Women's Overall Knowledge Levels about Reproductive Health
Most women are generally well-informed about reproductive health issues, but lack awareness of some
key facts that could help them avoid unplanned pregnancies and protect their future fertility. Overall,
about a quarter (27%) of women age 18-44 received high scores on a knowledge test about
reproductive health; 42 percent scored moderately well and 31 percent received low scores.
2
Women who are more knowledgeable about reproductive health take more measures to protect their
health than others. Those who scored high on the knowledge test are more likely to have conversations
with their sexual partner about HIV (48% v. 44% for those with moderate scores and 38% for those
with low scores) and about STDs (34% v. 27% for those with moderate scores and 21% for those
with low scores).
The Large Majority of Reproductive-Age Women Know That:
1. A woman can get an STD through vaginal intercourse (99% correct).
The real facts:
Vaginal intercourse is considered "safe" if a latex or synthetic condom is used consistently and
correctly, that is the condom is placed on the man's penis well before it has any contact with his
partner's vagina, since his pre-ejaculatory fluid can contain HIV and other STDs and her vaginal fluid
can contain those pathogens as well.
24
2. STDs can have long term health effects (87% correct). However, only 70 percent can actually name
a long term effect from an STD.
The real facts:
STDs can have long-term effects on a woman's health. Some of those long-term effects may be
infertility (sterility or difficulty getting pregnant); death; pregnancy and birth-related complications;
increased risk of cancer; serious neurological disease which would include mental illness, brain
damage, neurological damage, and depression; increased risk of HIV infection; and pelvic
inflammatory disease (PID).
25
3. A woman can get an STD through oral sex (82% correct).
The real facts:
Oral sex on a man or a woman is considered "safe" when a latex or synthetic barrier, such as a male
condom, female condom or dental dam, is used. If a person has unprotected oral sex, he or she is at
high risk for gonorrhea, syphilis, chancroid, herpes simplex virus, human papilloma virus, and
cytomegalovirus.
26
4. The purpose of a pap smear is to detect cancer (81% correct).
The real facts:
The papanicolaou smear (pap smear) is a screening test for cervical cancer in which cells scraped
from the surface of the cervix are placed onto a slide and examined under a microscope. (The pap test
may also detect cancer of the uterus, ovary, or vagina; infections; or the level of estrogenic stimulation
of the cervix.)
27
5. Age affects fertility (79% correct).
The real facts:
Age affects fertility. Only 0.5 percent of women age 15-19 are physically unable to have a child
because of illness or surgery other than contraceptive sterilization, whereas 11.7 percent of women age
35-39 and 18.2 percent of women 40-44 are unable to.
28 The effects of age on fertility are moderate,
and do not begin until the late 30s.
29
6. Some STDs have no symptoms (79% correct).
The real facts:
The following STDs may have no symptoms:
Chlamydia
Trichomoniasis
Gonorrhea
Human papillomavirus
Genital herpes
Hepatitis B
HIV (in early stages)
A Majority of Reproductive-Age Women Know That:
1. Having an STD can affect fertility (71% correct).
- Women who have actually had an STD are more likely to know this than those who have not
(81% v. 69%).
The real facts:
Having once had an STD can affect fertility. Gonorrhea and chlamydia are major causes of cervicitis
(inflammation of the cervix) and PID (pelvic inflammatory disease) in women. These infections
account for between 10 percent and 90 percent of all infertility, depending on the geographic region
and particular group studied. Human papillomavirus, or genital warts, is a frequent precursor to
cervical dysplasia and cancer. The impact on fertility depends on the treatment for this condition,
which may lead to hysterectomy (removal of the uterus). Cervical treatment may also reduce fertility
because of scarring and/or damage to cervical cells, which can contribute to pre-term deliveries or
possible pregnancy loss.
30
2. It's not possible to get an STD from a toilet seat (70% correct).
The real facts:
No, it is not possible to get an STD from a toilet seat. STDs are fragile and do not live long outside the
body. They are present in high enough concentrations to infect a person only in blood, semen or
vaginal secretions. Bacteria or viruses responsible for STDs are transmitted through vaginal, oral, or
anal sex or mucous membrane-to-mucous membrane contact with an infected person or sharing
injection drug needles with an infected person. They are not airborne or food borne, and they are not
caused by casual contact with a toilet seat.
