Parenthood intentions of 16-18-year-olds in England: a survey of school students

There is a need to understand teenagers' views towards having children to better tailor sexuality and reproductive health education. We conducted a survey of parenthood intentions for 16-18-year-old students. The survey was anonymous, contained open-ended and multiple-choice questions and was live from 10 May 2021 to 18 July 2022. The sample size was n = 931. Quantitative data were analysed descriptively and using chi-squared tests; qualitative data were analysed thematically. The majority of students (64%) indicated they wanted to have children in the future, with 49% desiring to have two children. Students who opted against having children cited the turbulent state of the world, concerns about parenthood, and, for many females, negative associations to pregnancy and childbirth. Many students felt concern about the possibility of having children in the future (45%), expressing concerns about their ability to have healthy children and worries about the lives their children might lead. Six themes were identified in their responses to the question 'What are your concerns about the possibility of having children in the future?': Fears; Self-doubt; Health and wellbeing; Big investment; Hinderance to personal aspirations; and Non-inclusive LGBTQ+ education. We conclude by making recommendations as to how school reproductive health and sex education might be improved.

Experiences of users of period tracking apps: which app, frequency of use, data input and output and attitudes

RESEARCH QUESTION

What are the experiences of users of period tracking apps in relation to which apps they use, their frequency of use, the type of data and their attitudes to period tracking apps?

DESIGN

This was an observational mixed-methods study using an online survey designed using Qualtrics XM. The survey included 50 open-ended and multiple choice questions, but only specific questions were analysed in this study. The survey was promoted via social media for 22 days between 30 June and 21 July 2021.

RESULTS

Of the 375 total participants, 326 responses were complete and included in analysis. In the results section further down, this is explained as 330 complete responses, with 4 additional responses excluded due to data inconsistencies. The participants' age range was 14-54 years, with a mean of 26.0 (±7.81) years. Most participants (61.9%) had been using a period tracking app for 2 years or longer. Of these 85.6% entered more data when on their period, 31% at a frequency of once a day. There were approximately equivalent proportions of participants who felt that entering data into their app was either 'part of their normal routine' (43.3%) or 'not a priority' (38.0%). Thematic analysis of the participants' experiences of using period-tracking apps revealed five main themes: symptom tracking and understanding general health; concerns with period start date predictions; the problems with fertility tracking; concerns about cost; and concerns about data privacy.

CONCLUSIONS

The infrequency of data inputting and the wide range of symptoms tracked reflects the differing needs of participants from their period-tracking apps. This highlights the need for increased education and research into understanding the realities of variations in using apps.

Women's knowledge and attitudes to the menopause: a comparison of women over 40 who were in the perimenopause, post menopause and those not in the peri or post menopause

OBJECTIVES

To evaluate women's knowledge and attitudes towards the menopause by comparing three groups of women: perimenopause, post menopause and those women not in either the peri or post menopause (other).

METHODS

A 35 question online survey was advertised on social media to evaluate women's attitudes and knowledge of the menopause. Three groups of women were compared: perimenopause, post menopause and those women not in either the peri or post menopause (other).

RESULTS

Most women were completely uninformed or only had some knowledge of the menopause before the age of 40. Most women thought that the menopause should be taught at school, but over 80% had received no menopause education at school themselves. The most popular sources of menopause information were independent websites and friends. Perimenopausal women were significantly more likely than postmenopausal women to use online resources for menopause information. The perimenopausal and postmenopausal groups had more positive attitudes towards the menopause than the other group. 57.5% of postmenopausal women found the menopause difficult or very difficult. Most women were happy about no longer menstruating, although some expressed sadness regarding fertility loss.

CONCLUSIONS

Most women had limited knowledge and negative attitudes towards the menopause, leaving them unprepared to cope with the physical and psychological changes associated with this stage of life. Improved menopause education is required to improve quality of life during the menopausal transition and a most positive narrative of life postmenopause.

Reproductive health education in the schools of the four UK nations: is it falling through the gap?

