04-09-2012, 12:41 PM
Women's attitudes towards mechanisms of action of family planning methods
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ABSTRACT
Background
To ensure women's right to a free choice in family planning (FP), the World Health Organization (WHO) recommends that information related to FP should include, at a minimum, the following for each method: effectiveness, correct use, mechanism of action, side-effects, health risks and benefits, reversibility, and protection against sexually transmitted infections [1]. Knowledge about each of these aspects can have practical implications regarding acceptance and satisfaction with the chosen method as well as minimize user errors. It is also important to acknowledge that women have different preferences and can accordingly make a choice of the method best suiting their wishes.
According to available evidence, some FP methods, including oral contraceptives, emergency contraception, and intrauterine devices, can act before and occasionally after fertilization [2-12]. Postfertilization effects may include structural and biochemical endometrial changes as well as alterations in fallopian tube motility. These effects may prevent implantation or pre-implantation embryonic development. The contribution of postfertilization effects to the overall effectiveness is potentially different for different methods [13]. Some authors have pointed out that postfertilization effects could be an important issue for some women, especially those who believe that human life begins at fertilization [14,15]. Apart from individual convictions, the preferences may differ by cultural background [14,16-18].
Methods
We carried out a cross-sectional survey in a sample of women in reproductive age (18–49) from ten Primary Care Health Centres in various areas of Pamplona, Spain. Women attend this kind of centre for obtaining primary care from family physicians. These centres are part of the National Health Service and they do not have any particular religious affiliation. Prior to distributing the questionnaire women were asked about their age and women under 18 were excluded (age of majority in Spain). Additionally, the questionnaire contained a question about any surgery or known pre-existing condition causing infertility. Women who stated yes were asked to terminate the questionnaire just after initial questions and were excluded from the analysis.
We assumed that a fraction of respondents who will consider not using a family planning method sometimes acting after fertilization but before implantation will be in the range between 20 and 40% and we sought to estimate this proportion with ± 3% confidence interval, requiring a sample size of approximately 700 participants. We decided to include around 50–80 women per centre, depending on the population in each area; resulting in a total of 755 participants which is also a sufficient sample size for the multivariate analyses of the study [22].