Are women ready for more liberal delivery of emergency contraceptive pills?

Over-the-counter provision of emergency contraceptive pills: a systematic review

OBJECTIVE

To synthesise evidence around over-the-counter (OTC) emergency contraceptive pills (ECPs) to expand the evidence base on self-care interventions.

DESIGN

Systematic review (PROSPERO# CRD42021231625).

ELIGIBILITY CRITERIA

We included publications comparing OTC or pharmacy-access ECP with prescription-only ECPs and measuring ECP uptake, correct use, unintended pregnancy, abortion, sexual practices/behaviour, self-efficacy and side-effects/harms. We also reviewed studies assessing values/preferences and costs of OTC ECPs.

DATA SOURCES

We searched PubMed, CINAL, LILACS, EMBASE, clinicaltrials.gov, WHO International Clinical Trials Registry Platform, Pan African Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, Cochrane Fertility Regulation and International Consortium for Emergency Contraception through 2 December 2020.

RISK OF BIAS

For trials, we used Cochrane Collaboration's tool for assessing risk of bias; for other studies, we used the Evidence Project risk of bias tool.

DATA EXTRACTION AND SYNTHESIS

We summarised data in duplicate using Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence Profile tables, reporting findings by study design and outcome. We qualitatively synthesised values/preferences and cost data.

RESULTS

We included 19 studies evaluating effectiveness of OTC ECP, 56 on values/preferences and 3 on costs. All studies except one were from high-income and middle-income settings. Broadly, there were no differences in overall ECP use, pregnancy or sexual behaviour, but an increase in timely ECP use, when comparing OTC or pharmacy ECP to prescription-only ECP groups. Studies showed similar/lower abortion rates in areas with pharmacy availability of ECPs. Users and providers generally supported OTC ECPs; decisions for use were influenced by privacy/confidentiality, convenience, and cost. Three modelling studies found pharmacy-access ECPs would lower health sector costs.

CONCLUSION

OTC ECPs are feasible and acceptable. They may increase access to and timely use of effective contraception. Existing evidence suggests OTC ECPs do not substantively change reproductive health outcomes. Future studies should examine OTC ECP's impacts on user costs, among key subgroups and in low-resource settings.

Emergency contraceptive pill use among women of reproductive age in Pathein, Myanmar

Purpose

Emergency contraceptive pills (ECPs) allow a second chance to prevent unwanted pregnancy in unplanned sexual intercourse. Therefore, it helps reduce the rate of induced or unsafe abortions. Although they are available over-the-counter in Myanmar, relevant information remains improperly known by women and its use is limited. The purpose of this paper is to identify the prevalence and associated factors of ECPs use among women of reproductive age in the delta region of Myanmar.

Design/methodology/approach

This community based cross-sectional study was conducted in Pathein Township, Ayeyarwady Division, Myanmar from March 30 to April 29, 2018. This study was conducted among 238 respondents selected using multistage sampling and face-to-face interviews employed structured questionnaires. Multiple logistic regression was used to analyze the associations among variables.

Findings

The prevalence of ECPs use among reproductive aged women was 11.3 percent. Factors significantly associated with ECPs use were high monthly family income (AOR=4.50, 95% CI=1.31–15.48), condom use (AOR=4.40, 95% CI=1.07–18.16) and never having experienced pregnancy (AOR=6.20, 95% CI=2.06–18.67).

Originality/value

To improve the use of ECPs, extension of services such as opening hours or working days is needed. The government and NGOs should implement the services to support women who have encountered unplanned sexual intercourse so that unwanted pregnancy can be prevented.

Association between knowledge about levonorgestrel emergency contraception and the risk of ectopic pregnancy following levonorgestrel emergency contraception failure: a comparative survey

Objective

To study the association between knowledge about levonorgestrel emergency contraception (LNG‐EC) and the risk of ectopic pregnancy (EP) following LNG‐EC failure.

