address the observed distrust in health professionals, it is essential to improve contraceptive care quality and promote shared decision‐making, which would likely increase satisfaction with contraceptive choices and mitigate negative narratives online.
1. Introduction
In contemporary society, social media has quickly become an important platform for sourcing health information [1]. Particularly for frequently stigmatized conditions and symptoms, including those related to sexual and reproductive health, these platforms provide free, anonymous, and readily accessible up‐to‐date information and support [2, 3]. Furthermore, they create a non‐judgmental environment where users, especially young adults, can seek help without fear of repercussions [3]. TikTok, one of the newer social media platforms launched in 2017, has swiftly gained widespread popularity and now boasts a user base of 2.05 billion worldwide [4, 5]. TikTok differs from other social media platforms, such as YouTube, because its videos are shorter, lasting several seconds to minutes, and easier to create due to the uncomplicated editing and music‐inclusion functionality [6]. The widespread reach of this medium presents a great opportunity for health professionals and organizations to disseminate (public)health messages and educational information, potentially increasing health literacy, self‐efficacy, and treatment adherence among populations [7]. TikTok is well‐known for its recommendation algorithm, which utilizes personal interaction data to suggest videos and keep users engaged with the platform [8]. This algorithm, however, can generate information “filter bubbles” that limit users' exposure to previously viewed information content and, as such, restrict access to alternative perspectives, thereby reinforcing existing beliefs and inadvertently perpetuating misinformation [9, 10].
Given that the majority (69%) of TikTok users fall between the peak reproductive ages of 18 and 34 years, the platform offers a distinctive opportunity for this demographic to develop and share reproductive health information [4]. For example, TikTok videos on contraceptive choice and use, two critical aspects of reproductive health that encapsulate both the selection process of a contraceptive method and its practical application, attract billions of views, indicating a high level of engagement and influence [11, 12, 13]. Recent research, however, suggests that although reproductive health information videos score high on understandability, they commonly lack quality and accuracy, therefore posing a significant risk for the spread of misleading and false information [14, 15, 16]. Such false content is often categorized as either “misinformation” or “disinformation,” with the latter intentionally created and shared to cause harm [17]. Given that the intent behind messages is often unclear, whether created by genuinely concerned individuals or those undermining trust in healthcare, the term “misinformation” will be used hereafter for all false or misleading health‐related information [17].
Misinformation is especially prevalent in videos concerning hormonal contraception when uploaded by self‐proclaimed experts or non‐health professionals, whose knowledge is often based on personal experiences or beliefs [18, 19]. These individuals may use titles that are largely unregulated in many countries, allowing anyone without formal education or training to adopt them [20, 21]. In conjunction with personal opinion videos that discuss negative experiences with the contraceptive pill, such content may shape viewers' beliefs and choices regarding contraception and foster distrust in conventional healthcare, potentially increasing the risk of unwanted pregnancies [11, 13]. Another example of how misinformation on TikTok may influence reproductive choices, through shaping contraceptive beliefs, can be seen through the millions of TikTok videos that promote the effectiveness of “natural” birth control methods such as Fertility Awareness‐Based Methods (FABMs) that aim to identify the fertile window by tracking biomarkers for ovulation including basal body temperature and cervical mucus [22]. While these methods can be effective, and are a valid choice for many people using contraception, the success of FABMs in pregnancy prevention depends on several additional factors, including the method used, sufficient training or instruction, motivation, partner cooperation, and natural biomarker variability [22, 23]. Yet, TikTok influencers who endorse these fertility trackers often fail to disclose the lack of evidence supporting their effectiveness when used incorrectly [11, 23]. Furthermore, they also fail to mention that FABMs for pregnancy prevention are generally ineffective as standalone methods, thereby misleading young viewers and potentially contributing to unintended pregnancies [11].
