Increased use of contraception can delay childbearing, space births, and limit completed family size. This results in a decline in fertility leading to economic improvements, better health outcomes for women and children, and improved gender equality (Bongaarts, 2016). Therefore, reducing unmetneed for contraceptives is a top priority for organizations working in global health and international development (FP, 2020, UN, 2017). Specifically, the Bill and Melinda Gates Foundation is pursuing an increase in adoption of family planning as one of the key mechanisms to improve gender equality (Equal is Greater, 2019).

Despite billions of dollars that have gone into this effort worldwide, contraceptive use remains lower than its potential. According to the Demographic Health Survey, the primary reason for non-use of contraceptives is “method related health concerns” (Sedgh and Hussein, 2014) and within this broad category, the belief that using contraception will cause infertility is common (Payne, Sundstrom & DeMaria, 2016; Richardson et al., 2016; Küçük, Aksu, & Sezer S, 2012).

This belief extends to low-, middle-, and high-income countries across the world. Studies in Bangladesh (Henry et al., 2015; Shahabuddin et al., 2016) and Vietnam (Nguyen et al., 2006) report that this fear is a major barrier to contraception use. A systematic review of barriers to contraception use among young people in low- to middle- income countries reported that the belief that contraception use would cause infertility was the most cited reason for non-use (Williamson et al., 2012). Despite the fact that this belief is well-documented, there are few interventions or communication campaigns that directly address it. Interventionists may be fearful that addressing it could exacerbate this misperception, but we know that ignoring it already has deleterious effects on contraceptive use.

It is critical for policy- and behavior-change program designers to understand and mitigate the impact that the fear of infertility has on a woman’s desire to use contraception. If interventions succeed in reducing the prevalence of the belief that contraceptives cause infertility, this could increase use of contraceptives and reduce unmet need for contraception. This would have positive economic, health impacts, and gender equality impacts.

Debunking misperceptions is not easy, but to move the needle on contraceptive use and to ensure that women are armed with accurate information, it is critical to properly address it. Extensive formative research with communities before a communication campaign takes place is a logical first step to ensure that messages resonate. Furthermore, real time monitoring and rigorous evaluations of contraceptive uptake will take effort but could move the needle to get closer to reaching the Family Planning 2020 goals (FP, 2020).

By Erica Sedlander, Sigur Center Field Research Grant Recipient for Summer 2019. Her work strives to improve women’s health both in the U.S. and globally. She uses mixed methods to examine multi-level factors that affect behavior changes. She serves as a Research Scientist in the Department of Prevention and Community Health and is a Doctoral Candidate in the Milken Institute School of Public Health. Erica’s work on women’s behavioral health can be found here.

References:

Bongaarts, J. (2016). Slow down population growth. Nature, 530: 409–412.

Equal is greater. (2019).https://www.gatesfoundation.org/equal-is-greater/

Family planning. (2020). http://progress.familyplanning2020.org/

Henry, E., Lehnertz, N., Alam, A., Ali, N., Williams, E., Rahman, M., Ahmed, S., El Arifeen, S., Baqui, A., & Winch, P. (2015). Sociocultural factors perpetuating the practices of early marriage and childbirth in Sylhet District, Bangladesh. International Health,7(3): 212–217.

Küçük, M, Aksu H, & Sezer S. (2012). Misconceptions about the side effects of combined oral contraceptive pills. Gynecological Endocrinology, 28(4): 282-285.

Nguyen, H., Liamputtong, L., & Murphy, G. (2006). Knowledge of contraceptives and sexually transmitted diseases and contraceptive practices amongst young people in Ho Chi Minh City, Vietnam. Health Care for Women International, 27(5): 399-417.

Payne, J.B., Sundstrom B., DeMaria, A.L. (2016). A qualitative study of young women’s beliefs about intrauterine devices: Fear of infertility. Journal of Midwifery and Women’s Health,61:482-488.

Richardson, E., Allison, K., Gesink, D., & Berry, A. (2016). Barriers to accessing and using contraception in highland Guatemala: The development of a family planning self-efficacy scale. Open Access Journal of Contraception, 77.

Sedgh, G., & Hussain, R. (2014). Reasons for contraceptive nonuse among women having unmet need for contraception in developing countries. Studies in Family Planning, 45(2): 151–169.

Shahabuddin, A. S. M., Nöstlinger, C., Delvaux, T., Sarker, M., Bardají, A., Brouwere, V. D., & Broerse, J. E. W. (2016). What influences adolescent girls’ decision-making regarding contraceptive methods use and childbearing? A qualitative exploratory study in Rangpur District, Bangladesh. PLOS ONE,11(6): e0157664.

United Nations Foundation. (2017). Family Planning 2020. http;//www.familyplanning2020.org/about.

Williamson, L.M., Parkes, A., Wight, D., Petticrew, M., & Hart, G.J. (2009). Limits to modern contraceptive use among young women in developing countries: A systematic review of qualitative research. Reproductive Health, 6(3).