Emergency contraception: an unresolved issue

Women's attitudes towards mechanisms of action of birth control methods: a cross-sectional study in five European countries

AIMS AND OBJECTIVES

To assess women's attitudes towards the mechanisms of action of birth control methods.

BACKGROUND

When addressing women's knowledge of and attitudes towards birth control methods, researchers frequently focus on side effects, effectiveness or correct use. Women's opinions about mechanisms of action have been much less investigated, and research is usually concentrated on the EC pill.

DESIGN

Cross-sectional study.

METHODS

Women, aged 18-49, from Germany, France, the UK, Sweden and Romania were randomly selected (n = 1137). They were asked whether they would use a method that may work after fertilisation or after implantation and whether they would continue using it after learning it may have such effects. Logistic regression was performed to evaluate the influence of certain characteristics on women's attitudes.

RESULTS

Almost half of women in Romania and Germany would not use methods with postfertilisation effects, while the lowest percentages were found in Sweden and in France. Regarding methods with postimplantation effects, higher percentages were found in all the countries. Highly educated women and those using a highly effective method were more likely to use methods with postfertilisation effects. On the contrary, married women, those who stated that human life begins at fertilisation and women with middle/high religiosity were less likely to consider using methods that may act after fertilisation.

CONCLUSIONS

One-third of European women reported that they would not consider using a method that may have postfertilisation effects.

RELEVANCE TO CLINICAL PRACTICE

Given that postfertilisation effects may not be acceptable to some women, informing them of which methods may have these effects is essential to obtaining complete informed consent and to promoting women's autonomy.

Knowledge and beliefs about mechanism of action of birth control methods among European women

BACKGROUND

Adequate knowledge is essential for making informed decisions. We attempted to determine the level of knowledge about mechanisms of action of birth control methods in five representative samples of European women.

STUDY DESIGN

Randomly selected women, aged 18-49 years, completed an anonymous survey in Germany, France, the UK, Sweden and Romania (N=1137). Participants were asked about how contraceptive methods work and if providers should inform them about this issue. Multiple linear regression was used to evaluate women's characteristics associated with their knowledge of mechanisms of action.

RESULTS

The majority of women identified the unequivocal mode of action of condoms, sterilization and abortion. Fewer than 2% identified all possible mechanisms of action of hormonal contraceptives and intrauterine devices. Highly educated women correctly identified the mechanism or mechanisms of action of more methods than less educated women (β=0.22, 95% confidence interval 0.01-0.43). Regardless of their sociodemographic characteristics and their belief about when human life begins, most women (75%) stated that the provider should inform them about possible postfertilization effects.

CONCLUSIONS

European women have low knowledge about mechanisms of action of several contraceptive methods. The majority want to be informed about possible postfertilization effects. Since adequate knowledge is essential for making informed decisions, providers are encouraged to inform women about all possible mechanisms of action of contraceptives.