As TikTok content continues to grow, it becomes progressively challenging to discern reliable and accurate health information from false or misleading content, representing a significant public health concern [24, 25]. Previous research has assessed the quality and reliability of contraceptive health content on older social media platforms [11, 12, 13, 26]. However, analyses for TikTok are missing from the academic literature, with the exception of a limited number of studies focusing on specific types of contraception [14, 18, 27]. To address this gap, this cross‐sectional study aimed to systematically evaluate popular TikTok content on contraception created by various types of users, to identify and analyze misinformation.
2. Methods
2.1. Search Strategy and Video Selection
A TikTok search was conducted using a newly opened account for a hypothetical 18‐year‐old female user living in Australia, to avoid bias from algorithms that recommend personalized content based on previous interactions and preferences. To examine how video creators present contraception information on TikTok, we compiled a list of 33 hashtags in mid‐August 2023, arranged by their number of views. This list was generated by exploring the most popular hashtags in posts on contraception methods, and through a systematic brainstorming process of related terms, informed by our expertise in public health and medicine. From the 15 hashtags, out of the original 33 that surpassed a randomly chosen cutoff of 75 million views, we excluded hashtags specifically related to IUDs (n = 3) as this topic was partially captured under other hashtags and previously explored by Wu et al. [27].; hashtags that were also associated with topics outside of contraception, such as #cyclesyncing (n = 3); similar terms to #thepill, including #birthcontrolpills and #birthcontrolpill (n = 2); and hashtags not specifically focused on contraception choice and use (n = 2). The remaining five hashtags are presented in Table 1.
TABLE 1.
Selected hashtags related to contraceptive methods.
| Hashtag | Views |
|---|---|
| #birthcontrol | 4.4 billion |
| #contraception | 810.2 million |
| #thepill | 295.6 million |
| #naturalbirthcontrol | 96.8 million |
| #cycletracking | 73.1 million |
For each of the selected hashtag, the URLs of the 25 most popular or “top” videos were retrieved and documented in an Excel spreadsheet. Videos were excluded if they were duplicates, if the content did not directly address information or advice about contraceptive choice and use (e.g., experiences of pain related to IUD insertion or removal), if they were published in a language other than English, or removed from TikTok by the content creator during the selection process. From the remaining videos for each of the five hashtags, only the top 20 videos were chosen to ensure an even distribution across the hashtags, totalling 100 videos for data analysis (see Figure 1). This number is consistent with previous TikTok content analyses [16, 27, 28, 29, 30].
FIGURE 1.
Flowchart of video selection and assessment.
2.2. Data Extraction
Over the next few weeks, following an initial review of 10 videos to ensure consistency in our coding approach, two non‐clinical reviewers (AD and MB), both with backgrounds in public health and reproductive health research, independently conducted the data extraction task and added their findings to separate Excel spreadsheets. In cases where their assessments differed across any part of the extraction process, a third reviewer (CM), who has both public health and clinical expertise in sexual and reproductive health, was consulted to reach a consensus. For each included video, the basic characteristics were recorded, including the publication date, title, number of views, length of the video, number of “likes,” number of comments received, times shared, number of followers, and times saved to favorites. The video creators were categorized into five distinct groups based on the information provided in their biographies: general uploaders (everyday users, including influencers), medical professionals (physicians, nurses, midwifes, pharmacists), hormone health coaches (self‐proclaimed), health educators (unregulated titles, including naturopaths, nutritionists, wellness educators, herbalists, sport coaches and food coaches), and online companies. Their country of origin, age, gender presentation, and ethnicity were documented based on self‐identification when available in the videos or user bios. When this information was not provided AD and MB used visual cues to estimate these characteristics. Additionally, we assessed the video content to determine its purpose. This included creator advice, which refers to non‐persuasive recommendations aimed at guiding or informing viewers and facilitating informed decision‐making about contraception options or practices without explicitly advocating specific actions or employing persuasive language; personal experience, which centers around individual narratives that provide insights into the realities of using contraceptives; and creator opinion, which reflects the creator's subjective beliefs, feelings, or attitudes about the topic. In addition, the specific contraception methods discussed were recorded, along with any expressions of trust or distrust in health professionals and/or hormonal contraception, as well as any explicit rejections of hormonal methods.