31
3. It is important for gynecological care providers to know about the number of sexual partners a
woman has had when recommending a method of birth control because of her risk for STDs, including
HIV (68% correct).
- Women who have had many sexual partners (11 or more) are no more likely to say that's
important information a health provider should know. In fact, a quarter (24%) say the number of
sexual partners a woman has had is private information that a health care provider doesn't need to
know.
The real facts:
A woman's number of sexual partners is important information her health professional should know,
according to Contraceptive Technology (1994) and ACOG's Guidelines for Women's Health Care
(1996). CT recommends asking every patient how many sexual partners he/she has had in the last
year. ACOG's guidelines also recommend a clinician ask every patient about his/her sexual history
and practices, which includes their number of sexual partners. ACOG states that a patient's number of
sexual partners may not only indicate STD risk, but also help determine the best method of
contraception for her.
4. It's not possible to get an STD through kissing (65% correct).
The real facts:
Dry kissing is considered a "safe" sexual activity for prevention of sexually transmitted diseases,
including HIV. Wet kissing when both partners do not have broken skin, cracked lips or damaged
mouth tissue, is considered "possibly safe." However, kissing and all other sexual activities are
considered completely "safe" when both partners are monogamous, and known by testing to be free of
STDs and HIV.
32 Regarding HIV transmission, the CDC National Center for HIV Prevention advises
that casual contact through closed-mouth or "social" kissing is not a risk. It recommends against
"French" or open-mouthed kissing with an infected person because of the possibility of contact with
blood. However, no case of AIDS reported to CDC can be attributed to transmission through any kind
of kissing.
33
Fewer than Half of Reproductive-Age Women Know That:
1. The best time for a woman to get a pelvic exam is two weeks after her period starts (45% correct).
The real facts:
A pap smear and other tests performed in a pelvic exam may be performed at any time when a patient
does not have heavy bleeding. However, optimal timing is midcycle (2 weeks after a woman's period
starts) and when a woman has not had intercourse for 24 hours or placed anything in her vagina for at
least 48 hours (including a tampon).
34
2. Smoking affects fertility (41% correct).
The real facts:
Smoking affects fertility. Smoking is associated with lower conception rates and increased rates of
spontaneous abortion. Smoking also appears to increase slightly the risk of placenta previa
(implantation of the placenta near or over the cervix, which can result in premature delivery) and
negatively affects the developing fetus, which results in some cases in low birth weight babies. In
addition, smoking may cause poor semen quality in men.
35
3. Having an abortion does not affect later fertility (34% correct).
The real facts:
Having an early abortion does not affect fertility, unless the woman experiences serious complications
such as infection. Such complications are very rare and research suggests that when safe and legal
abortions are available, abortion has no impact on fertility risk statistics. However, post-abortion
infections, caused by unsafe abortions, can be a major cause of infertility in countries where abortions
are performed in unsafe or illegal conditions (CT, 1994). There are still some questions about the
impact of late abortions (after 13 weeks) on future fertility.
4. The long term use of birth control pills does not affect later fertility (23% correct).
The real facts:
Research indicates that long-term use of birth control pills does not affect a woman's fertility. A
woman taking birth control pills may, however, take longer (2-3 months) to become pregnant after
discontinuing pills compared to women who were using barrier contraceptives or contraceptive
implants. There is also no evidence to suggest that a woman's return of fertility is improved by
periodically taking a break from pills. Pills, in fact, can protect a woman's future fertility by helping to
prevent some causes of infertility, such as pelvic infections, uterine fibroids, ectopic pregnancies,
ovarian cysts, endometrial cancer, and possibly endometriosis.
