A long-time hit on the decline. Czech women’s contraception is changing

Over the past 15 years, the number of female contraceptive users in the Czech Republic has halved. Consumption peaked in 2007, when approximately 1.2 million women used it. Since then, however, the numbers have steadily declined.

From the survey that Seznam Zprávy commissioned from the Ipsos company as part of the How is life in the Czech Republic project, it follows that more than 11 percent of all Czech women currently use contraception.

“Compared to 2008, the use of hormonal contraception among the young generation between the ages of 18 and 35 has decreased from 62 to 32 percent by 2022,” explains Jiřina Kocourková, head of the Department of Demography and Geodemography at Charles University.

According to experts, there are several reasons. “Women are more aware of the risks associated with using combined hormonal contraception. The younger generation in particular prefers greater coexistence with nature and refuses to use extra ‘hormones’,” explains Kristýna Hlinecká, head doctor of the Clinic of Gynecology, Obstetrics and Neonatology of the VFN in Prague.

This is also the case of Markéta Urbanikova, who has been using pills since she was 15 years old. She describes taking this form of protection as an automatic thing.

“No one pushed me to do it at the time, but mainly I had the pills fixed as the only right option. All the girls around me were taking them. At a certain hour at school, for example, our phones all started ringing and we went to get some pills,” he recalls.

After six years, she said, she became more interested in the possible effects on her health. And she observed that many women around her were dropping this protection. “I started thinking about it. In retrospect, I can see that I was very depressed. I felt faint and had a reduced libido,” says Urbaníková.

“I know that contraception helps a lot of women, but it bothers me that it often only solves the symptoms of the problem, not its essence,” she explains, explaining why she stopped taking it completely.

According to doctors, there has been a significant increase in women who think similarly. “However, some people believe even not completely correct and verified information on the Internet, which warns against hormones as such. Which is not always good,” says gynecologist Peter Koliba from the Gynartis clinic in Ostrava.

“Women are overwhelmed with information about the harmful effects of contraception,” agrees gynecologist Zdeněk Vebera, who has a practice in Brno. “At the same time, the risks that women are afraid of come true only very rarely,” he adds.

The most common side effects include irregular menstrual bleeding, nervousness, irritability, headaches, breast tension or weight gain. Migraines, skin changes or vomiting are rare.

A certain group of women have a thrombophilic mutation and should not use contraception at all. “They represent about three to five percent of the population,” notes Koliba.

“Generally, there is a slight increase in thrombotic activity such as blood clotting. The resulting concerns are justified,” adds Vebera.

The risk of thromboembolic disease is significantly increased by most combined hormonal contraceptives. “This needs to be taken into account when prescribing,” emphasizes Michael Halaška, head of the Obstetrics and Gynecology Clinic of the University Hospital of Královská Vinohrady.

These problems may occur with increased probability if the woman smokes or if thromboembolism has occurred in her family.

“On the other hand, we must say that unwanted pregnancy increases the risk even more for predisposed patients,” adds Halaška.

Long-term users may have difficulty conceiving after stopping. “When a woman takes birth control without interruption from 14 to 35 and then stops it, saying she wants to have a child, a problem arises. At this age, the chance of getting pregnant drops to a quarter,” comments Vebera.

At the same time, experts mention a number of positives. “After the revolution, there was a shortage of high-quality preparations. Today, the offer is quite wide and contraception is low-dose. The benefit is certainly higher than the risk, except for exceptions,” thinks Koliba.

“Hormonal contraception reduces the risk of ovarian cancer and endometrial cancer throughout life. So from an oncological point of view, this is a benefit,” adds Halaška.

However, there are more factors behind the decline in pill consumption. “We also have a kind of social change in the conduct of sexual practices. Various self-identifications, the Internet, and the availability of Internet pornography are changing the behavior of a large number of women and men. Even with regard to non-coital practices,” explains Koliba.

Kristýna Hlinecká from VFN also agrees with this. “There is a definite change in sexual appetite. Thanks to this, the number of women preferring an intrauterine device is increasing,” he observes.

However, the roots of the current decline in pill consumption may go even further back in history. A boom in the use of contraception occurred in the 1990s and made it possible to postpone pregnancy until older women.

“Just like in other countries of Eastern Europe, there was a sharp drop in fertility to the value of 1.1 children per woman,” points out demographer Kocourková, who has been researching the topic for a long time.

At the same time, the abortion rate dropped significantly. “Nowhere else has the decline and postponement of fertility until an older age occurred as quickly as here, without the increase in the abortion rate,” he emphasizes.

According to Koliba, then, the strong years, which postponed pregnancy with the help of contraception, probably moved to the age when they want to have children. So they no longer need protection. “Women are having their first child at a much older age than in the past,” he points out.

The decline in the use of hormonal contraception has been attributed to the use of condoms – from 20 percent in 2008 to 30 percent in 2022. ” emphasizes Kocourková.

In 15 years, there has also been an increase in the number of people who do not use any protection – their number has grown from 13 to 19 percent.

“I cannot judge whether the refusal of contraception is a positive or a negative trend. Unfortunately, this is not reflected in an increased number of abortions – or at least not yet,” sums up Koliba.

Changes in use vary by education and partnership status. The use of hormonal contraception is twice as likely to be declared by women with lower education. At the same time, they less often state that they rely on the method of intermittent intercourse.

“One of the explanations offered is that more educated women are more focused on a healthy lifestyle and avoid the use of hormones,” comments Kocourková on the statistics.

“An even greater risk of not using any of the methods is also declared by women living in unmarried cohabitation or without a partner. Here, one of the explanations offered is that there are changes in partner behavior – fewer and fewer women have a permanent partner, so it is basically not worthwhile to use hormonal contraception in the long term,” he explains.

According to a survey by the agency Ipsos, most women use contraception in households with an income of over 60,000 crowns – that’s more than eight percent. In households with a monthly income of up to 20,000 crowns, on the other hand, only one and a half percent take it.