The Wise Report

Reproduced by kind
 permission of the Women's Infomation Service - Unipath

     The Wise Report     

Unipath

1993

Reproduced by kind
 permission of the Women's Infomation Service - Unipath


FERTILITY

If we could fall pregnant just by kissing and holding hands, find babies under gooseberry bushes or wait for the stork to drop one by, as we may have first learnt in the playground, we would be in a permanent baby boom!

  • Europe-wide misunderstanding regarding the process of ovulation and timing of conception.

  • Over 50 per cent of women assume you ovulate when taking the Pill.

  • One in 10 believe ovulation occurs during menstruation; one-third in the UK

  • Number of fertile days universally over-estimated - between 7-11 days.

  • Italy and Germany are best informed, UK the worst (21 per cent saying 21+ days).

  • Infertility viewed as more likely to be attributable to the woman than the man.



Starting a family has to be one of the most important decisions you ever make in life - whether you're a man or a woman. Yet we probably spend more time and effort finding out about a new car than we do about when is the best time to conceive.

Admittedly you can't go to your local garage and pick up a brochure or indeed take a test drive, but by finding out a little more about fertility and when you are most fertile, conception could be so much easier.

But knowing when you are fertile is not just about conception, it also

gives women the ability to control their choice of contraception.

  • "It (knowing when you are fertile) gives you power to choose.
    You didn't want to get pregnant you would avoid that time.
    If you did want to get pregnant, you would go for that time."



Behind The Scenes

Given the major role menstruation plays in women's lives, our knowledge of what actually happens 'behind the scenes' is very poor. Not just in the UK, but across Europe, there is a very basic factual understanding of ovulation, and if you probe this knowledge further, it is full of errors and contradictions passed on from parents, friends or poor sex education.

Confusion reigns in almost all areas relating to ovulation and its implications for fertility.


DESCRIPTION OF OVULATION

DESCRIPTION
OF
OVULATION
      UK    
%
  France  
%
  Italy  
%
Germany
%
Sweden
%
Nether
lands
%
When the egg is released by the ovary*
92
56
59
66
86
83
The time when it is possible to become pregnant*
12
64
40
38
44
23
When the egg is fertilised by the sperm
7
17
6
2
-
4
The menstrual period
1
4
2
1
6
4
* correct



The timing of ovulation is accurately predicted - 14 days prior to menstruation - but the more detailed knowledge is lacking.

For example, over 50 per cent of women in all countries wrongly believe that ovulation still occurs when taking the (combined) Pill and this figure increases to over 70 per cent in Germany.

The UK and France share a common level of understanding and interpretation of ovulation but on some aspects there are differences in opinion and agreement of up to 35 per cent between the six countries surveyed.

In Britain, just over 70 per cent of women identify the 2-3 days around the day you ovulate as the most likely time to become pregnant.

However, less than half realise that the period before and after you ovulate is the ONLY time you can get pregnant.

In contrast, in Germany nearly 80 per cent of women agree with this statement.

Symptoms of Ovulation

Symptoms of Ovulation

  • "My voice gets rough."

  • "I get very energetic."



Despite their poor knowledge of ovulation in relation to fertility, 28 per cent of women affirm they can tell when they ovulate.

Although it may be dismissed as psychosomatic by many, a number of women do experience one or more symptoms that indicate ovulation, from abdominal pain to changes in the colour/consistency of cervical mucus.




SYMPTOMS OF OVULATION

SYMPTOMS
OF
OVULATION
      UK    
%
  France  
%
  Italy  
%
Germany
%
Sweden
%
Nether
lands
%
% who believe they can tell when they are ovulating
28
35
46
29
54
21
Abdominal Pain
16
22
18
21
37
15
Vaginal Discharge / Cervical Mucus Change
8
10
30
10
16
2
Mood Changes
6
15
14
4
10
4
Hardening of Breasts
3
12
6
4
12
2
Backache
2
0
-
1
2
1
Temperature Rise
1
1
-
-
1
0


Italian and Swedish women are most likely to be aware of their ovulation primarily because of their lower Pill usage.

The most common symptom is abdominal pain, although in Italy cervical mucus change is the most common, indicating the wider use of mucus monitoring as a method of contraception.

Some of the other symptoms experienced include headaches and dizziness, anxiety, an increase in appetite and a rise in sexual awareness / excitement.



Fertile Period

Most of us will have grown up with the belief that you can get pregnant at any time of the month, probably as a means of making sex seem so perilous with the odds of getting pregnant so heavily stacked against us, we wouldn't dare consider the act.

