Twenty-five years since the landmark International Conference on Population and Development in Cairo, most countries have made great strides in increasing access to and voluntary use of family planning.
However, pernicious, difficult-to-address myths and misconceptions around modern contraception still discourage or prevent millions of women from beginning or continuing to use a method.
When the Cairo conference convened delegations from 180 countries and included thousands of nongovernmental organizations and activists from around the world in 1994, the average number of births per woman was 3.0. The conference endorsed a new approach to stabilize population and enhance development by recognizing women’s critical role. Two and a half decades later, the global fertility rate has dropped to 2.5.1
This decline has been achieved through increased use of modern contraceptives, from 54 percent in the mid-1990s to 57 percent of all couples today.2 But even today, millions of women who want to avoid pregnancy are not using a modern contraceptive method, and surveys show that a major reason is concern about the side effects and/or health risks of contraceptive methods. However, the surveys don’t show how many of these women are avoiding modern contraception because of myths and misconceptions about the various methods.
Side Effects and Health Risks: Real or Imagined?
To understand how myths about contraceptives take shape, it is important to see the link between imagined side effects and the very real ones that women encounter every day. Inaccurate information about contraception is often the product of users and providers attempting to understand the chemical and biological processes that make contraceptives work.
Many modern contraceptives contain hormones that can cause certain side effects in some women. Depending on the method being used, these may include breast tenderness, headaches, weight gain, lack of regular menstrual bleeding, nausea, and/or loss of bone density with continued use over many years.
These potential side effects often form the basis for a wide range of misconceptions. For example, where women’s ability to bear children is key to their socio-economic status, they frequently fear that the temporary prevention of pregnancy with contraception can lead to permanent infertility with sustained use.3 They may believe that lack of a monthly period signals a dangerous buildup of blood inside their bodies. Some believe that nausea that can be caused by an oral contraceptive may be a sign that acid in the pill is burning their stomach or ovaries.4 Others believe that contraceptive pills accumulate in some other body organ.5
Fear of side effects, both real and imagined, is a major reason why women discontinue using contraception, which can result in unintended pregnancies. 6 A study in 36 countries found that discontinued use resulted in more than one third of unintended pregnancies.7 However, many health surveys do not distinguish between misperceptions and actual side effects when asking women why they stop, making it difficult to know the exact impact of each.8
Myths Can Take on a Life of Their Own
Rumors about contraceptives are spread by and among women themselves, often through their informal social networks. A study in Kenya found that young women who were surveyed rarely mentioned health providers as sources of information on contraception; rather, their main sources were peers and community members.9 Indeed, the study concluded that social networks often served as the primary influence on decisions regarding use of contraception.
In addition, providers who do not understand how contraceptives work can help myths spread by incorrectly addressing the questions about genuine side effects that their patients bring up, which can confuse or scare these women to stop using family planning. A study of Brazilian gynecologists, for example, found that nearly 75 percent of them believed women who have never given birth can become infertile if given an intrauterine device (IUD).10 Incorrect understanding can also lead providers to deny women access to their desired contraceptive based on inaccurate information. For example, some providers are unaware that adolescents can safely use any modern contraceptive method, including long-acting methods such as the IUD.11
Combatting Myths Requires Specific Tools and Messaging
Dispelling incorrect information is difficult because of the concept of “stickiness”, which suggests that repeating or reiterating a false claim, even when trying to prove it wrong, actually works to make those hearing it remember or support it more.12
Further complicating matters, most people tend to look for or believe information that already fits their established opinions and beliefs.13 As a result, if the accurate information is not presented effectively, both users and contraceptive providers may double down on their existing misunderstanding of how contraceptive methods work instead of taking in this new information and becoming more willing to use or effectively offer family planning.
Twenty-five years on from the Cairo conference, hundreds of millions of women are using modern family planning methods. Reaching the hundreds of millions more who still want to plan childbearing but aren’t using contraception will require innovative tactics and approaches to break down the myths and misconceptions that scare women away, while at the same time respond to the very real side effects that these methods can cause.
References
[1] United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects: The 2017 Revision (New York: United Nations, 2017).
[3] Lisa M. Williamson et al., “Limits to Modern Contraceptive Use Among Young Women in Developing Countries: A Systematic Review of Qualitative Research,” Reproductive Health 6, no. 1 (2009): 3.
[4] Nadia Diamond-Smith, Martha Campbell, and Seema Madan, “Misinformation and Fear of Side-Effects of Family Planning,” Culture, Health, & Sexuality 14, no. 4 (2012): 421-33.
[6] Williamson et al, “Limits to Modern Contraceptive Use Among Young Women in Developing Countries.”
[7] Anrudh K. Jain et al., “Reducing Unmet Need by Supporting Women With Met Need,” International Perspectives on Sexual and Reproductive Health (2013): 133-41.
[9] Rhoune Ochako et al., “Barriers to Modern Contraceptive Methods Uptake Among Young Women in Kenya: A Qualitative Study,” BMC Public Health 15, no. 1 (2015): 118.
[10] Agnaldo Lopes da Silva-Filho et al., “Barriers and Myths That Limit the Use of Intrauterine Contraception in Nulliparous Women: A Survey of Brazilian Gynaecologists,” Postgraduate Medical Journal 93, no. 1101 (2017): 376-81.
[11] World Health Organization, Department of Reproductive Health and Research, and Johns Hopkins University, Bloomberg School of Public Health, Center for Communication Programs, Family Planning: A Global Handbook for Providers, Evidence-Based Guidance Developed Through Worldwide Collaboration, 2018 Update (Baltimore and Geneva: Johns Hopkins University, Bloomberg School of Public Health and WHO, 2018).
[12] Stephan Lewandowsky et al., “Misinformation and its Correction: Continued Influence and Successful Debiasing,” Psychological Science in the Public Interest 13, no. 3 (2012): 106-31.
[13] Brendan Nyhan et al., “Effective Messages in Vaccine Promotion: A Randomized Trial,” Pediatrics 133, no. 4(2014): e835-42.