Reproductive health education is crucial to ensure young people understand their reproductive system and can make informed decisions about their sexual lives and fertility, including whether they want to have children or not. This study involved an investigation of the intended UK school curricula for 14-18 year-olds as they relate to reproductive health. Analysis revealed substantial differences. Most, but not all, specifications include sexually transmitted infections, hormonal aspects of reproduction, contraception, the menstrual cycle and assisted reproductive technology (ART). Important topics, such as endometriosis, fertility, preconception health, pregnancy, miscarriage, menopause and infertility (except in the context of ART) are missing from examination specifications and/or the RSE/RSHP curricula. We conclude that many young people in the UK are at risk of leaving school with inadequate understanding of concepts that have important implications for their reproductive health. There are differences between nations, with Scotland having the most comprehensive coverage of topics in its curriculum. High-quality reproductive health education should be an entitlement for all young people. It should give young people accurate and up-to-date information and enable them to discuss issues and develop their own thinking. Ideally, sex and reproductive health education would be taught comprehensively across the RSE/RSHP and science curricula.

P-069 Men’s fertility knowledge and attitudes to starting a family in Greece, Nepal and the UK

Study question

What are the views of men from Greece, Nepal, and the UK on having children and what is their knowledge of fertility?

Summary answer

Between countries, there were similarities and differences in men’s views to having children. Men showed limited fertility knowledge, and access to fertility information varied.

What is known already

The global total fertility rate (TFR) has dropped to below 2.5 compared to 5 in 1950, currently being 1.61 in the EU. Internationally, the age at which people are having children has increased and is over 30 in many countries. Delaying parenthood is leaving many with smaller family sizes than desired or involuntary childlessness due to age-related infertility.

Although many men are keen to be fathers, existing studies relating to fertility knowledge and having children focus heavily on women. Compared to women, men’s fertility knowledge is limited as fertility education is rarely taught or tailored for men.

Study design, size, duration

Two anonymous surveys were conducted. The UK survey (live from 25 April – 1 December 2021) was launched via social media. Men internationally could complete the survey, and high numbers of men from Nepal participated.

The Greek survey (live from 11 – 26 May 2021) was launched in Greece through a market research company. The end sample size was n = 244 for Greece, n = 205 for Nepal and n = 128 for the UK.

Participants/materials, setting, methods

Men aged 25 to 45 years old, who wanted children but were currently childless, were included. There were four parts to the survey: basic demographics; their attitude to having a family; their fertility concerns; and their fertility knowledge. For the UK survey, since one of the authors had a link with Nepal, particular effort was made to recruit from Nepal as well as from the UK.

Main results and the role of chance

When asked how many children men wanted, most Greek (59%), Nepalese (66%) and UK (58%) men wanted two children, but higher levels of Greek (24%) and UK (25%) men wanted three children compared to Nepalese men (9%)(p < 0.001).

The ideal age men wanted to have had/have their first child was 35 years in Greece (23%), but it was 30 years in Nepal (24%) and in the UK (30%). The COVID-19 pandemic had not affected most men’s decision to have children: Greece’s (64%), Nepal (48%), UK (70%). But it had affected 21% Greek, 27% Nepalese and 16% UK men who are now intending to delay having children.

Greek (46%), Nepalese (48%) and UK (47%) men felt moderately informed on female fertility. Greek (45%), Nepalese (50%) and UK (45%) men felt more informed about male than female fertility. When questioned on when they think a woman is fertile in her menstrual cycle, 50% Greek, 38% Nepalese, and 42% UK men answered incorrectly.

The internet was the most common source men accessed fertility information from: Greece (67%), Nepal (30%) and the UK (26%). The second most common source for Greece (18%) was doctors, but for Nepalese (18%) and UK (18%) men, it was school.

Limitations, reasons for caution

The study had a relatively small sample size (n = 577). It is well documented that men typically do not show high engagement with surveys. It was only promoted on social media. Respondents were typically highly educated, active on social media and knew English or Greek to an adequate level.

Wider implications of the findings

The International Fertility Education Initiative is developing resources to deliver tailored fertility education across different populations. This survey shows that there are cultural differences that need to be considered when designing such resources.

Trial registration number

Not applicable

P-494 A survey of women’s experiences, behaviours and attitudes of using period tracker applications (apps)

Study question

What are women’s experiences, behaviours and attitudes to ovulation and period prediction when using a period tracker app?

Summary answer

Some women altered their behaviour in response to ovulation prediction and some felt stressed in response to their period arriving earlier or later than predicted.