If only conception was that easy!

Although most UK women know the most fertile days are in the middle of the cycle (72 per cent) and that this is the time pregnancy is most likely, over one-third wrongly believe you can become pregnant at any time throughout the cycle.

This perception is slightly higher among Pill users who lack the knowledge of a 'real' menstrual cycle.

The number of fertile days is over-estimated throughout Europe at between 7 and 11 days with UK women the worst informed - over one in five saying 21 plus days.

Italy and Germany are the best informed with 34 and 37 per cent respectively stating 3-4 days - the most fertile days for a woman are the 3-4 days around ovulation.

It is therefore not surprising that conception is more of a miss than hit affair for many couples.



Fertility-Infertility

"I'd just like peace of mind.
Not that I want kids right now -
but that I 'm not taking the Pill for nothing."

Knowing they are fertile is important to most women, whether they want to start a family in their early twenties or establish a career first; the discovery that you are sub-fertile or possibly infertile is a devastating one.

You only have to look at the millions of pounds spent on fertility treatment every year to see the level of importance society and individuals place on being able to bear children.


"I often think to myself that I hope when I stop taking the Pill and try for a family I will not have to survive years of Fertility treatment."

Women in the UK are pessimistic when it comes to the assumption of fertility with one in five estimating that a quarter of the population experience difficulty in conceiving.

Older women tended to assume that they were fertile without question and also assumed this of their partners. Younger women, however, are more likely to question their fertility, perhaps because of greater media exposure on sub-fertility. Also, as there is a trend to delay pregnancy until later in life when women feel 'ready' or it is appropriate for their relationship, their career or finances, there is concern that once the decision to start a family has been taken, there would be more pressure on conception and limited time for treatment should there be a fertility problem.




The Biological Clock

The concern that a woman's biological clock is constantly ticking away is widespread with 62 per cent of women feeling that age has an affect on the time taken to conceive.

A Little Knowledge Is a Dangerous Thing

A Little Knowledge Is a Dangerous Thing

There are a wide variety of reasons given as to why some women take longer than normal to conceive:

  • Sixty-four per cent of women feel biological problems such as defects in Fallopian tubes, not ovulating, irregular periods and lower levels of fertility are the main reason for conception problems

  • 39 per cent believe that general health and lifestyle affect levels of fertility: smoking, drinking, weight, illness, one quarter blame the male partner;

  • 14 per cent for low sperm count

  • 17 per cent feel contraception - primarily the length of time spent on the Pill could cause a delay in conceiving

  • a further 17 per cent link sexual problems such as trying too hard, having sex at the wrong time of the month, not having enough sex and incompatibility with a partner to delayed conception

Although sub-fertility is just as likely to be due to the male partner as it is to the female, 43 per cent of UK women blame themselves - this is consistent throughout Europe.

Thirty-seven per cent attribute it to the man while only 18 per cent concede it may be a joint problem.




PREGNANCY

We spend most of our early years trying to avoid it, and then the rest of our lives living with the consequences of it - pregnancy.

  • Average number of children across Europe: 2.2.

  • Average age when first child was born across all countries: 24.

  • 65 per cent of European women plan their first pregnancy.

  • Contrary to popular belief, the majority of women do not reduce alcohol consumption,
    stop smoking or take greater care of their health when planning to conceive.

  • On average, UK women take 7 months to become pregnant for the first time.


Many of us will experience pregnancy and it can be one of the most rewarding, as well as emotionally and physically exhausting, events of our lives.

" .... I have a really nice job and a good career, but I won 't feel complete unless I have a child ...... "


More and more women are turning to home pregnancy tests such as Clearblue One Step for early diagnosis of pregnancy. Many routine hospital and doctor's tests cannot be carried out until about two weeks after a woman's missed period. But over one million women every year in the UK prefer to use home pregnancy tests which can provide results in minutes and can be used on the first day of a missed period.



2.2 Children

Just over a third of UK women questioned have no children but of those who do, one in five have three children - a much higher proportion than our European counterparts.

However, the trite '2.2 kids and a dog' is still the most common family size, with a fairly even split between boys and girls.

In the UK, the majority of women have their first child at the average age of 24.

Women in the Netherlands tend to leave it later (average age 25) while French women start younger - one in five have their first child between 19-20 years.

The average interval between children is just over two and half years; in Italy and Germany the age gaps are longer - 3.9 and 4.1 years.



