Skepticism about hormones: condoms are replacing the pill as the most popular form of contraception

Pille, coil or condom? Contraceptive behavior among adults in Germany is changing. More women are abandoning hormonal contraception, and condoms are being used more frequently again.

On Thursday, the Federal Center for Health Education (BZgA) presented the first results of a representative follow-up survey on the “contraceptive behavior of adults in 2023.” As part of the study, BZgA surveyed 1,001 sexually active adults aged 18 to 49 by telephone from August to September 2023.

Accordingly, the pill is becoming increasingly unpopular: in 2007, 55 percent of those surveyed were still using it. In 2023 it was only 38 percent. In contrast, condoms are used significantly more often – 53 percent. In 2007, 36 percent said they used condoms as a form of contraception.

According to the BZgA, other methods of contraception are only relevant for a small proportion of the contraceptive-using population aged 18 to 49 years. However, IUD use is on the rise, with 18 percent more young people now using the contraceptive. In 2011, the share was still three percent.

Durex, Billy Boy and Ritex are now back in shopping carts more frequently. Where did changes in contraceptive behavior come from? Authorities cite “increasingly critical attitudes towards hormonal contraceptive methods” as the reason for the increased use of condoms. Unlike a few years ago, the physical and psychological effects of hormonal contraception are more noticeable among the sexually active population. According to the survey, 61 percent of men and women agree with the statement that hormonal contraception has “negative effects on the body and soul.” In 2018, approval was just 48 percent.

Which contraceptive is right for me?

15 percent of women who use contraception base their decision on their contraceptive choice on a general avoidance of the pill or general hormonal contraceptives, according to the BZgA. This attitude has increased significantly in recent decades: twelve years ago, only one percent of women gave such a reason.

There is also growing awareness on social media about the physical and mental consequences of using hormonal contraceptives. For example, it publishes reports on personal contraception and provides information on various methods.

The BZgA survey results also show that more and more people are using the Internet to learn about contraceptives. For 49 percent of men and 47 percent of women, websites are important sources of information.

For the majority of women surveyed, gynecological consultations remain the most important source of information. This was stated by 73 percent of women. By visiting a gynecologist, every woman can receive an individual consultation – unlike searching on the Internet.

According to the BZgA, almost all respondents (94 percent) said they were “very well” or “well” informed about the contraceptives they use.

It depends on tolerance

The fact that hormonal contraception is now increasingly discussed, even at a young age, can be seen from the results of the BZgA survey: young respondents are particularly critical of the use of hormones. The percentage of respondents aged 18 to 29 using the pill as a form of contraception fell from 72 percent to 46 percent over twelve years.

According to Johannes Niesen, spokesman for the Federal Institute for Prevention and Medical Education (BIPAM) and acting head of the BZgA, health aspects and tolerability of the respective contraceptive have become more important when choosing a contraceptive. “For more than half of those surveyed, the condom is the number one contraceptive.” Not only does a condom have the advantage of working without hormones, but it also protects against sexually transmitted diseases.

In addition, reliability of a contraceptive method is an important criterion for 39 percent of sexually active adults when choosing a contraceptive method, and ease of use for 30 percent. The reliability and safety of contraceptive methods is indicated by the so-called Pearl index. The smaller it is, the safer the contraceptive method: according to the pro familia consultation center, the Pearl index for condoms ranges from two to twelve, for pills – 0.1-0.9. A Pearl index of 0.1 means that one in 1,000 women using the same contraceptive for a year will become pregnant.

The cost of using contraception is an important factor for 19 percent of all women and men when choosing a contraceptive. Individual sexual orientation is also critical.

According to the BZgA, the proportion of respondents who usually use contraceptives has not changed. In 2018 it was 71 percent; in the current survey, 70 percent said they use contraception. The type of contraception changes with age and desire to have children.