2.3. Quality and Reliability Assessment
The same two authors (AD and MB) also independently evaluated the health information communicated in the TikTok videos for their reliability and quality, utilizing the DISCERN instrument [31]. Originally developed to assess the quality of written health information on treatment choices, DISCERN is now also widely applied in research examining the quality of health information disseminated online and through social media videos [32, 33]. In their systematic review, Sattora et al. [32] identified that, across all health topics, 46% of the 101 included studies on TikTok videos reported on content accuracy using tools such as DISCERN.
The DISCERN instrument comprises 16 items that are divided into three sections. The first section includes eight items that assess the reliability of the video information (DISCERN‐R), for example, if the aims and sources used to compile the information were made clear. Items nine to 15 make up the second section and focus on the quality of the video information on contraception (DISCERN‐Q). For example, whether the video explains how the chosen contraception methods work and if its benefits and risks are discussed. All 15 items are rated using a continuous 5‐point scale, ranging from 1 (indicating the criterion is not met) to 5 (indicating the criterion is completely met). The intermediate ratings 2, 3, and 4 are allocated based on the perceived degree of shortcomings, reflecting partially met criteria. The final section includes only one item that entails an overall assessment of the video quality as a source of contraception information (DISCERN‐OQ). This item is also rated on a 5‐point scale, with 1 indicating a low‐quality video; 3 a moderate quality video; and 5 a high‐quality video [31]. DISCERN scores for each section were calculated by averaging the ratings provided by the two reviewers (AD and MB). In the case of inconsistent scores, discussions with a third reviewer (CM) resulted in a final score. Aligning with previous research, the total DISCERN score (DISCERN‐T) was classified as very low quality (< 26), poor quality (27–38), fair quality (39–50), good quality (51–62), and high quality (> 63) [34, 35, 36].
2.4. Data Analysis
We performed statistical analyses with the statistical software STATA [37]. The characteristic variables are presented as frequency (n) and percentage (%). Since all continuous variables were found to be non‐normally distributed, they are presented as median [min, max]. The Kruskal–Wallis test was applied to assess potential differences in the DISCERN scores among the independent content creator groups. Since this test requires at least five observations in each group to ensure the accuracy of the p‐value, the online company group (n = 2) was excluded from the analysis [38]. In the event of significant main effects, subsequent analysis involved the application of the Bonferroni post hoc test for multiple comparisons. Statistical significance was considered for p‐values < 0.05.
Prior to adjudication by the third reviewer, interobserver agreement on the ratings of the 16 DISCERN items was assessed using the quadratic weighted Cohen's Kappa (QWK) [39]. This measure is generally applied when evaluating ordinal data with three or more categories, as it accounts for the magnitude of (dis)agreement between two raters [39]. Thus, differences in scores that are further apart, for example “1” and “5,” are considered more significant than those closer together, such as “4” and “5”. The benchmark values for strength of intercoder agreement proposed by Landis and Koch as cited in Sim and Wright [40] were used: < 0.01, poor; 0.01–0.20, slight; 0.21–0.40, fair; 0.41–0.60, moderate; 0.61–0.80, substantial; and 0.81–1, almost perfect.
3. Results
3.1. Creator Characteristics
Among the top 100 TikTok videos about reproductive health, five types of video creators were identified. General uploaders were responsible for most (58%) of the videos, followed by those who called themselves hormone health coaches (15%) and health educators (15%) (see Table 2). Medical professionals contributed 10% of the videos, and (online) companies only uploaded two (2%) videos (Table 1). Most videos originated from the United States (60%), the United Kingdom (16%), and Australia (11%), and were created by white (78%), female‐presenting (99%) millennials (ages 27–40) (58%).
TABLE 2.
