Understanding the fear that birth control causes infertility

People around the world in low-, middle- and high-income countries mistakenly believe that using birth control will cause infertility. In Ethiopia, knowledge of contraceptive methods is almost universal and barriers to access are declining, but barriers in demand persist. The top reason women cite for not using birth control is a “method-related health concern,” with many believing the infertility myth. New research led by Erica Sedlander explored what’s associated with this myth to suggest strategies to address it and help people make informed choices about using birth control.

Surveying women of reproductive age in Ethiopia, they found that self-efficacy to use family planning, husband’s support of family planning, and visiting a health center in the last 12 months were linked with a reduced odds of believing that birth control causes infertility. A belief that their husbands will leave if they’re unable to get pregnant was linked to increased odds of believing this myth.

Although fear of infertility is an individual-level phenomenon, it may be grounded in higher-level factors. Sedlander found in previous research in Kenya that someone’s social network beliefs affected their birth control use more than their own beliefs. Within this study, at the interpersonal level, fear about husbands’ reactions was significantly associated with fear of infertility. The findings suggest that for many women, use of contraception was associated with two negative outcomes: that they would become infertile and that their husbands would leave as a result.

They also found that a home visit with a health worker who discussed family planning wasn’t associated with beliefs about birth control and infertility. It suggests that debunking this myth was perhaps not part of the curriculum. As health workers often come from the communities they serve, some might believe it themselves. Educating them about the seriousness and prevalence of this information might be a logical next step.

They did find that visiting a health center where the provider spoke about family planning was linked to reduced odds of believing misinformation about infertility. This implies differences in the type of information women may be receiving when visiting health centers as opposed to at a home visit.

Belief that infertility will result in abandonment from one’s husband was associated with increased odds of holding the belief that modern contraception results in infertility. Family planning efforts need creative ways to include men in the conversation. Informing couples that infertility can be the result of both male and female factors may alleviate the burden on women. Future interventions might also consider working with newly married couples to engage in open discussion about family planning within the home. A communications campaign for couples could acknowledge that using contraception and becoming a mother are not mutually exclusive.

Of course, there’s the concern that addressing the belief could make it worse. That may be one reason that interventions have largely ignored it. Rather than stating that contraception doesn’t cause infertility, interventions might want to include information about the real causes of infertility.

Expecting women to use contraception when they believe it could result in infertility and a host of negative ramifications without addressing their misperceptions brings up ethical questions for people working to simply increase contraceptive use. A more person-centered family planning approach that considers each woman’s lived experiences is necessary to truly meet people’s needs.