Perception and use of reversible contraceptive methods in Germany: A social listening analysis

Abstract

Background: With an increasing array of contraceptives in the market, it is important to understand how users perceive them and how their interests evolve over time.

Objectives: In this analysis, we aimed to examine the contraceptive interests of women and couples in Germany using data derived from social media posts.

Study design: Social listening analysis.

Methods: Posts from Urbia-a German Internet community-mentioning at least one reversible contraceptive method between April 2006 and April 2021 were carefully selected by searching for a defined set of keywords and phrases. The frequency of mention of each method was studied and their trend over the last 5 years was analyzed. The significance of trends was evaluated using Mann-Kendall test. Additionally, 656 random posts were individually assessed for method transitions and problems associated with specific contraceptives.

Results: The contraceptive pill was the most frequently mentioned method of contraception followed by natural family planning methods, condom, hormonal coil, and copper/gold coil. Although general interest in hormonal contraception was higher compared to non-hormonal, interest in the pill decreased and interest in natural family planning and copper/gold coil increased. Most women switched from the pill to non-hormonal methods, almost half of them using a condom. Almost all migrations to natural family planning were from the pill and most migrations to non-hormonal intrauterine devices such as the coil were from hormonal methods. The common problem associated with most contraceptives was side effects.

Conclusion: Social media provides valuable information about contraceptive experiences that can be used to monitor contraceptive prevalence patterns and attitudes within a large population in a very short span of time. A good understanding of how various contraceptives are currently perceived helps in identifying strategies for improving existing family planning policies.

Plain language summary: Currently, there are a variety of contraceptive products available in the market. To understand how users perceive them and how their interest evolves over time, we analyzed social media posts from Urbia, a German Internet platform. We scraped posts between 2016 and 2021 from the "child-desire" and "contraception" forums and analyzed the relative frequency of mentions of different contraceptive methods. We also looked at 1000 individual posts from 1000 different users, analyzed method switches and the problems associated with individual methods of use. The oral pill was the most frequently mentioned method of contraception followed by natural family planning methods, condom, hormonal coil, and copper/gold coil. Over the last 5 years however, the mention of the pill dropped, whereas the mentions of natural family planning and copper or gold coil increased. Further analysis of individual posts showed most women migrating from the pill to other non-hormonal methods such as natural family planning and condom. Almost all migrations to natural family planning were from the pill and most migrations to non-hormonal intrauterine devices such as the coil were from hormonal methods. The most common problem associated with the pill and non-hormonal intrauterine devices was side effects. Through this analysis we show that social media serves as a useful tool to monitor contraceptive prevalence and attitudes within a large population in a very short span of time. Our findings give policy makers an idea on the topics where more counseling and education may be required to help women and couples find their best suited method of contraception.

Keywords: contraception; hormonal contraception; natural family planning; non-hormonal contraception; oral contraceptive pill.

Figure 1.

General interest in various methods of contraception. The bar graph above represents the relative frequencies (%) of mention of different contraceptive methods in posts in the last 5 years (2016–2021). Methods whose mentions were below 1% are groups under “Other.”

Figure 2.

Time-series trends of hormonal and non-hormonal methods of contraception in Germany. Relative frequencies of mention of hormonal (MKtau = −0.52, p = 0.008) and non-hormonal (MKtau = 0.52, p < 0.001) methods of contraception in posts, in the last 5 years.

Figure 3.

Time-series trends of top three hormonal methods of contraception: (a) pill (MKtau = −0.4, p = 0.036), (b) hormonal coil (MKtau = −0.07, p = 0.61), and (c) vaginal ring (MKtau = −0.09, p = 0.333).

Figure 4.

Time-series trends of top three non-hormonal methods of contraception: (a) natural family planning (MKtau = 0.67, p < 0.001), (b) condom (MKtau = 0.2, p < 0.161), and (c) copper/gold coil (MKtau = 0.29, p < 0.017).

Figure 5.

Changes in the contraceptive behavior of women. The chord diagrams above depict migrations from and to different methods of contraception. Each method is represented by a specific color. The arrowhead indicates the method women switched to. The thickness of the arrow indicated the proportion of women who switched from one method to another.

Figure 6.

Problems related to the use of the pill. The bar graph shows the common problems stated by women using/who used a pill (n = 456).

Figure 7.

Problems related to the use of NFP. The bar graph shows the common problems reported by women using/who used NFP methods (n = 21).

Figure 8.

Problems related to the use of non-hormonal IUDs. The bar graph shows the common problems reported by women using/who used non-hormonal IUDs (n = 21).