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.