New Survey Spotlights Women’s Knowledge, Misperceptions
About Birth Control Options and Effectiveness
American College of Nurse-Midwives survey finds that health providers are not adequately communicating with women about their birth control options, methods
Silver Spring, MD – Despite the broad range of options available to women for birth control and family planning, a survey of more than 1200 US women between 18 and 45 released today by the American College of Nurse-Midwives (ACNM) shows that women do not feel knowledgeable about many of these options and have harmful misperceptions about their effectiveness. The survey also found that many women don’t feel they are able to have in-depth conversations with their health care providers to make well-informed decisions on birth control and family planning.
“The survey provides really interesting considerations for both women and health care providers in the area of birth control and family planning,” said Lisa Kane Low, CNM, PhD, FACNM, a practicing midwife and member of the ACNM committee that developed the survey. “For example, while women are encouraged to seek out and obtain the information they need to make sound decisions on contraception, and when or if they have a family, it’s incumbent on health care providers to create an environment where women feel comfortable opening up to them about their needs,” Low said. “If more options and their effectiveness are shared with women in an in-depth manner, women could be better informed and more confident in their decisions about which birth control best meets their unique needs.”
“These survey findings are especially timely given the implementation of the Affordable Care Act (ACA), which enables more women to have access to contraceptive services,” said ACNM President Ginger Breedlove, CNM, PhD, FACNM. “As health care providers, we have a critical role to play in discussing all forms of birth control options and services by providing attentive and engaging patient-provider discussions so women can make optimal choices around contraception and family planning, and avoid unintended pregnancies.”
Forty percent of women surveyed said they did not receive in-depth counsel or information from their health care provider about how to use the type of birth control they were prescribed. While most said they were knowledgeable about abstinence (70%), only a little more than half of women said they were very knowledgeable about condoms (55%) and less than half of women said they were very knowledgeable about birth control pills (49%), the withdrawal method (43%), and tubal ligation (28%). Only 21% of women said they were very knowledgeable about intrauterine devices (IUDs) and 17% were very knowledgeable about hormonal implants, recognized by the Centers for Disease Control and Prevention (CDC) in its 2011 report, “Effectiveness of Family Planning Methods,” as 2 of the most effective forms of birth control. Fewer than 1 in 100 pregnancies occur in women who use either an IUD or implant.
Although 64% of women said their health care provider presented them with multiple birth control options, some women were concerned about the information provided and how the conversations took place. One in 10 women said they felt pressured to choose one type of birth control method over another, 1 in 10 women shared that they had questions they felt they were unable to ask, and another 1 in 10 women felt their health provider made assumptions about them that led their provider to prescribe a certain type of birth control.
Many women also report concerning misperceptions about the effectiveness of various birth control options in preventing unplanned pregnancy. When presented with a list of 16 birth control options, 57% of the women surveyed ranked birth control pills as the most effective, while 43% said condoms were the most effective. When asked which type they used the most, the top 3 forms were birth control pills (27%), followed by condoms (20%), and withdrawal (13%). Despite their proven effectiveness, the survey found only 2% of women using hormonal implants and 6% of women using IUDs as their form of birth control.
While condoms are effective in preventing sexually transmitted infections and birth control pills can be highly effective in preventing pregnancy for some women, according to the CDC 2011 report, 18-21% of women relying on condoms will become pregnant and 9% of women taking birth control will become pregnant. The CDC also reports that the withdrawal method—the third most prevalent form of birth control among survey respondents—results in unintended pregnancy for 22% of women.
“These data show a clear correlation between what women perceive to be the most effective types of birth control and what types they are actually using. Unfortunately, in many cases these perceptions are not entirely accurate and are not supported by the evidence,” Breedlove said. “Women deserve complete and practical information delivered in positive, respectful conversations by an engaging health care professional. If we can create an environment of healthy dialogue and shared decision making, we can help change perceptions so women make educated choices that are best suited to their needs.”
Another clear finding of the survey was a gap in knowledge about who provides birth control and family planning services. Only 26% of women were aware that certified nurse-midwives (CNMs) and certified midwives (CMs) offer family planning and birth control services, despite this being a specialty for the profession. Additionally fewer than 5% of the women reported that they had consulted a CNM or CM to make a decision about which type of birth control best suits their needs.
Midwives are uniquely positioned to address this identified knowledge and service gap in birth control and family planning for US women. While there are a full range of health care providers who offer birth control and family planning services, Breedlove said midwives are experts in this area and are an underutilized resource. Midwives serve as partners in their clients’ health care, and provide personalized services tailored to each woman’s unique needs—a care style that is especially suited to assist women in making important birth control and family planning decisions.
“While we are well-known as maternity care providers, CNMs and CMs provide a broad range of vital health care services to women through the lifespan, including guidance and counsel on birth control, and prescribing all types of contraception,” Breedlove said. “We listen to women and help them figure out what works for them at 18, 30, or 50—whatever their stage of life. Using an evidence-based model of care coupled with our education and training regarding family planning and contraception, midwives can help narrow this significant and harmful gap in family planning services for women.”
Because the ACA improves coverage for services related to sexual and reproductive health, Breedlove said its implementation will also afford women greater access to midwives, who specialize in providing these services. “As the ACA is implemented, many women will gain access to coverage for reproductive health services that they never have had before. This presents a real opportunity to do more to improve women’s knowledge about and access to effective family planning options. Midwives are experts in providing these services which are vitally important to women’s health,” Breedlove said.
In a separate survey conducted by ACNM last year, women reported that despite stating satisfaction with their current health care providers and services, women were not truly receiving the services they wanted and were not having the in-depth conversations necessary to receive optimal care. Both surveys were distributed as part of ACNM’s ongoing Our Moment of Truth campaign, launched last year to encouragewomen to actively engage and participate in managing their health and learn more about the full range of available options, including the evidence-based, woman-centered care of midwives from puberty through menopause.
ACNM’s 2013 Survey on Women’s Health Care Experiences & Perceptions: Spotlight on Family Planning & Contraception was programmed and fielded through GMI-Lightspeed Research during August 2013. The online survey link was distributed to and completed by 1224 women between the ages of 18 and 45, comprising a representative sample of US demographics for this age group, including race, income level, and geographic distribution.
About Our Moment of Truth™: A New Understanding of Midwifery Care
Our Moment of Truth™: A New Understanding of Midwifery Care presents midwifery as a solution for many women who are looking for more out of their care. Recognizing that many women are not receiving the care they desire, Our Moment of Truth™ challenges women to take a moment to examine the type of health care they are receiving, evaluate what they want from their health care experience, and become aware of their full range of options. Our Moment of Truth™ offers women the information and tools they need to ask the right questions of their provider and have an important dialogue on critical health issues before moving forward with a care plan. Explore the new Our Moment of Truth™ tools and resources for finding desired health care at www.ourmomentoftruth.com.
About the American College of Nurse-Midwives