Characteristics of video creators (n = 100).
| Characteristics (n = 100) | n/% | |
|---|---|---|
| Video creator background | General uploader | 58 |
| Medical professional (physician, nurse, midwife, pharmacist) | 10 | |
| Hormone health coach | 15 | |
| Health educator (naturopath/nutritionist/wellness educator/herbalist/sport coach/food coach) | 15 | |
| (Online) company | 2 | |
| Country of origin | United States | 60 |
| Canada | 2 | |
| United Kingdom | 16 | |
| Ireland | 1 | |
| Nigeria | 2 | |
| Korea | 1 | |
| Australia | 11 | |
| New Zealand | 1 | |
| Unknown | 6 | |
| Creator age (years) | Teenager (15–17) | 3 |
| Young adult (18–26) | 33 | |
| Millennial (27–40) | 58 | |
| Older aged (> 40) | 5 | |
| Unclear | 1 | |
| Creator gender presentation | Female | 99 |
| Male | 1 | |
| Transgender or unspecified | 0 | |
| Creator presumed ethnicity | White | 78 |
| Black | 13 | |
| Asian | 3 | |
| Latina | 5 | |
| Unknown | 1 |
3.2. Video Characteristics
The TikTok videos received a total of 4.85 billion views, with a median of 327 300 views, ranging from 5200 to 89 900 000 views. The shortest video had a length of 4 s, and the longest lasted 215 s, while the median view time was 44.5 s (see Table 3). The 100 videos received a total of 14.6 million likes, with an average of 19 850 likes and 233 comments. They were, on average, shared 244 times, added as a favorite 1556 times, and had 76 300 followers. The videos created by the two online companies had, on average, the most views, likes, and comments, while the hormonal coaches and health educators obtained the least views, likes, and comments. Medical professionals and general uploaders had the most followers and therefore greater potential reach.
TABLE 3.
Characteristics of included videos (n = 100) by video creator.
| Characteristic | General uploader n = 58 median (min–max) | Medical professional n = 10 median (min–max) | Hormonal health coach n = 15 median (min–max) | Health educator n = 15 median (min–max) | Online company n = 2 median (min–max) | Total median (min–max) |
|---|---|---|---|---|---|---|
| Number of views (× 103) | 384.9 (15.5–17 900) | 597.7 (27.6–89 900) | 100 (5.2–1900) | 319.1 (33.8–11 800) | 1895 (891–2900) | 327.3 (5.2–89 900) |
| Length (s) | 33 (4–180) | 40.5 (13–169) | 78 (5–215) | 59 (6–118) | 442.5 (28–57) | 44.5 (4–215) |
| Likes | 27 450 (285–1 800 000) | 25 450 (800–1 700 000) | 5060 (123–212 600) | 4182 (84–1 500 000) | 57 650 (20300–95 000) | 19 850 (84–1 800 000) |
| Comments | 365 (15–20 300) | 283 (24–29 000) | 61 (1–553) | 220 (1–3867) | 1145 (104–2186) | 233 (1–29 000) |
| Shared | 300 (14–105 400) | 294 (22–97 800) | 52 (4–8105) | 308 (2–36 700) | 2518 (506–4529) | 244 (2–105 400) |
| Added to favorites | 1582 (27–138 400) | 4459 (67–46 000) | 1278 (24–25 700) | 1348 (13–333 500) | 10,416 (7232–13 600) | 1556 (2–333 500) |
| Followers | 43 900 (119–4 938 000) | 228 550 (317–1 700 000) | 76 600 (7994–825 600) | 122 600 (3658–615 800) | 37 000 (17500–56 500) | 76 300 (119–4 938 000) |
3.3. Video Content
Among the 100 unique videos collected from the five selected hashtags, fertility awareness/cycle tracking (38%) was the most frequently discussed contraception method, closely followed by the pill (35%). Methods least considered were other hormonal methods (13%), including implants, hormonal intrauterine devices (IUD), injections, vaginal rings, and skin patches; the copper IUD (6%); other contraceptive methods (2%), including withdrawal and emergency contraception; and barrier methods (1%), such as condoms and Femcap. Five videos discussed some alternative measures of birth control, including the use of papaya seeds, coconut oil, and neem oil as natural spermicides. Fifty‐three percent of the creators, who all were either general uploaders, hormonal health coaches, or health educators, explicitly rejected hormonal birth control. Notably, the majority of general uploaders and health educators rejected the use of hormonal birth control in their videos (64% and 67%, respectively), either for themselves or others. In 34% of the videos, general creators (n = 25, 74%), hormonal health coaches (n = 2, 6%), and health educators (n = 7, 21%) expressed a distrust in health professionals and/or hormonal contraception. The statements of distrust were predominantly based on creators' advice (non‐persuasive recommendations; n = 12, 35%), personal experiences (n = 14, 41%), or creator opinions (subjective beliefs; n = 5, 15%). Only a few videos that expressed distrust came from creators that sought advice (n = 1, 3%) or participated in a sponsored promotion (n = 2, 6%). An overview of the video content by creator group is presented in Table 4.
