Abstract
BACKGROUND: The use of the pill, the most widely used hormonal contraceptive, has been declining in Germany for several years. The aim of the study is to present current trends in pill use differentiated by age and to gain a more detailed understanding of the development of critical attitudes towards the pill and hormonal contraceptives in general from a biographical perspective. METHODS: Data were analysed on the use and evaluation of the pill from the mixed-methods study "women's lives 4" involving 5579 women with contraceptive needs. The results were compared with data from the previous 2012 study. In addition, 20 qualitative interviews on critical attitudes towards hormonal contraceptives were evaluated using content analysis and hermeneutic reconstruction. RESULTS: Pill use declined from 45.7% in 2012 to 25.3% in 2024. Critical attitudes are more prevalent among younger respondents. Their development is facilitated by insufficient information-based decision-making options, especially at the beginning of the contraceptive biography, which limits agency and self-determination. The distancing from hormonal contraception takes place as a reflexive process. There is a close connection between critical attitudes towards hormonal contraceptives and their non-use. DISCUSSION: The decline in pill use is consistent with the findings of other studies. The interviews reveal insufficiently met information needs regarding hormonal contraception and the resulting limitations on self-determination in contraceptive decisions. This underscores the importance of needs-based education and counselling for self-determined reproductive behaviour.