What is known already

Period tracker apps are designed to help women track and predict menstrual cycle dates and symptoms. The majority of period tracker apps predict the date a woman is ovulating and the date of her period. Several studies have shown that ovulation cannot be accurately predicted using menstrual cycle dates, and many apps assume that women ovulate on day 14 of their cycle whereas recent large studies have shown this to be closer to days 16/17. With regards to the prediction of the first day of the period, reports have shown that period tracker apps do not always correctly predict this.

Study design, size, duration

We conducted an anonymous, online survey using multiple choice and open-ended questions on Qualtrics software. The survey was live for 19 days, from 30th June – 20th July 2021 and was promoted using the social media of authors 1 and 3 (Twitter, Instagram, Facebook and Linkedin). The qualitative data was analysed thematically.

Participants/materials, setting, methods

The inclusion criteria was that participants had to be using or had previously used a period tracker app, be able to read English and have access to the online survey.

Main results and the role of chance

From 375 total responses, 330 complete responses were analysed, giving a completion rate of 88.0%. Respondents were aged between 14-54, with a mean age of 26.0 (±7.81). When asked what was the best thing about using the app, 29.7% (98/330) respondents selected ‘To know when I’m ovulating’. The majority of respondents sexual activity was not influenced by their app’s predicted dates (65.5%, 216/330). However, a total of 17.0% (56/330) of respondents stated that it was, with 10.9% (36/330) stating they avoided having sex on fertile days predicted by the app. Respondents were asked if their period ever started earlier than the app predicted; 54.9% (189/330) said it had and 72.1% (238/330) said it had started later than predicted. When asked how they felt if their period arrived earlier or later than expected, thematic analysis of responses when periods started earlier revealed 4 themes: feeling unaffected, being frustrated/unprepared, feeling anxious/stressed, and feeling confused/intrigued. Thematic analysis when their period arrived later than expected revealed 6 themes: anxious/concerned about pregnancy, disappointed about pregnancy, seeking advice/informing healthcare professionals, thoughts about the menopause, feeling unaffected and being better prepared.

Limitations, reasons for caution

All surveys have a selection bias. The survey was only promoted on social media of two of the authors. As the survey was in English, the women who answered the survey were mainly UK residents who were highly educated.

Wider implications of the findings

Period tracker apps need to be clearer of their intended use and reliability, especially for period and ovulation prediction. Inaccurate predictions can affect the users’ health and behaviour. This study calls for period tracker app companies to update their apps to provide transparency about their intended use and capabilities.

Trial registration number

NA

P-493 Sex and fertility education in the UK: an analysis of biology curricula and students’ experiences

Study question

What is currently being taught in United Kingdom (UK) secondary schools relating to sex and fertility and what are students’ experiences of this education?

Summary answer

There are large gaps in the UK’s biology curriculum relating to sex and fertility education with important topics being neglected.

What is known already

Sex and fertility education is essential to enable people to make informed choices about family building. This is especially important as maternal and paternal age is increasing globally. School is an important source of this education but sex and fertility education is often minimal. In order to optimise people’s contraceptive behaviour and fertility planning, an understanding of the reproductive cycle, basic physiology of fertility and preconception health is required. Fertility education interventions have been shown to improve fertility knowledge and decrease planned ages of childbearing among young adults but only if repeated.

Study design, size, duration

This study aimed to evaluate the current biology curricula relating to sex and fertility education at GCSE (General Certificate of Secondary Education) and A level (Advanced Level) in the UK and to determine 16-17-year-old students’ experiences of their sex and fertility education. This year group was chosen as we are interested in what students have learnt by the end of their mandatory education (years 1 to 11), and their experiences of this education.

Participants/materials, setting, methods

The analysis of the curricula was conducted using the most recently published specifications for science and biology at GCSE and biology at A level for the Awarding Bodies that dominate the GCSE and A-level market in the UK. The school survey included a 47-item online survey distributed to year 12 students in four secondary schools across England. In total, 244 students participated in the survey.

