Countering Myths and Misperceptions about Contraceptives

"This issue of Outlook examines the scope and impact of misperceptions about contraception, the science behind debunking misperceptions, and approaches that programs are using to address this persistent problem."

According to Outlook publisher PATH, research on misperceptions about contraception are not usually separated from concerns about contraceptive side effects, though there is overlap between them that message developers must understand. This document aims to discuss the relationship between misperception and side effect and suggest how these might be addressed through training and communication campaigns. [Footnotes are removed by the editor.]

For example, in adopting a contraception method, client fear of infertility is the predominant misperception, followed by fears of cancer and of side effects that impede lifestyle needs. In addition, women, men, and providers may have misperceptions differing from scientific evidence about the suitability of methods or availability of services for particular audiences, e.g., long-acting methods may be believed to be "unsuitable for youth." The results of misperception may be a cessation of contraception, use of a less effective method, or incorrect use of a method - sometimes resulting in health risks. For example, Nigerian youth report using abortion rather than taking daily birth control pills. Sources of misperceptions may be: providers, the social networks of women who have experienced side effects, and the internet.

On misperception versus side effect: "In the absence of conclusive data, opinions are mixed about the relative impact of documented side effects versus misperceptions on contraceptive use...Analyses of survey data indicate that the overall problem of side effects and health concerns is a significant barrier to adoption and continued use of contraception...[In an Iraqi study] early IUD [intrauterine device] removal was more likely among women who reported having fears (64.6 percent) compared to women without fears (30.8 percent)." Provider interactions in discussions of side effects are suggested to have possible implications for women's fears of contraception: Dismissive reactions to women's concerns about the disruptive results of side effects may result in women giving up instead of seeking reliable services.

Cognitive science research suggests that providing information to correct misperceptions may have little impact or exacerbate fears. "Cognitive scientists have used their understanding about how people think to identify a number of strategies for 'debiasing' people who hold misperceptions:

• Focus on providing correct information rather than negating myths.
• Keep the information simple and limited (for example, three pieces of information can have more impact than ten).
• Create an alternate, compelling explanation to replace the myth.
• Present messages through sources that are trusted by the intended audience.
• Present information graphically, when possible.
• Repeat the correct messages frequently."

"[P]romising approaches include provider training and communication campaigns. In general, approaches that may be helpful for addressing misperceptions are consistent with providing high-quality, client-centered care, including offering accurate information, supportive counseling, a broad range of contraceptive options, and access to follow-up services (for help managing side effects or switching to a more acceptable method)." At the training level, provider materials need to follow the "debunking principles" above, "focusing on simple and correct information that does not repeat or reinforce myths, and addressing the ideas and emotions that contribute to misperceptions."  One suggestion is to create job aids "such as visuals that help to explain the health benefits and low risks associated with using contraceptive methods."

Campaigns have included, for example, a RESPOND Project campaign that used "evidence-based strategies for debunking myths about long-acting methods through mass communication campaigns paired with a community-based outreach strategy in eight countries (Bangladesh, Ethiopia, Ghana, Guinea, Honduras, Kenya, Tanzania, and Uganda) including: 

• Repositioning methods in a positive light rather than directly countering the misperception.
• Using simple, catchy messages.
• Presenting information graphically.
• Repeating messages frequently and in different formats (e.g., television, radio, brochures, posters)."

Messages that emphasise methods that take into account local biases include those that frame long-acting methods as "birth spacing," a "term that implies future fertility and connects with the strongly held worldview that preserving fertility is important." Videos can tell the stories of real people, “another way of framing the message to be consistent with the recipient’s worldview." Similarly, to address misperceptions about non-scalpel vasectomy (NSV) in India, messages addressed myths about negative effects on sexual performance. Campaigns may boost acceptance but not address concerns in the long term. A challenge is analysing why women stop using a method (often due to side effects) so that providers can address those specific concerns.

"[P]otential areas for further research include:

• Identifying the ideas and emotions that fuel misperceptions, the sources of misperceptions, and the role of provider biases and misinformation in perpetuating contraceptive misperceptions in specific locations.
• Developing and evaluating innovative, evidence-based strategies to overcome myths and misperceptions. Even in the absence of additional research, family planning programs and providers can address misperceptions using the following approaches:
• Focus on providing correct information, including that contraceptives are safe and can help women and men achieve their fertility and life goals. The fact that misperceptions are hard to change once established makes it especially important to get it right the first time - for example, when new methods are being introduced.
• Avoid restating misperceptions during counseling or in client education materials and campaigns.
• Provide simple, alternate explanations for common misperceptions.
• Recognize that side effects can be significant client concerns (that can lead to or reinforce misperceptions), help clients manage them, and normalize the process of switching to a different method, if needed.
• Address provider misperceptions through pre-service and in-service training, preferably using materials that are designed based on cognitive science principles for addressing misperceptions.
• Pretest messages and materials prior to implementation, not only for comprehension by clients but for immediate impact countering common misperceptions."