TABLE 4.
Video content based on creator group (n = 100).
| Video content | General creator n = 58 (%) | Medical professional n = 10 (%) | Hormonal health coach n = 15 (%) | Health educator n = 15 (%) | Online company n = 2 (%) | Total n = 100 (%) |
|---|---|---|---|---|---|---|
| Contraceptive method | ||||||
| Fertility awareness/cycle tracking | 13 (34) | 3 (8) | 13 (34) | 8 (21) | 1 (3) | 38 (38) |
| The pill | 25 (71) | 3 (9) | 1 (3) | 6 (17) | 0 (0) | 35 (35) |
| Other hormonal method | 11 (85) | 1 (8) | 1 (8) | 0 (0) | 0 (0) | 13 (13) |
| IUD copper | 4 (67) | 2 (33) | 0 (0) | 0 (0) | 0 (0) | 6 (6) |
| Natural methods | 4 (80) | 0 (0) | 0 (0) | 1 (20) | 0 (0) | 5 (5) |
| Other, including withdrawal and emergency contraception | 1 (50) | 1 (50) | 0 (0) | 0 (0) | 0 (0) | 2 (2) |
| Barrier methods a | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (100) | 1 (1) |
| Purpose of video | ||||||
| Creator advice b | 14 (30) | 8 (17) | 12 (26) | 12 (26) | 1 (2) | 47 (47) |
| Personal experience | 32 (94) | 1 (3) | 1 (3) | 0 (0) | 0 (0) | 34 (34) |
| Creator opinion c | 7 (70) | 1 (10) | 0 (0) | 2 (20) | 0 (0) | 10 (10) |
| Promotion/advertisement | 3 (43) | 0 (0) | 2 (29) | 1 (14) | 1 (14) | 7 (7) |
| Advice seeking | 2 (100) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (2) |
| Rejection hormonal birth control | ||||||
| Yes | 37 (70) | 0 (0) | 6 (11) | 10 (19) | 0 (0) | 53 (53) |
| No | 15 (50) | 8 (27) | 2 (7) | 3 (10) | 2 (7) | 30 (30) |
| Neutral or not mentioned | 6 (35) | 2 (12) | 7 (41) | 2 (12) | 0 (0) | 17 (17) |
| Video expresses distrust in healthcare provider and/or hormonal birth control | ||||||
| Yes | 25 (74) | 0 (0) | 2 (6) | 7 (21) | 0 (0) | 34 (34) |
| No | 30 (48) | 10 (16) | 12 (19) | 8 (13) | 2 (3) | 62 (62) |
| Not relevant or mentioned | 3 (75) | 0 (0) | 1 (25) | 10 (0) | 0 (0) | 4 (4) |
Including condoms and Femcap.
Creators' non‐persuasive recommendations.
Creators' subjectiveopinion, reflecting personal beliefs, feelings, or attitudes.