Main results and the role of chance

There are six Awarding Bodies in the UK that set the examinations for GCSE and A-level students. At GCSE level, the hormonal control of the menstrual cycle, contraception and ART are taught within the human reproduction section of the biology curriculum. STIs are used as examples of communicable diseases, but pregnancy does not feature other than as a consequence of contraceptive failure. At A level, there is generally less teaching of relationships, sexuality and fertility-related topics than at GCSE. The results of the school survey showed that some topics, notably puberty, the menstrual cycle, contraception and STIs, were more likely to be learnt in school. However, topics such as endometriosis, menopause, miscarriage and polycystic ovarian syndrome were more likely to be learnt outside school. Abortion was the most common topic learnt outside school, followed by puberty. The most popular sources of sex education outside school were the internet and social media. In the students’ responses to how they think sex and fertility education can be improved, six themes became apparent: LGBTQ + (lesbian, gay, bisexual, transgender, queer and others) inclusivity; topic variety; logistical improvements; attitudes towards sex; gender equality; and applicability to real life.

Limitations, reasons for caution

The COVID-19 pandemic significantly disrupted schools during the 2020/2021 academic year. Consequently, we were unable to distribute the survey to as many schools as planned. We hope to continue this study in the 2021/2022 academic year to allow further comparison between the experiences of different groups of students.

Wider implications of the findings

Ideally, school sex and fertility education would involve a comprehensive and holistic programme and would provide young people with full, accurate information to prepare them for later life. We hope that the results of our study can be used to improve sex and fertility education for young people.

Trial registration number

NA

An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause

Introduction:

Women are not usually taught about the menopause formally, and many general practitioners have relatively little training. The aim of this study was to explore perimenopausal women’s attitudes and knowledge of the menopause.

Method:

An online survey was designed to evaluate attitudes and knowledge of the menopause in women older than 40 years. The survey was generated with Qualtrics XM® and promoted via social media. In all, 3150 women started the survey. In this study, data from 947 perimenopausal women were analysed.

Results:

Regarding women’s attitudes to the menopause, 38.8% were accepting of it but more than 30% were dreading it. The women had experienced a number of menopause symptoms including mood swings (68.9%), brain fog (68.3%), and fatigue (66.8%). More than 90% of women had never been taught about the menopause at school, and more than 60% did not feel informed at all about the menopause. School was thought to be the best place for menopause education to start (83.6%). In all, 68.2% of women had only looked for information about the menopause as their symptoms started and they had talked to friends and used a variety of websites to look for information. When asked for their free-text views on the menopause, thematic analysis produced four themes: the overarching knowledge gap, the onset and impact of symptoms, perimenopause: the hidden phenomenon, and managing symptoms: differing schools of thought.

Conclusion:

Lack of education for women and their general practitioners is causing perimenopausal women to go through this important stage in their lives with a lack of knowledge and appropriate medical care. It is essential that women are taught about the menopause, from school onwards and that we offer health professionals appropriate training starting from the medical school curriculum.

A survey of women’s experiences of using period tracker applications: Attitudes, ovulation prediction and how the accuracy of the app in predicting period start dates affects their feelings and behaviours

Introduction:

Using an online survey, the aim of this study was to ask women about their real-life experiences of using period tracker apps, their attitudes towards using their app, the information the app provided regarding ovulation and how the accuracy of the app in predicting period start dates affects their feelings and behaviours if their period comes earlier or later than predicted.

Methods:

This mixed-methods observational study was conducted by an online survey of 50 multiple-choice and open-ended questions. The survey was generated with Qualtrics XM^® and promoted via social media. It was open to any person who had used a period tracker.

Results:

From 375 total responses, 330 complete responses were obtained, giving a completion rate of 88.0%. Respondents were aged between 14 and 54, with a mean age of 26.0 (±7.81). When asked what was the best thing about using the app, 29.7% (98/330) of respondents selected ‘To know when I’m ovulating’. Respondents were asked if their period ever started earlier than the app predicted; 54.9% (189/330) said it had and 72.1% (238/330) said it had started later than predicted. When asked how they felt if their period arrived earlier or later than expected, thematic analysis of periods starting earlier revealed four themes: feeling unaffected, being frustrated/unprepared, feeling anxious/stressed and feeling confused/intrigued. Thematic analysis when their period arrived later revealed six themes: anxious/concerned about pregnancy, disappointed about pregnancy, seeking advice/informing healthcare professionals, thoughts about menopause, feeling unaffected and being better prepared.

Conclusion:

Period trackers need to be clearer on their intended use and reliability, especially for period due date and ovulation. Qualitative analysis shows the impact of inaccurate predictions on aspects of the users’ health. This study calls for period tracker app companies to update their apps to provide transparency to their users about their intended use and capabilities.