Less than half of female adolescents and young women can correctly answer questions about how contraceptives work, according to a new nationally representative survey published in the Journal of Adolescent Health.

Researchers surveyed 1160 English-speaking individuals aged 15-29 years who were assigned female at birth. Participants were asked about contraceptive facts, such as whether intrauterine devices (IUDs) cause abortions (they do not), whether emergency contraception pills are the same as abortion pills (they are not), and whether menstrual cycle-tracking apps are highly effective at preventing pregnancy (they are not).

Overall, participants answered just 48% (P < .05) of questions correctly. Younger adolescents scored lowest: those aged 15-17 years answered just 38.9% correctly compared with 47.3% for those aged 18-24 years (P < .05) and 53.6% for those aged 25-29 years (P < .05). Non-Hispanic Black respondents scored 36.9% compared with 46.9% for Hispanic respondents (P < .05) and 50.5% for non-Hispanic White respondents (P < .05). LGBTQ+ respondents had greater knowledge than their heterosexual peers (53.3% vs 45.9%; P < .05).

Only 13% knew that teenagers younger than 18 years can obtain birth control pills over the counter. Just 21% answered correctly that taking periodic “breaks” from oral contraceptives is unnecessary. Only 40% recognized that menstrual cycle-tracking apps are not highly effective at preventing pregnancy, and 56% knew that emergency contraception is different from abortion pills.

“There are several urgent misconceptions clinicians need to address when working with adolescents and young adults,” said Brooke Whitfield, PhD, the study’s lead author and postdoctoral research associate at the Reproductive Equity Action Lab at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. “Given the current political climate and the strategic mislabeling of methods like IUDs, emergency contraception, and some birth control pills as abortifacients, it’s critical that clinicians offer clear, evidence-based explanations of what these methods are and how they work.”

Clinicians say the findings echo what they see in practice.

“I live in Indiana, where sex education is not required, and if it is provided, it must emphasize abstinence only,” said Tracey Wilkinson, MD, associate professor of pediatrics and obstetrics & gynecology at Indiana University School of Medicine, Indianapolis, who was not involved in the study. “That means most young people are learning about contraception from the internet, social media, or even pornography. It’s pretty bleak,” she said.

Wilkinson said she begins by asking patients what they already know.

“We need to assume they’re learning from multiple sources and not minimize or belittle that information, no matter how inaccurate it is,” she said. “If you do, the patient can lose trust in that interaction.”

She added that deliberate online misinformation makes the job harder. “Young people are trying to navigate the information world just like the rest of us are, and they’re struggling given all the misinformation that’s out there,” Wilkinson said.

Whitfield said that knowledge gaps also extend to sexually transmitted infections (STIs).

“We’ve seen a continued rise in STIs for over 10 years, with young people aged 15-25 accounting for about half of all new cases,” Whitfield said. “Yet in our sample, only 54% knew that condoms are the only form of contraception that also prevents STIs.”

The survey was conducted shortly after the FDA approved Opill, the first over-the-counter birth control pill, in 2024. But awareness was low — just 13% of respondents knew teens could access it, and only 21% of adults knew about it.

“You can’t use a method you don’t know exists,” Whitfield said. “The good news is that Opill seems to be filling a gap, but only for those who know about it. We still need a major push to increase awareness, especially among adolescents and young adults.”

“Now what we have to do is work on their awareness of that and their trust,” said Wilkinson.

Clinicians can help reduce knowledge disparities by normalizing questions, using plain language and visual aids, addressing misinformation respectfully, and screening for mistrust, Whitfield said.

“Representation matters,” Whitfield said. “Use inclusive language, avoid assumptions, and when possible, offer materials or referrals that reflect the patient’s identity and lived experience.”

For Whitfield, the bottom line for clinicians is about building trust.

“Ultimately, it’s about providing medically accurate information in a nonjudgmental, trust-building way. Medical mistrust is high, including among young people, and being dismissive of their questions or their desire for nonhormonal options can quickly shut down dialogue.”

The survey, conducted by Power to Decide using Ipsos KnowledgePanel, was fielded from July to September 2024. Funding was provided by The JPB Foundation. Whitfield and Wilkinson did not disclose any relevant conflicts of interest.

Lara Salahi is a health reporter based in Boston.