Surprise! Surprise!

With a growing trend towards having the first child mid-twenties, it is perhaps not unexpected to find that 65 per cent of women questioned deliberately plan their first pregnancy.

For second pregnancies, planning is more common-place and even in Germany they seem to have overcome their initial shock with 65 per cent of women planning their second child.

The reasons given for planning a pregnancy are varied but focus primarily on women's relationships with their partner, with the most common reason being "it was the right time in the relationship" - 69 per cent. Having "the right gap between children" is also an important influencing factor, particularly in the Netherlands, although less so in Italy where only 20 per cent of women take it into consideration.

In the UK, age is far less of a consideration than elsewhere in Europe, despite being cited as a reason for conception taking longer. In Germany, half the women questioned feel this is important in planning a pregnancy. Little peer pressure was felt although a general pressure to have a baby is more significant, particularly in Italy:


WHY PREGNANCY PLANNED

WHY PREGNANCY PLANNED
      UK    
%
  France  
%
  Italy  
%
Germany
%
Sweden
%
Nether
lands
%
It was the right time in the relationship
69
51
48
76
75
68
Wanted the right gap between the children
44
39
20
35
45
49
I / partner was the right age
26
41
42
50
34
45
Wanted a certain number of children
22
24
13
19
31
33
It was the right time in my career
10
13
4
6
22
12
Wanted it to be born at a specific time of year
3
9
2
6
9
9
I was under pressure
2
4
15
4
2
2
Wanted a specific sex
1
3
14
1
2
2
For Financial reasons
6
3
3
6
3
2
My friends were having babies / family pressure
1
3
2
1
7
6


Women who have never planned a pregnancy expect financial and career considerations to greatly influence their decision about when to start a family. However, based on mothers' actual experience, these reasons are more important in theory than in practice:



ANTICIPATED
ACTUAL
It was the right time in my career
42%
10%
For Financial Reasons
47%
6%

In Sweden planning your family around your career is far more important (22 per cent) while in Italy, a woman's career appears to take second place, bowing to the pressure of the partner, his family and the need to produce a son and heir.



Practice What We Preach

Planning pregnancy often means just making the decision to start a family rather than taking active steps, other than the obvious one, to stop contraception.

Even if pregnancy has not occurred after a period of time, little is done apart from seeking further information or advice (11 per cent).

We certainly don't practice what we preach - women who have not yet planned a pregnancy expect they will do a lot more to prepare themselves for conception than they actually do.

In the UK, women claim they will stop/cut down on alcohol consumption (29 per cent), improve their diet (26 per cent), stop/cut down on smoking (25 per cent) take more exercise (17 per cent).

In reality, these figures drop drastically:


Practice What
We Preach
ANTICIPATED
%
ACTUAL
%
Stop / cut down alcohol
29%
3%
Improve Diet
26%
2%
Stop / cut down on smoking
25%
4%
Take more exercise
17%
-


Disappointing and disturbing statistics considering the efforts made by the medical profession and the media to warn women of the dangers of smoking and alcohol to the unborn child, particularly pre-conception and during the first three months of pregnancy.

This important message is obviously yet to be driven home.



Easy As ABC

Perhaps the fact that most women find it relatively easy to conceive could be the reason behind their inaction when it comes to planning for pregnancy.

Of those who plan pregnancy, 82 per cent find it easy to conceive their first child while 11 per cent find it very difficult. However, UK women do experience more difficulty in conceiving than in other European countries.

The widespread use of natural family planning methods in Italy, and therefore the greater knowledge Italian women have of their cycle and fertility, is probably one of the main reasons why they become pregnant more quickly than women in the rest of Europe.

UK women take the longest time to conceive - possibly an indication of our poor knowledge of fertility and also a sign that we should be preparing our bodies, and lifestyles, for pregnancy rather than just letting nature run its course.


LENGTH OF TIME TAKEN TO BECOME PREGNANT -
DIFFERENCES BETWEEN FIRST AND SECOND PLANNED



Lend An Ear

It may be the wealth of often unwanted advice offered to women when trying to get pregnant that delays them from actively seeking it themselves - most women claim they would only seek advice on conception after their perception of the normal time taken to become pregnant had passed.

In the UK, the average expectation is six months, advice will be sought after eight months and women will not 'become concerned' until nearly a year has gone.

However, it will not be until a one-year point has been reached that a GP will classify a couple sub-fertile and refer them to a specialist.



