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Womens' knowledge of contraception and risk

 

Clinical bottom line

Women, even broadly well-educated women in a prosperous part of England, do not know how effective various forms of contraceptive are, nor are they able to judge the absolute or relative risks of different methods.


Reference

JE Edwards et al. Women's knowledge of, and attitudes to, contraceptive effectiveness and adverse health effects. British Journal of Family Planning 2000 26: 73-80.

Study

This study involved a series of focus groups with women of different ages and backgrounds in and around Oxford. There were four groups. Two involved mothers, two unmarried women, of middle and lower socioeconomic groups, with and without long-term partners, with professional, non-professional, and student backgrounds. The age range was 18 to 45 years. Overall, 41 women were involved.

They participated in semi-structured groups examining knowledge of contraceptive effectiveness, and their knowledge of the risks of adverse effects of hormonal contraceptives. Their attitudes to adverse events was sought.

Results

The women recruited varies from a supermarket checkout worker, through teachers and students, to women with significant postgraduate qualifications and experience. female sterilisation, contraceptive pills, intrauterine devices, and male condoms were used for contraception, the former with older women with completed families, the latter with younger women without children.

Women were asked about the effectiveness of various forms of contraception. The percentage knowing or guessing the correct answer for a variety of methods is shown in Table 1. There were large differences between groups, both in terms of the correct guesses or knowledge, and in the over or underestimate of effectiveness of different methods. Only for the male and female condom and male sterilisation did about a half or more know or guess the correct answer.

Women consistently over estimated effectiveness of female sterilisation, but tended to underestimate effectiveness of intrauterine devices, contraceptive implants, and hormonal oral contraceptives.

Table 1: Women knowing or guessing correct effectiveness of various contraceptive methods

Method
Percent correct
Male condom
49
Female condom
56
Intrauterine device
32
Hormonal implant
29
Oral contraceptive
12
Male sterilisation
63
Female sterilisation
22

Knowledge of the risk of thrombosis in health women, women using hormonal contraception, and pregnant women was not correctly known by most women in these focus groups. There was a tendency, all three circumstances, for the risks of thrombosis to be over estimated (Figure 1).

Figure 1: Women knowing or guessing risks of thrombosis

When it came to common adverse events with contraceptives, women were generally unhappy with any weight gain of 3 kg or more, but generally happy with weight loss of 3 kg, but not of 6 kg. Amenorrhoes was more acceptable than not, but bleeding plus spotting were not acceptable to many women, and prolonged bleeding to hardly any women.

Comment

Women, even broadly well-educated women in a prosperous part of England, do not know how effective various forms of contraceptive are, nor are they able to judge the absolute or relative risks of different methods.