3.4. Video Quality and Reliability
Inter‐reviewer agreement on the DISCERN ratings indicated substantial agreement (QWK = 0.62) for the reliability of the TikTok videos, moderate agreement (QWK = 0.51) for the quality of the video information, and fair agreement (QWK = 0.46) for the overall video quality. Our DISCERN findings, presented in Table 5, suggest an overall low to poor reliability and quality of the included videos with a total median grading result of 27 (min–max: 24–30.5). The videos created by hormone health coaches and general uploaders had the lowest median total scores, 26 and 26.25, respectively, while the medical professionals' videos had the highest (33) total median DISCERN score. Regarding the separate reliability (DISCERN‐R) and quality scores (DISCERN‐Q) of the video information, the results were similar: generally, the scores of videos created by medical professionals were the highest, while the scores of the videos created by hormone health coaches and general uploaders were the lowest. When it came to scoring the overall video quality (DISCERN‐OQ), medical professionals overall uploaded moderate‐quality videos, while all other video creators uploaded low to moderate‐quality videos. The Kruskal‐Wallis test showed that the differences were significant across the four creator groups for the total DISCERN scores (χ 2(3) = 10.11, p = 0.02), the reliability scores (χ 2(3) = 12.26, p = 0.007), and the overall video quality scores (χ 2(3) = 18.79, p = 0.0003), but not for the quality of the video information (χ 2(3) = 2.14, p = 0.54). The post hoc test showed significant differences between medical professionals and general uploaders in terms of video reliability (p = 0.009), overall video quality (p < 0.005), and total score (p = 0.002). Additionally, significant differences were found between medical professionals and hormone health coaches for overall video quality (p < 0.005) and total score (p = 0.004), as well as between medical professionals and health educators for overall video quality (p < 0.005) and total score (p = 0.026).
TABLE 5.
Quality assessment of included TikTok videos by video creator (n = 100).
| DISCERN section | General uploader n = 58 median (min–max) | Medical professional n = 10 median (min–max) | Hormonal health coach n = 15 median (min–max) | Health educator n = 15 median (min–max) | p‐value* (Kruskall–Wallis) | Online company n = 2 median (min–max) | Total median (min–max) | QWK |
|---|---|---|---|---|---|---|---|---|
| DISCERN‐R (n = 8) | 13 (9.5–21.5) | 16.25 (13.5–22.5) | 14 (11–19) | 14.5 (12–17) | 0.0066 | 17 (15–19) | 14 (12–16) | 0.62 (p < 0.001) |
| DISCERN‐Q (n = 7) | 11 (7.5–18.5) | 12.75 (7.5–21.5) | 10.5 (7.5–15) | 11.5 (7.5–14) | 0.5448 | 9.25 (8.5–10) | 11 (9.5–13) | 0.51 (p < 0.001) |
| DISCERN‐OQ (n = 1) | 2 (1–3.5) | 3 (2–4) | 2 (1.5–2.5) | 2 (1–2.5) | 0.0003 | 2.75 (2.5–3) | 2 (2–2.5) | 0.46 (p < 0.001) |
| DISCERN‐T (n = 16) | 26.25 (20.5–41.5) | 33 (23–49.5) | 26 (20.5–36.5) | 27.5 (22–32.5) | 0.0177 | 29 (26–32) | 27 (24–30.5) |
Abbreviations: DISCERN‐OQ, overall assessment of the video quality as a source of contraception information; DISCERN‐R, the reliability of the video information; DISCERN‐Q, the quality of the video information; DISCERN‐T, the total DISCERN score; QWK, quadratic weighted Cohen's Kappa.
p‐value for first four video creator groups.
4. Discussion
This study assessed 100 TikTok videos under the most‐viewed hashtags relevant to contraception methods, namely #birthcontrol, #contraception, #thepill, #naturalbirthcontrol, and #cycletracking. The videos received a total of 4.85 billion views and 14.6 million likes, confirming that young people of peak reproductive years may be increasingly turning to social media platforms for information on contraceptive choices and usage [13]. It is generally recognized that increased access to health information and education can empower individuals to make autonomous choices about contraception options [41]. However, since social media content related to contraception often varies in quality and reliability, it is crucial for users to critically assess the information they access on these platforms, as much of this content is generated by non‐clinical sources and may not be evidence‐based [42]. Furthermore, social media creators tend to share negative health experiences and opinions as these posts generally result in higher engagement, which is prioritized by TikTok algorithms over the accuracy, reliability, and quality of information provided [43]. This has resulted in an abundance of inaccurate and misleading health information on social media, potentially influencing young people's knowledge and beliefs about contraception‐related issues [41]. In minority populations that already face significant barriers to accessing comprehensive sexual health education and healthcare services, such misinformation could further perpetuate existing health disparities, potentially leading to adverse health outcomes, including unintended pregnancies [44].