Methods

This study included 600 women who had visited the hospital with LNG‐EC failure. Of these, 300 with EP and 300 with intrauterine pregnancy (IUP) were recruited to the EP group and IUP group respectively. The participants were interviewed face‐to‐face using a standardized questionnaire.

Main Outcome Measures

Pearson's chi‐square tests and t‐test were used to compare the sociodemographic characteristics, reproductive and gynecological history, surgical history, previous contraceptive experience, and answers to 10 questions concerning the knowledge about LNG‐EC.

Results

Those who gave incorrect answers to the question regarding the basic mechanism and specific method of levonorgestrel emergency contraceptive pills (LNG‐ECPs) were at a higher risk of EP after LNG‐EC failure. Women who did not strictly follow instructions or advice from healthcare professionals were more likely to subsequently experience EP (p < 10⁻⁴). Women with LNG‐EC failure reported friends/peers, TV, and Internet as the main sources of information. No difference was observed with regard to the sources of knowledge on LNG‐EC (p = 0.07).

Conclusions

The results illustrate the importance of strictly following the doctor's guidance or drug instructions when using LNG‐ECPs. The media should be used to disseminate information about responsible EC, and pharmacy staff should receive regular educational training sessions in this regard. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

Characteristics of women who sought emergency contraception at a university-based women's health clinic

OBJECTIVE

The purpose of this study was to identify unique characteristics for seeking emergency contraception (EC) among sexually active unmarried women who attended a university-based women's health clinic (WHC).

STUDY DESIGN

Three hundred nine consecutive women who attended the women's health clinic for 3 months of the 2006 spring semester completed an anonymous self-administered questionnaire. Fisher exact and Student t tests were used to assess bivariate associations, and step-wise regression was used to determine independent associations.

RESULTS

Women who requested EC were more likely to have previously used EC (P < .001), to have had unprotected sex in the past 6 months (P < .001), to have experienced an unintended pregnancy in the past year (P = .009), and to perceive the need for EC use in the next 3 months (P < .001) but were less likely to use hormonal contraception or an intrauterine device (P < .001).

CONCLUSION

Our findings support the need for increased education that would include the use of and access to effective primary contraceptive methods in conjunction with EC awareness.

Use of emergency contraceptive pills and condoms by college students: a survey

OBJECTIVES

This study examined the intentions, knowledge, and attitudes of college students regarding the use of emergency contraceptive pills (ECPs) and condoms.

DESIGN AND SETTING

A cross-sectional descriptive study was conducted at 16 Korean colleges.

METHODS

Data were collected from March 15 to June 10, 2006 from a convenience sample of 1046 college students using a survey questionnaire. The survey included measures of demographic variables, intention to use ECPs (one item) and condoms (one item), knowledge about ECPs (12 items), and attitudes toward using ECPs (12 items) and condoms (16 items). All items except knowledge were rated on a 5-point Likert-type response format, with higher scores indicating greater intentions, more positive attitudes, and greater knowledge.

RESULTS

Of the 1046 participants, 76.3% had heard of ECPs and 13.2% of the sexually active participants (n=190) had used them. Participants showed a general lack of knowledge about ECPs and misconceptions about their safety. The intentions of using ECPs and condoms were positively correlated with each other and with attitude such that the more positive the attitude, the greater their intention to use both ECPs and condoms. There were significant gender differences on many of the variables, in that female students had higher knowledge about ECPs, intention of using ECPs and condoms, and more positive attitude toward condoms than male students who had more positive attitudes toward ECPs. Females had more concerns about the safety of ECPs than males.

CONCLUSIONS

The findings suggest that college students must be better informed about ECPs, and reassured about their safety. Additionally, promoting ECPs would not negatively affect condom use. Efforts are needed to disseminate up-to-date information to the general public and to develop educational and awareness programs to empower young people to make informed decisions about the use of ECPs and condoms.