A Special Time

Many women feel that having children makes them feel 'complete' as a woman. The relationship developed with their children, and particularly the bond and dependence of very young children, is central to many of their lives and a number want to have another child to perpetuate this dependency now lacking in their lives as their children grow older.

The arrival of children has changed women's lives fundamentally and perhaps their relationships with partners too.

The sense of responsibility for another life is constant and the bond between mother and child potentially very strong.

For women with children, pregnancy is a memorable and special time, even if not physically comfortable.

A period in their lives of considerable pride, wanting others to acknowledge their condition, particularly in the early months when it is not at all obvious.

Planned or otherwise, pregnancy, is seen very much as a special time for a relationship:


  • "You're at your most vulnerable, they know you really need them."

  • "My husband would like me to be constantly bareSoot and pregnant."



Although the experience of feeling the baby move inside is felt to be something that a partner just could not share.

Despite women's increasing independence, financially and to a certain extent emotionally, men take on a very protective role towards their pregnant partner to the point that they feel inhibited about sex for fear of harming the baby.

Food cravings seem to be more of an old wives' tale than truly symptomatic of pregnancy but women do admit to being "emotionally touchy" and "tearful" which leads to more erratic behaviour then usual.

Not surprisingly, the thought of pregnancy and giving birth is an unnerving prospect for women who haven't yet had children. The experiences of friends, the 'real life' education material used in schools and the often graphic portrayal of birth in the media has left many younger women daunted by the prospect.

There is also a concern about the ability to feel and be maternal - "I can't see me ever having an emotional bond" - as well as living up to the responsibilities of parenthood.

In addition, childless women feel some pressure from society to conform and have children.

Although this does not deter them entirely as motherhood is viewed as one, if not THE most positive aspect of being a woman.


  • "It's that bond with your children that a man could never have."

  • "The most rewarding thing I 've ever done in my life."



TOPLINE SUMMARY OF RESEARCH BY COUNTRY

At a glance, how WlSed Up To Womanhood are women in each of the six European countries surveyed?


TOPLINE SUMMARY OF RESEARCH BY COUNTRY


At a glance, how WlSed Up To Womanhood are women in each of the six European countries surveyed?

UK

  • Only 32 per cent of women were correctly informed that babies come from their "mummy's tummy"

  • One-fifth of women had no idea what was happening when their periods began.

  • 76 per cent experienced negative feelings about starting their period

  • Nearly one-fifth of facts of life discussions begin with children prompting the discussion instead of their parents

  • Although 92 per cent were accurate in describing ovulation, one-third believe that ovulation occurs during menstruation.

  • UK have the worst knowledge of fertile days - 21 per cent said 21+ days per month.

  • Although 72 per cent know that the fertile period is around the middle of the cycle, over one-third believe it is possible to become pregnant at any time throughout the cycle

  • On average, women take seven months to become pregnant for the first time.

  • Only 4 per cent stop or cut down on smoking when pregnant, despite 25 per cent saying that they would if they were to become pregnant

FRANCE

  • One-third were told that babies come from "under a gooseberry bush"

  • 17 per cent think that ovulation is the fertilisation of the egg by the sperm

  • Only 56 per cent could describe ovulation accurately

  • Youngest to start a family (one in five have their first child between 19-20 years)

  • 23 per cent think that it is possible to become pregnant just after menstruation

ITALY

  • 15 per cent feel pressurised by their partners and families to have a baby

  • 63 per cent found it easy to become pregnant, reflecting greater awareness of fertility

  • On average, take less than five months to conceive first baby

  • Only 20 per cent are concerned with having the right age gap between their first and second child

GERMANY

  • Oldest to start menstruation (14 years)

  • 37 per cent correctly stated that women are fertile for approximately 3-4 days every month

  • Over half the women that have children, were completely surprised to discover they were pregnant with their first child

  • Average of 4 years age gap between first and second child

SWEDEN

  • 29 per cent experienced positive feelings about starting periods

  • Only 36 per cent have regular cycles, reflects low use of oral contraception

  • 54 per cent believe they can tell when they are ovulating

  • 20 per cent believe it is possible to become pregnant just before menstruation

  • 22 per cent believe it is important to plan a family around their career

THE NETHERLANDS

  • 64 per cent were correctly informed that babies come from their "mummy's tummy"

  • Nearly 70 per cent knew exactly what was happening to them when they started their periods

  • 61 per cent keep a record of their menstrual period

  • 64 per cent of women have regular cycles

  • Concerned with having the "right age gap between children"



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