Not surprisingly, we found that all video content we assessed had poor reliability and quality, with a median DISCERN‐T score of 27, supporting previous research relating to the presence of contraceptive misinformation on social media [14, 18, 27]. Statistically significant higher scores were found among medical professional creators compared to general uploaders, hormonal health coaches, and health educators. However, videos created by medical professionals were still classified as having poor quality (median score of 33), highlighting the importance of not relying on these videos as a substitute for more extensive information [34]. A possible explanation for the low DISCERN scores is that due to the relatively short length of most videos, video creators have no room to address all the DISCERN criteria. Specifically, failing to include appropriate sources of support and information, or neglecting to address the risks and benefits of all contraception options, will considerably impact a total score. This insight underscores the importance for health professionals to clearly indicate in their videos where further resources can be found and to present less biased information by explaining risks and benefits effectively. Overall, our low‐quality ratings are comparable to other studies assessing the quality of the health information conveyed through TikTok videos [28, 34, 45].
Most of the video creators were based in the United States (or other similar high‐income, western countries), white, female‐presenting, English speaking, and in the millennial age‐range. This finding likely reflects the geolocation and preferences of our TikTok protagonist, as well as TikTok's algorithm which promotes content based on popularity, audience engagement, and trending topics [46]. Videos by hormonal health coaches and health educators had the least views, likes and comments, yet their substantial follower base suggest their influence should not be underestimated. Videos uploaded by medical professionals had on average the most views and followers, highlighting a potential strong demand for and trust in their expertise on this platform.
The most frequently discussed contraceptive methods were fertility awareness and cycle tracking (38%) and the pill (35%), reflecting the dichotomy between “natural” birth control methods and hormonal contraception. Most general uploaders, hormonal health coaches and health educators, representing more than half (53%) of the content creators, explicitly rejected hormonal birth control in their videos. This finding is in line with the extant literature to date that has recognized a growing dissatisfaction with hormonal contraceptives among the general population and an increasing interest in natural contraceptive methods [11, 47, 48, 49]. Le Guen et al. [48], noted an upsurge of social media influencers urging followers to regain control of their bodies by restoring the hormonal balance through natural birth control methods. In fact, a study by Pfender et al. [11] found that the desire to be “more natural” or “hormone free” ranked among the top three reasons why social media influencers decided to discontinue using hormonal birth control. It has been suggested that this trend might be driven by a desire to alleviate the unequal contraceptive burden placed on women and people who can become pregnant, and a wish to redeem control of a natural hormonal balance [48, 49].
Our study also revealed approximately one third (34%) of all video creators expressed distrust in health professional advice and/or hormonal contraception. Fourteen (41%) of them based their distrust solely on personal experiences, whereas 12 (35%) did so through personal advice. A general distrust toward hormonal contraception is, according to Le Guen et al. [48] fueled by health professionals' persistant focus on its safety and high effectiveness in preventing pregnancies, rather than on the potential side effects. A provider‐driven decision‐making process in contraceptive counseling, which fails to include information that reflects social norms and concerns, has proven to result in decreased satisfaction with the final chosen contraceptive method [50]. When shared‐decision‐making expectations are unmet, patients may perceive this as a subtle form of coercion favoring hormonal contraception, and thus a violation of their rights [49]. They might feel pressured, dismissed, and even deceived by medical professionals [30]. Consequently, TikTok may serve as an important platform which gives voice to women's lived experiences of distrust in health professional advice and the treatments they recommend [11, 15, 49]. While this can foster solidarity among others who share similar experiences, it also raises important implications for the medical profession. For example, multiple TikTok users expressed their disapproval of standard contraceptive counseling practices, instead advocating for advice from “hormone health coaches” or “health educators” over medical professionals. A simple Google search of these terms yields numerous blogs and websites offering advice not typically addressed in a healthcare setting. Recent research suggests that this increasing reliance on social media for health information from individuals, whether qualified or not, is reshaping the patient‐provider relationship into one where providers act merely as gatekeepers for obtaining prescriptions [49, 51, 52]. This shift undermines patient‐centered interactions that promote shared decision making. To ensure that contraceptive care within medical settings aligns with broader principles of sexual and reproductive health equity, Kavanaugh et al. [53] argued that medical professionals must provide a higher quality of contraceptive care. This improvement is subsequently associated with greater satisfaction among individuals regarding their chosen contraceptive methods, ultimately leading to fewer negative postings online.
