Open Access Highly Accessed Research article

Women’s perceptions and reasons for choosing the pill, patch, or ring in the CHOICE study: a cross-sectional survey of contraceptive method selection after counseling

Christian Egarter1*, Brigitte Frey Tirri2, Johannes Bitzer3, Vyacheslav Kaminskyy4, Björn J Oddens5, Vera Prilepskaya6, Arie Yeshaya7, Maya Marintcheva-Petrova8 and Steven Weyers9

Author affiliations

1 Medical University of Vienna, Vienna, Austria

2 Frauenklinik, Kantonsspital Baselland, Bruderholz, Switzerland

3 Frauenklinik, Universitätsspital Basel, Basel, Switzerland

4 P.L. Shupik National Medical Academy of Post-Graduate Education, Kiev, Ukraine

5 Global Medical Affairs, Merck, Sharpe & Dohme Corp., Oss, The Netherlands

6 Scientific Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation, Moscow, Russian Federation

7 Department of Obstetrics and Gynecology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

8 Biostatistics and Research Decision Sciences, Merck, Sharpe & Dohme Corp., Oss, The Netherlands

9 Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium

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Citation and License

BMC Women's Health 2013, 13:9  doi:10.1186/1472-6874-13-9

Published: 28 February 2013



The European CHOICE study was a cross-sectional survey that evaluated women’s combined hormonal contraceptive choices before and after contraceptive counseling in Austria, Belgium, Czech Republic and Slovakia, the Netherlands, Poland, Sweden, Switzerland, Israel, Russia, and Ukraine. The changes in method selection before and after counseling were reported previously. In this paper we present the reasons given by the 18,787 participating women for selecting their contraceptive method of choice, as well as their perceptions about the contraceptive pill, patch, and ring after counseling.


Women with an interest in a combined hormonal contraceptive method (pill, patch, or ring) were counseled using a standardized counseling leaflet. The women completed questionnaires, which included questions on why they had selected a particular method of contraception, and the extent to which they agreed with statements about the attributes of the pill, patch, and ring. The results for each country were compared with the percentages for all countries combined by using a binomial regression model. Multiple logistic regression models were used to investigate the extent to which the probability of choosing a method was related to prespecified aspects (i.e. perceptions) of each contraceptive method.


‘Easy to use’, ‘convenience’, and ‘regular menstrual bleeding’ were important selection criteria. ‘Nondaily administration’ was one of the main reasons women selected the patch or ring. ‘Daily use’ and ‘will forget to take it’ were the primary reasons for not selecting the pill, while the main reasons for not choosing the patch included ‘not discrete, visible’ and ‘can fall off’. In a small number of instances, the ring was rejected because some women don’t like to use a ‘foreign body’. Women’s perceptions influenced their contraceptive decisions: positive perceptions about a method increased the likelihood that a woman would select it. After counseling, many women associated the pill with forgetfulness, and many still did not know about the patch or ring’s key attributes. Women’s knowledge about a particular method was generally greater if they had chosen it.


To support informed contraceptive decision-making, healthcare professionals should realize that a woman’s view of a method’s ease of use is more important than perceived efficacy, tolerability, health benefits, or risks.

Combined oral contraceptive; Contraceptive transdermal patch; Contraceptive vaginal ring; Counseling; Reason; Perception