Women’s Attitudes toward Family Planning Methods: A Review of Research from Spain​

By: Samantha Marshall, MD

Director’s Note: The applications of fertility awareness-based methods (FABMs) are international and far-reaching. At FACTS, we seek to share the best evidence available with our healthcare colleagues and students around the world, empowering them to educate their patients more effectively about fertility. Former FACTS elective student, Dr. Samantha Marshall, summarized research [1] that underscores the importance of acknowledging patient beliefs in discussions about family planning methods. As seen in this study conducted in Spain by de Irala et al, adequate patient education should include a thorough explanation of the mechanism of action of various methods, as postfertilization effects may influence a patient’s preferred method of family planning.

Introduction

Over the years, numerous methods of family planning have been discovered and developed. Many methods are now available for patients to choose from, and they differ in effectiveness, mechanism of action, and associated adverse effects. It is important for patients to be aware of all these characteristics when selecting the family planning method that is best for them. Previous research has focused on mechanism of action and how it affected a patient’s choice of family planning method; however, the mechanism of action itself can be reason enough for some patients to reject certain methods. Specifically, family planning methods that may exert postfertilization effects, such as oral contraceptives, emergency contraception, and intrauterine devices, [2][3][4] may not be agreeable to some patients based on moral and/or religious beliefs. The study by de Irala et al [1] aimed to assess whether the presence of postfertilization effects impacted patients’ decisions to use certain methods of family planning and which patient characteristics were more likely to be associated with a specific choice.

“Many methods are now available for patients to choose from, and they differ in effectiveness, mechanism of action, and associated adverse effects. It is important for patients to be aware of all these characteristics when selecting the family planning method that is best for them.”

Methodology

The researchers completed a cross-sectional study on women between the ages of 18 and 49 (reproductive aged women). The women were selected from ten primary care health centers in Pamplona, Spain and completed a 30-item questionnaire. The questions pertained to a patient’s beliefs, attitudes, and preferences regarding the use of family planning methods with effects either pre-fertilization, post-implantation, or post-fertilization but pre-implantation. The survey also assessed a patient’s level of religiosity based off their church/worship attendance and personal assessment of the importance of faith. After collecting data, the researchers used logistic regression to assess characteristics independently associated with four outcomes: would use a family planning method that occasionally works after fertilization vs. after implantation and would continue using a family planning method after learning that it works after fertilization vs. after implantation.

Results

The researchers sampled a total of 755 patients. After excluding patients outside the age criteria and those unable to become pregnant as well as accounting for surveys not completed, 581 total surveys were utilized in the analysis. The patients had a mean age of 30.8; most had completed some amount of post-high school education, about half were married, and the majority (69.7%) were Catholic but with low religiosity. Nearly 80% of participants indicated they would desire pregnancy in the future but more than half had never been pregnant. Nearly half of patients reported they believe life begins after fertilization.

When asked which characteristics affected their choice of birth control, efficacy, convenience and ease of use, and absence of side effects were indicated most frequently. About 40% of patients indicated they would not utilize a family planning method that may have effects after fertilization but before implantation, and 57% would not use a method that has effects after implantation. Approximately 35% reported they would stop using a method if they found out it worked after fertilization but before implantation, and 56% said they would stop using a method if they found out it worked after implantation.

“About 40% of patients indicated they would not utilize a family planning method that may have effects after fertilization but before implantation, and 57% would not use a method that has effects after implantation.”

Regarding patient characteristics related to their choice of family planning method, participants with higher education degrees (university or PhD) and those who believe life begins at or after implantation or are unsure of when life begins were more likely to use a method that exerts effects after fertilization. Conversely, women with higher religiosity were less likely to utilize these methods.

Discussion

The results of this study support the researchers’ hypothesis that the mechanism of action of family planning methods may impact a woman’s choice in method. Not only did the results demonstrate that a patient’s beliefs regarding when life begins impact their choice of a family planning method, but they also support the notion that religious beliefs can have a strong impact on a woman’s choice of family planning method. Namely, many Catholic patients of high religiosity are unlikely to select family planning methods that exert effects after implantation or after fertilization.

This study has several limitations. It was conducted in a city of Spain in which much of the population is Catholic. The strong beliefs of some Catholics regarding reproduction and reproductive methods skew the survey’s diversity of beliefs and responses. Additionally, the study assumes each participant has a certain level of understanding regarding female reproduction. While the survey did provide explanation of family planning methods, there was no method of verifying each participant had sufficient understanding to complete the survey.

“Each family planning method is unique, and patients deserve accurate and complete explanations to enable informed decisions that align with their personal beliefs and goals.”

In all fields of medicine, it is imperative to respect and value patients’ beliefs and desires. This study underscores the importance of acknowledging patient beliefs when discussing family planning methods. It also highlights the importance of thorough explanations of family planning methods when discussing this with patients. Each family planning method is unique, and patients deserve accurate and complete explanations to enable informed decisions that align with their personal beliefs and goals.

References

[1] de Irala J, Lopez del Burgo C, Lopez de Fez CM, Arredondo J, Mikolajczyk RT, Stanford JB. Women’s attitudes towards mechanisms of action of family planning methods: survey in primary health centres in Pamplona, Spain. BMC Womens Health. 2007;7:10. Published 2007 Jun 27. doi:10.1186/1472-6874-7-10.
[2] Matyanga CMJ, Dzingirai B. Clinical Pharmacology of Hormonal Emergency Contraceptive Pills. Int J Reprod Med. 2018;2018:2785839. Published 2018 Oct 4. doi:10.1155/2018/2785839.
[3] Buskmiller C, Harrison D, Ruppersberger LA, Yeung PP Jr. Systematic Review of Postfertilization Effects and Potential for Embryo Formation and Loss during the Use of Intrauterine Devices. Linacre Q. 2020;87(1):60-77. doi:10.1177/0024363919854289.
[4] Larimore WL, Stanford JB. Postfertilization effects of oral contraceptives and their relationship to informed consent. Arch Fam Med. 2000;9(2):126-133. doi:10.1001/archfami.9.2.126.

ABOUT THE AUTHOR

Samantha Marshall, MD

Samantha Marshall, MD is a recent graduate of Georgetown University School of Medicine in Washington, DC. She completed her undergraduate education at Miami University in Oxford, Ohio. She is pursuing residency in internal medicine and plans to complete a fellowship in gastroenterology. Dr. Marshall enrolled in the FACTS elective to gain a better understanding of natural family planning methods and ways to share these methods with future patients so they feel more empowered over their health and reproductive decisions.