4.1. Limitations
Although we conducted a thorough search and evaluation of all selected videos, this study is still constrained by several limitations. Firstly, there is a potential for selection bias due to the process used to select our hashtags, the relatively small sample size of 100 videos, and the inclusion of English‐language only videos. Secondly, the cross‐sectional comparative study design only offers a snapshot in time, implying that different outcomes might have emerged if the study was conducted at another time. Thirdly, the use of the DISCERN instrument, originally designed for appraising written health information, has only relatively recently been applied to social media contexts, and its rating process is susceptible to the subjective judgment of researchers. Observer bias was reflected in the overall moderate inter‐reviewer agreement score, although we aimed to mitigate this by including a third reviewer when notable discrepancies between ratings were identified. Lastly, we acknowledge the possibility of errors in the categorization of the video creators, as this process was based purely on the information provided by the uploaders.
Moving forward, future research should explore the impact of and engagement with contraception information on social media, particularly the influence of self‐proclaimed hormone health coaches and educators on young adults' contraceptive decision‐making. Considering the popularity of these video creators and their tendency to spread misinformation about hormonal contraception, it is crucial to investigate the potential harm caused by misleading content [54]. Additionally, future researchers that aim to assess the quality and reliability of TikTok video content should consider developing a validated DISCERN instrument that is tailored to the information communication style characteristics of social media platforms.
5. Conclusion
Recent years have witnessed a shift toward the use of online sources for health information, as they offer accessible, convenient, and engaging content, potentially benefiting individuals from marginalized communities who often experience barriers to traditional health education or healthcare. The social media platform TikTok offers a wealth of information on reproductive health, including contraception methods, and is increasingly being used for contraceptive decision‐making. Our study, however, revealed that this information lacks the necessary rigor, undermining patients' ability to confidently make informed decisions. Furthermore, the growing distrust in hormonal contraception and the increasing interest in natural contraceptive methods, influenced by perceptions that healthcare providers prioritize efficacy over personal experience, might contribute to unintended pregnancies [55]. These findings carry several implications. First, healthcare providers must acknowledge that young adults may obtain information about contraceptive methods from social media platforms like TikTok. Consequently, it is essential for providers to incorporate this awareness into their contraceptive counseling sessions, ensuring that any biases regarding hormonal contraceptives are addressed. Second, our study underscores the need to improve the quality of contraceptive health information available online. TikTok's widespread reach offers an excellent public health opportunity to disseminate accurate contraceptive education and information that is accessible to all individuals, regardless of their background or resources. Finally, recognizing the effectiveness of personal and relatable contraceptive content, collaboration with individuals who share such experiences and advocate for safe and effective contraception methods is crucial to ensure that messages truly resonate with their audience [12, 30].
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgments
Open access publishing facilitated by La Trobe University, as part of the Wiley ‐ La Trobe University agreement via the Council of Australian University Librarians.
de Moel‐Mandel C., Donnelly A., and Bugden M., ““Do You Know What Birth Control Actually Does to Your Body?”: Assessing Contraceptive Information on TikTok ,” Perspectives on Sexual and Reproductive Health 57, no. 3 (2025): 358–367, 10.1111/psrh.70025.
Funding: The authors received no specific funding for this work.
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