Attitudes, awareness, compliance and preferences among hormonal contraception users: a global, cross-sectional, self-administered, online survey

Abstract

Background: Healthcare professionals have a responsibility to help each woman select the most appropriate hormonal contraceptive according to her personal preferences, needs and circumstances.

Objective: To assess attitudes, awareness, compliance and preferences of hormonal contraceptive users.

Study design: A cross-sectional survey conducted through self-administered, online questionnaires. One questionnaire was administered in the US and another was administered in the UK, France, Germany, Spain, Italy, Brazil, Australia and Russia (Eight-Country Survey questionnaire).

Participants: Current hormonal contraceptive users, aged 18-44 years, in the general community.

Results: Questionnaires were completed by 5120 women. The mean age of the respondents was approximately 31 years and over 70% were current contraceptive pill users. Many women did not plan on having children in the next 3 years (range 44% in Russia to 77% in the US and UK), but a quick return of fertility upon contraceptive discontinuation was desired by the majority of women in all countries (range 54% in the US to 91% in Russia). Rates of discontinuation or switching to a different hormonal contraceptive in the past year ranged from 30% in Germany to 81% in Brazil. Requests to switch because of side effects ranged from 24% in Spain to 57% in Brazil. Results from the Eight-Country Survey questionnaire indicated that 42% of women would consider using one of the most effective contraceptive methods even if their menstrual cycle changed, 58% would accept irregular bleeding initially if they had fewer periods over time, 53% did not want/had concerns about foreign/additional estrogen in their body, 85% would prefer a monthly option with a lower hormone dose over a daily pill, 80% would consider switching contraceptives to minimize estrogen exposure and 74% would prefer an estrogen-free/progestin (progesterone congener)-only pill to avoid potential side effects from foreign/extra estrogen. Oral contraceptive users across all countries admitted missing (range 39% in the UK to 65% in Brazil) or taking a pill at the wrong time (range 12% in Spain to 67% in Brazil) in the previous 3 months. Approximately 81% of all respondents said they would consider using a method that did not require daily, weekly or monthly dosing. The proportion of women believing themselves well informed about their contraception options ranged from 30% in Russia to 86% in the US. Informed women were generally more aware of alternative methods than their uninformed counterparts. Responses also varied significantly among women in different age groups.

Conclusion: These findings demonstrate that a range of factors influence a woman's choice of contraceptive. This highlights the importance of individualized counselling during contraceptive selection to ensure that the option recommended is tailored to the personal preferences of each woman to improve compliance, continuance and prevention of an unwanted pregnancy.