Are Young Women Totally Over the Pill?

Lately, I’ve felt like I’m the last ­millennial still on the Pill. For as long as I can remember, my girlfriends have set daily alarms to remind themselves to pop their tiny tablets. In high school, it seemed like everyone was taking it—for acne, bad cramps, and you know, to avoid pregnancy. In college, when more of us were actually having sex on the reg, the trusty BC Pill achieved true BFF status. But these days, well, we’re kind of growing apart. One of my pals blames it for her blood clots; another told me that taking it from age 13 to 34 was enough. One ditched it because she suspected the hormones were messing with her metabolism. I’m still swallowing it, for now…but my Pill pack has started to seem kinda like a Discman in a Spotify world … and not in a hip, ironic way.

It may be hard to imagine, but when the Pill debuted in 1960, it was bigger than God. Soon almost one-third of American women were using it (in place of condoms and diaphragms, mostly). By 1967, nearly 13 million women in the world were. “Suddenly, women were in this position of having more contraception options other than to not have sex,” says ob-gyn Lauren Streicher, MD, director of the Northwestern Medicine Center for Sexual Medicine and Menopause. By the 1980s, up to 80 million women were users—and enjoying the newfound freedom that came with the Pill’s 91 percent effectiveness (99 percent when used perfectly). Since it hit the market, the number of U.S. women in the workforce has more than tripled. Just try to name another pharmaceutical that has done so much for womankind (no, not Viagra). R-E-S-P-E-C-T. So why all the sudden ungratefulness?

Cosmo teamed up with Power to Decide, a national campaign to prevent unplanned ­pregnancies, to find out. And what we discovered—in a survey of more than 2,000 young women—signals a massive birth-control shift. A whopping 70 percent of women who have used the Pill said they’d stopped taking it or thought about going off it in the past three years. Yup, almost three-fourths of young women are no longer feeling the med that led to their mothers’ and grandmothers’ liberation.

The New Guards

“I’ve definitely seen attitudes change over the past few years,” says Andrea Chisholm, MD, an ob-gyn in Cody, Wyoming. “Millennials are ­looking for more convenience.” And there are now many other easier — but just as trust­worthy — birth-control methods out there, adds ob-gyn Mary Jane Minkin, MD, a clinical ­professor at Yale School of Medicine.

It’s true that we’ve never had so many ways to prevent pregnancy. Our survey revealed that 25 percent of women stopped or plan to stop taking the Pill because there is another kind of birth control they want to try. Many are intrigued by the IUD, or intrauterine device, a long-lasting and extremely effective option whose popularity has surged since 2012, when the American College of Obstetricians and Gynecologists proclaimed newer versions to be totally safe. (In the ’70s, an infamous IUD called the Dalkon Shield was linked to serious complications, like infertility.) Others who’ve cooled on the Pill — 18 percent, in our survey — said they’re switching to the patch, implant, or shot, all get-it-and-forget-it methods that don’t require once-a-day reminders.

For some, the new fuss-free options make the Pill’s scheduling seem annoying— and daily dosing kind of quaint. “Seriously, ­having to take it at the same time every day is ridiculous,” says Kaitlin, 30, from Saint Louis. What with work, working out, and a personal life, she wondered, who can be bothered? “And if you miss one, you have a total freak-out that you’re pregnant.” Kait­lin recently ditched the Pill and put a ring on, or in, it. She changes her vaginal ring just once a month. “If you’re a ­ type A person, the Pill can work,” she said, “but if you are more go-with-the-flow or don’t have a structured life, it’s hard.” Another reason women seem to be abandoning the Pill: politics. The Trump administration has threatened to rescind free birth-control coverage through insurance. Meaning, ­re-upping your Pill pack each month could cost you—while the IUD, if installed right now (usually for free, if you have insurance), could outlast this presidency. “I keep trying to get my friends to switch,” said Paulie, 30, who lives in New York City. “Paul Ryan is coming for your Pill, pals!” Planned Parenthood reported a 900 percent spike in IUD interestafter the 2016 election. Dr. Chisholm confirms that more and more of her patients have been asking about longer-acting methods since then.

An Unclear Choice

But the Pill’s decline among young women isn’t just about politics or convenience. There are also the rumors; you know, those ones. Some women told me that a decade or more on the Pill could lead to miscarriage (nope) or that the body needs a “break” every few years (false). “It’s common to share these stories with friends, but they can leave people with the wrong impression,” says Ginny Erlich, CEO of Power to Decide.

News reports can be similarly confusing. A recent study linked the Pill (as well as hormonal IUDs) to breast cancer. But the increased risk was relatively small, and most media coverage failed to mention that the Pill also decreases your risk of other serious types of cancers, like ovarian and endometrial. Then there’s what I’ll call the Goop factor. As juice cleanses go mainstream, athleisure becomes SFW, and the multibillion-dollar wellness industry infiltrates Instagram, artificial hormones can feel a bit early aughts. And some women are worried about ingesting them, according to our survey. (The synthetic hormones in birth control pretty much mimic the ones in our bodies, but they’re still lab-made.) A full 26 percent said they were switching to zero-hormone condoms versus other types of hormonal BC. “I’m not all about being natural and eating organic, but I feel like, why do it if you don’t have to?” explained Kayla, 28, from Davenport, Iowa, who just ditched the Pill after eight years. “I was like, Why am I taking hormones when I’m not even having sex?”

The must-be-natural craze is fueling questionable birth-control practices, like the fertility awareness method. Once used mainly for religious reasons, it’s now blowing up thanks to fertility-tracking apps. “I’m thrilled by technology, but these apps are basically variations of the [famously unreliable] rhythm method,” cautions Dr. Minkin. And buyer, beware: In January, 37 women using Natural Cycles, an app that the European Union has approved as legit birth control, alleged that they still became pregnant.

“The idea that somehow these hormones are bad for you is incorrect,” says Dr. Streicher. “No medicine is risk-free, but the risks of the Pill are quite low — especially compared to the risks of pregnancy.” Still, side effects do exist—and were cited by 25 percent of women in our survey. Common complaints included weight gain, mood swings, and loss of sex drive. (It’s worth noting that other hormonal methods can cause similar issues, and even the non-hormonal IUD may bring on heavier periods or increased cramping.)

Which is all to say: There is no right or wrong decision to make about the Pill. It works, and it may be great for you—or not. “Birth control is a journey, and women change methods all the time based on what’s right for their body or life circumstances,” says Erlich. If you do move on, just be sure to find another method that suits you, unless you’re planning to procreate.

As for me, I’m sticking with the Pill. Call me old-fashioned, but it has done its job—and kept me zit-free. Plus, I can now order it through an app. What’s more millennial than that?

For more of sex and relationship news, pick up the April 2018 issue of Cosmopolitan on newsstands March 6, or click here to subscribe to the digital edition!

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