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. (http://www.medicine.ox.ac.uk/bandolier/booth/sexhlth/womenoc.html)
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 sterilization
|
63
|
Female sterilization
|
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.