Reproductive Health Profiles for Different Types of Women3
| | Unmarried Women | Married Women |
| | 1-2
partners | 3-6
partners | 7+
partners | 1-2
partners | 3-6
partners | 7+
partners |
| High score on the knowledge test | 17% | 29% | 29% | 27% | 27% | 32% |
| Have a gyn. exam at least once a year | 70% | 81% | 80% | 76% | 74% | 76% |
| Always use birth control if at risk | 69% | 74% | 72% | 70% | 73% | 75% |
| Use condoms if at risk | 68% | 77% | 72% | 46% | 45% | 39% |
| Have had an STD test | 39% | 51% | 76% | 32% | 48% | 62% |
| Have had an HIV test | 47% | 52% | 69% | 36% | 50% | 60% |
| Have talked with partner about STDs | 37% | 32% | 52% | 10% | 26% | 38% |
| Have talked with partner about HIV | 49% | 58% | 68% | 28% | 42% | 46% |
| Number of women interviewed | 76 | 94 | 102 | 316 | 179 | 150 |
Other Findings about the Reproductive Health of Childbearing-age Women
According to this survey, only about a third (36%) of childbearing-age women say their overall health is
currently excellent. Half (53%) say their health is good, and 11 percent say it is only fair or poor. Over
a quarter (27%) report having had a reproductive health problem at some point (9% have one now)
and 11 percent report having had a sexually transmitted disease.
Ninety-three percent of women age 18 to 44 are sexually active; seventy-eight percent have had sexual
intercourse in the last three months. About a fifth (22%) of sexually active women age 18-44 have had
only one sexual partner. About as many (25%) have had 7 or more partners, and 12 percent have had
11 or more partners.
Four percent are pregnant now and three percent are trying to get pregnant. Two-thirds (67%) have
had a child already. Among women who are currently trying to get pregnant, almost two-thirds (64%)
have had pre-conception counseling. Those who have had pre-conception counseling are no more
knowledgeable about fertility than other women with the exception that they are somewhat more likely
to know that smoking adversely affects fertility (46% v. 38%).
Half (50%) of women age 18 to 44 are at risk for an unplanned pregnancy. Those considered not at
risk are either not having sexual intercourse, sterilized, infertile, pregnant, trying to get pregnant, or have
a partner who is sterilized or infertile.
A quarter (26%) of the women surveyed report being sterilized or are infertile. The incidence of
sterilization and infertility rises dramatically with age (from 5% for women age 18 to 24 to 46% for
women age 40 to 44) and is higher for women who have already had a child than it is for childless
women (37% v. 6%).
Divorced, Separated, and Widowed Women
Women who are widowed, divorced and separated report more concerns about their reproductive
health, but are less likely than other women to take some important steps to protect themselves. These
"newly single women" are the most likely to have had a test for HIV (67% v. 45% for married women
and 44% for never-married women). However, they are less likely than never-married women to use
condoms (56% v. 79%) and they are more likely to have had an unplanned pregnancy (50% v. 43% of
married women and 34% of never married women).
4
Methodology
This survey was designed and analyzed by the Kaiser Family Foundation, Glamour magazine, and
Princeton Survey Research Associates (PSRA). The survey was conducted by PSRA. The results are
based on telephone interviews with a nationally representative sample of 1,001 women age 18-44.
Interviews were conducted during the period July 10 through July 28, 1996. All interviews were
conducted by female interviewers.
The margin of sampling error for results based on the total sample is plus or minus four percentage
points, at the 95 percent level of confidence. The margins of sampling error for sub-groups of the total
sample are larger than four points. Besides sampling error, question wording and the practical
difficulties involved in conducting surveys can also produce error in survey estimates.
Footnotes
1 The interviewing for this survey was conducted shortly after a U.S. Food and Drug Administration Advisory Panel approved the use of some birth control pills to prevent pregnancy within 72 hours of unprotected sex.
2 The knowledge test included 14 questions. High scorers gave at least 11 correct answers, while low scorers gave fewer than 9 correct answers.
3 Classification of women by marital status and number of sexual partners combined was more revealing than one based on age and marital status combined.
4 The unplanned pregnancies for newly single women did not necessarily occur after their marriage ended.
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