A randomised controlled trial to determine the impact of fertility
awareness education on the behaviour, knowledge and attitudes of condom users
C. Pyper (1), V. Lamprecht (2), M. Vessey (1), D. Smith (3), L. Bromhall (1),
E. Greenhall (4), H. Doll (1)
Department of Public Health, Institute of Health Sciences, Oxford, UK (1);
Institute for Reproductive Health, Georgetown University, Washington DC, USA
(2); Oxford Centre for Medical Statistics & Office of Biostatistics &
Bioinformatics, Medical College of Georgia, USA (3); Oxfordshire District Health
Authority Family Planning Service, Oxford, UK (4)
This study was a collaborative effort between the University of Oxford and
Georgetown University, Washington DC.
Aim: To assess the impact of fertility education on the behaviour,
knowledge and attitudes of condom users.
Design: A randomised controlled trial.
Setting: Primary health care centres.
Subjects: Eighty-four couples aged 18 to 45 who used condoms as their
method of contraception.
Methods: The women were followed up for a total of four menstrual
cycles. All women were asked to record menstrual cycle information including,
intercourse frequency, and condom usage. At the end of four menstrual cycles,
the women’s fertility knowledge assessed using a questionnaire. The couples
were then randomised into two groups. Allocation of couple to group was at
random using a sequence of computer generated random numbers sealed into
numbered envelopes and opened by the nurse just prior to the visit after four
cycles. The intervention group received a single educational session about
fertility knowledge, whereas the control group did not. The couples were then
followed for four further menstrual cycles recording the same information as
previously. The women randomised to receive fertility education were also asked
to record observed signs of their changing fertility throughout the menstrual
cycle, and days they thought they were fertile. After a total of eight menstrual
cycles all the women in the study were asked repeat the fertility knowledge
questionnaire. In addition an in-depth interview was conducted to determine
their knowledge, attitudes and behaviour relating to using condoms.
Main outcome measure: The difference in pattern of protected and
unprotected intercourse during the fertile and infertile phases of the four
menstrual cycles after randomisation.
Results: The fertility education intervention significantly increased
the frequency of unprotected intercourses in the post fertile phase of the cycle.
There were no pregnancies resulting from the unprotected intercourses in the
intervention group. The fertility knowledge of the couples increased
significantly in the intervention group.
Conclusions: The fertility education intervention significantly
increased the frequency of unprotected intercourses in the post fertile phase of
the menstrual cycle. These findings suggest that if fertility education is
targeted at monogamous couples it is likely to encourage them to target their
risk taking behaviour at time that are unlikely to result in a pregnancy.
However it is argued that a small amount of knowledge can be a dangerous thing
and if fertility education is offered indiscriminately it could result in
increased frequency of risk taking and increased exposure to STIs to those
couples at risk.
