Over 80% of women attending the metropolitan Family Planning New South Wales (FPNSW) clinic at Ashfield we surveyed had visited a CM practitioner or used CMs in the previous 12 months, and two thirds were currently using CMs. Our study highlights the popularity of dietary supplements, including vitamins and minerals, and consultation with chiropractors and acupuncturists. This population reported using CM for health maintenance and self care. The advantages of CMs identified by participants included enhanced self-care, perceived safety, and being ‘natural’. Most participants did not mention their CM use because they considered this information irrelevant to their clinical consultation (rather than out of a fear of rejection); because they had not been asked; or because this information had been dismissed after disclosure.
Although the prevalence of CM use we recorded was slightly higher than that (74.4%, 95% CI 70.7–78.1) reported in the last national survey undertaken in Australia , it is consistent with that observed by other authors among pregnant Australian women . A cohort study has shown that women who consulted with CM practitioners had increased over time, with 9%, 16%, 21% and 33% of women consulting a CM practitioner in 1996, 2000, 2003, and 2006, respectively  The slightly higher rate of CM utilisation in our study may be explained by the fact that women attending a FP service may be more likely to use CM for self care or consult with practitioners, or our definition of CMs.
Women accessed information on CMs most frequently from non-medical sources including the internet, family and friends. These findings are supported by other studies from different clinical populations . Forty-four percent of clients mentioned their consultations and self-prescribed use of CM to their healthcare provider. There are no reported studies of a general clinic population with which to compare our findings. However a study of pregnant women in the USA suggests similar levels of non-disclosure (52%) to health care providers .
We have shown that many women combine conventional health care with self-administered CM and consultations with CM practitioners. The findings also highlight that some women have limited awareness of the importance of disclosing CM use to the practitioner in the FP unit. This finding is important because the latter may, therefore, not receive full information to include in the clinical history of the patient or become aware of a potential interaction between prescribed medications and CM remedies.
The survey had a response rate of 94%, reducing the potential for a response-bias. Also the opportunity for measurement error was reduced by (i) piloting of the questionnaire, (ii) revising the instrument prior to implementation of the study, and (iii) having a researcher on site to assist with enquiries.
However, there are limitations to the study. Respondents were self-selected rather than randomly chosen, and therefore may not be representative of the clinic population as a whole. In fact we know that the sample was not representative of the larger clinic population with regard to two socio-demographic characteristics, significantly more women in the sample spoke English at home, and had a different level of education attainment than the FPNSW clinic population. Compared with national socio-demographic data the FPNSW clinic population has a slightly higher (5%) overseas born population, with a higher preference for other languages at home (5%). Our sample maybe more comparable to all family planning organisations in Australia. In addition, because we undertook a snapshot of clinic attendees during a two-week period, bias may have been introduced if there were groups of women who did not attend at this time of the year.
The questionnaire included CM modalities reporting a therapeutic claim. Our criteria may have led to some modalities being excluded, and consequently to the finding of a lower rate of utilisation than would otherwise have been the case. There is no widely accepted operational definition of CM. Wiedland  and colleagues report on an operational definition for CM therapies based on (i) therapies that rely upon non-allopathic models of health, (ii) exclusion from standard treatment within the dominant medical system, and (iii) self-care or care delivered by alternative practitioners. A lack of efficacy was not a criterion for identifying CM. If we had adopted the definition of CM described by Wiedland and co-authors’, the reporting of CM use in our survey would likely to have increased. Despite these limitations, the similarities of our findings with national surveys support the validity of the study. Our results indicate that CM is widely used by women attending a FP service at an inner city clinic in Sydney.
Despite the increased awareness from research on the importance of health care providers discussing CM use with their patients, we highlight our findings in the context of a gap in knowledge in this clinical setting. Our findings also have implications for international FP programmes where use of traditional medicines (traditional Chinese medicine, Indian Ayurveda, and practices that include herbal medicines) are prevalent . Women need to be informed that communication about use of CMs is relevant and important. Providing information and education to clinicians about what CMs are available and their benefits and risks would assist with demonstrating respect for women’s use of CMs. The study has drawn attention to non disclosure of CM in this clinic and the need for clinicians to be further informed about the potential for herb-drug interactions, and to be more proactive with seeking information about CM use, particularly among women using oral contraceptives. In our study 16 women reported use of St Johns wort in the previous 12 months, and six women were currently using this herb for anxiety of depression. Due to the anonymous nature of the questionnaire we do not know if these women were using oral contraceptives, however these is the possibility of potential a herb-drug interaction arising for some women. Further discussion about CMs may also have a positive impact on satisfaction with the consultation as clients may feel they are being listened to and that their healthcare providers are interested in their personal situation.
A large number of women appear to be uninformed about the safety of CM. We did not explore the reasons for women’s views towards the safety and effectiveness of CM, and this appears to be an under-researched area. Future research using qualitative designs would contribute valuable information to assist the development of appropriate communication strategies.