Experts advise, TikTok engages: Risk and misinformation surround hormonal contraception in Serbia

Abstract Background Globally, 61% of unintended pregnancies result in abortion. In Serbia, 74.5% of abortions are medically induced, and under 20% of women use modern contraception. Despite safety and reliability of hormonal contraception, misinformation about it persists in women's information ecosystems. This research aimed to analyze content, engagement metrics, and speaker representation of hormonal contraception-related posts across major social media in Serbia. Methods In April 2025, we conducted social listening across TikTok, YouTube, and Instagram in Serbia, utilizing predefined search terms and a clean browser with new social media accounts. Sixty posts were identified based on inclusion criteria. Posts were extracted and transcribed using an AI-powered transcription model, and all transcripts underwent content and thematic analysis facilitated by an LLM. Results Engagement levels were the highest on TikTok (363k views, 11k likes), followed by YouTube (26k views, 256 likes) and Instagram (views NA, 207 likes). Medical professionals were featured in 90% of YouTube, 50% of TikTok, and 60% of Instagram content. Positive attitudes (N = 32) were more prevalent than negative (N = 23), with the latter centered on side effects and risks. Negative experiences (N = 28) featured emotional, body, skin, and hair issues, and thrombosis risk, while motivators included protection (N = 9) and personal responsibility (N = 12). Barriers were fear of side effects, lack of information, and prejudice, while misinformation included mechanism of action and cancer. Consulting healthcare professionals was emphasized (N = 19). Conclusions Videos featuring healthcare professionals (YouTube) had lower engagement than those featuring laypeople (TikTok) sharing personal experiences intertwined with information, misinformation, and advice. Risks and side effects associated with hormonal contraception were in focus, and healthcare professionals were promoted as crucial in providing accurate information. Key messages • Low modern contraception use and high abortion rates in Serbia face an online ecosystem focused on negative attitudes and misinformation on hormonal contraception. • TikTok dominates contraception content engagement, featuring laypeople mixing personal stories and (mis)information, although consulting healthcare professionals is emphasized.