Young Women’s Fertility Knowledge Dr Victoria Newton, Research Associate (victoria.newton@open.ac.uk) Dr Lesley Hoggart, Senior Lecturer (lesley.hoggart@open.ac.uk) Faculty of Health and Social Care | The Open University | Walton Hall | Milton Keynes | MK7 6AA   Young Women’s Fertility Knowledge   Research Question What do young women (aged 16-20) know about fertility, how do they articulate this knowledge in relation to sexual behaviour and reproductive choice? Research Objectives To document and investigate what young women know about fertility and how this knowledge is interpreted at an individual level. To explore young women’s awareness of their fertility in relation to menstruation, contraception and pregnancy risk. Participants demonstrated some knowledge of a fertile period in a woman’s cycle when they thought it was easier to get pregnant. However this information was often vague. There was no comprehensive knowledge among participants regarding the points in their cycle when they were most or least likely to become pregnant. Most participants expressed an anxiety or fear of getting pregnant unintentionally at a point in their lives when they did not feel prepared for motherhood. However, almost all also spoke about occasions when they had taken a risk with their contraceptive: even just the other day, because I had sex with my boyfriend and I was going to get the pill but I just came on my period but then I was like, do I still need to take the pill, what if I just become pregnant and stuff like that, it scares me so much. This demonstrates that a fear or anxiety about getting pregnant does not always transfer into safer sex, despite a desire to avoid pregnancy. Where there was some knowledge of a fertile period, there was no acknowledgement by participants that they changed their sexual behaviour, or were more ’careful’ around this time.   Key Messages Blanket-teaching about the dangers of unprotected sex at any time is potentially detrimental, because it makes it more difficult for young women to understand their pregnancy-risk. Firstly, because they cannot fully assess pregnancy risk and may unwittingly engage in risk-raking behaviours. Secondly, because they may interpret engaging in unprotected sex and not becoming pregnant as a sign of their insusceptibility to pregnancy and may consequently continue to practice such behaviours, which inevitably will lead to a great risk of unintended pregnancy in the future (see also Williamson et al 2009, Hoggart et al 2010). Thus, episodes of unprotected sex that do not result in pregnancy can encourage a belief that ‘it won’t happen to me’, and this has implications for taking chances with contraception, ‘waiting to see’, and the accessing of Emergency Contraception. We suggest: -  It would be empowering for young women to be taught a more comprehensive understanding of their fertility and pregnancy risk, thus giving them a knowledge base which could help them 1) avoid unintended pregnancy in the future, and 2) to plan for children, should they wish to have them in the future. - In addition, a greater understanding of fertility in relation to emergency contraception among providers would allow for better prescribing regarding the most effective methods of emergency contraception since ECP taken after ovulation is ineffective (Novikova et al 2007, Noe et al 2011). Increased provision of the IUD as a method of emergency contraception should be available when the risk of unintended pregnancy is highest (Glasier et al 2011).   Glasier et al (2011) Can we identify women a risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception 84: 363-367. Novikova et al (2007) Effectiveness of levonorgestrel emergency contraception given before or after ovulation – a pilot study. Contraception 7: 112-118. Noe et al (2011) Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation. Contraception 84: 486-492. Hoggart et al (2010) Young People in London: Abortion and Repeat Abortion. Research Report.   Williamson et al (2009) Young women’s perceptions of pregnancy risk and use of emergency contraception: findings from a qualitative study. Contraception, 79: 310-315. This pilot project was undertaken at the University of Greenwich and funded in partnership with Greenwich Community Health Services.   I think she can get pregnant at any point, I don’t think the period matters at all. I think it’s at any point at all, I don’t really know, I’ve never thought about it. There is a week that they do it, I can’t remember where it’s like…obviously not on your period but sort of around that time and then obviously I think they have not certain times but they’d plan to do it at certain times, like if they read it somewhere or if they have one of those fertility test things, it says you should do it in their period of time isn’t it when you’re ovulating, would that be just over your period Most fertile time? I think you’re least likely straight after you stop your period because the egg hasn’t been released yet and you’re most likely when you’re ovulating and I think that’s between two and three weeks, like a week before you start your period, that’s when you’re most likely to get pregnant. I should think any day ‘cause you, ‘cause you get pregnant even when you’re on your period so I don’t know, I’d just think any day I read somewhere that it was two weeks after your last period you start to ovulate and that’s when you’re most fertile ‘Isn’t it two weeks before her period, the most fertile.