FP (33) Q2. RH/FP information products and programs for children and youth (5) Perceptions of risk of pregnancy and contraceptive side effects

8 August, 2018

Dear Amelia and all,

Thank you for your comment. http://www.hifa.org/dgroups-rss/fp-26-q2-rhfp-information-products-and-p...

"We should try to understand why sexually active young women have high levels of unmet need. Sedgh et al (2016)'s report demonstrated that it is not simply about access to contraceptives or basic information. Rather, the most common reasons for non-use of contraceptives were infrequent sex and concerns about contraceptive side effects."

I'd like to highlight the relevant parts of Sedgh et al's report:

1. Women who cite infrequent sex as a reason for non-use of contraception: 'Women may believe they have little or no risk of conceiving if they have sex infrequently or not at all... Women citing this reason may perceive that they have sex too infrequently to warrant contraceptive use, or believe that contraceptive methods are too burdensome for the number of times they have intercourse... Other women may be avoiding sexual activity instead of using a contraceptive method;11 these women could clearly benefit from improved services, including a range of contraceptive methods from which to choose. Attention must also be paid to the women citing infrequent or no sex who are sexually active—from 22% of those with unmet need in Armenia to 79% in Cambodia. This group may be underestimating their risk of becoming pregnant...'

Believing that one has no risk of conceiving if one has sex infrequently is clearly a misperception.

For these women, Sedgh et al suggest the following possible program responses:

- Counseling regarding women’s fertility, sexual experience and the risk of becoming pregnant.

- Discussion of pregnancy risk and contraception in primary care services other than family planning, or in integrated reproductive health services.

- Help choosing the methods that are most appropriate for the types of relationships that women have.

- As a backup, informing women about emergency contraception (contraception used in the first few days after unprotected intercourse) and increasing access to it in countries where it has been approved for use.

- Informing women about safe abortion options where they are available.

2. Women who cite contraceptive side effects as a reason for non-use of contraception: 'Concerns about the side effects and health risks associated with modern contraceptive methods had become increasingly common throughout the developing world.'

'Concerns about side effects and health risks have become more prevalent reasons for nonuse in the majority of countries in this analysis, possibly because more women have been exposed to the real side effects of contraceptive methods or to misinformation about the problems associated with use'

In our HIFA FP survey (Sept 2017) of HIFA members (highly educated health professionals and researchers), we found that:

1 in 7 respondents thought their friends and colleagues believe that 'contraceptives are dangerous to a woman's health'

1 in 7 respondents thought their friends and colleagues believe that 'contraceptives often cause long-term problems with fertility'

Myths and misconceptions about every method of FP/C are very common. Here are myths reported for just one contraceptive method (implants), by Andre Shongo, DR Congo:

1. If an implant is inserted in my arm and I'm pregnant, my baby will suffer from birth defects.

2. The implant can move in the body

3. Implants can cause cancer

4. The insertion and removal of implants is a procedure long and painful surgery that will cause permanent damage to my body.

5. Any pregnancy occurring in women under implant is an ectopic pregnancy

Misinformation, myths and misperceptions about the side effects or perceived harms of different contraceptive methods are far removed from reality.

As Roy Jacobstein, IntraHealth USA said in our first FP discussion (Sep/Oct 2017): "Any of us who have worked in FP know how widespread, deep and often recalcitrant these misunderstandings and myths can be."

So, while I agree that access to contraceptives and information do not provide the whole picture, I would suggest they permeate almost every aspect of family planning.

Finally, Sedgh et al's report concedes that it is unable to answer a key question on the basis of currently available evidence: Why do certain contraceptive methods elicit fears of health risks and side effects more than others? They call for more research on this, but I suspect that much has already been done in this area?

Best wishes, Neil

Joint Coordinator, HIFA Project on Family Planning

http://www.hifa.org/projects/family-planning

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 18,000 members in 177 countries, interacting on five global forums in three languages. He also currently chairs the Dgroups Foundation (www.dgroups.info), which supports 800 communities of practice on international development, health and social justice. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org