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Strong J. "Even when you write with a pencil there is an eraser to clean it": Examining men's conceptualisations of and involvement in emergency contraceptive use in Accra, Ghana. Soc Sci Med 2024; 344:116635. [PMID: 38324975 DOI: 10.1016/j.socscimed.2024.116635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 12/01/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024]
Abstract
Emergency contraceptive pills are an essential and unique post-coital method to avoid a pregnancy, with evidence showing the significant role men can have in procurement and decisions to use. Global Health recommendations specify that emergency contraceptive pills be used sparingly and under specific conditions. This increasingly misaligns with the myriad conceptualisations and rationales among the public for why they choose to use emergency contraceptive pills. There has been a paucity of research aiming to understanding men's involvement and how they shape women's access, choice, and autonomy. This study interrogates how emergency contraceptive pills are conceptualised by men in James Town, Ghana, and how this intersects with their motivations to be involved in its use. Mixed method data from a survey (n = 270) and in-depth interviews (n = 37) were collected between July 2020 and January 2021. The analysis examines men's framings of emergency contraceptive pills and how these shape their involvement in its use. Men's knowledge of post-coital contraceptives was high, while knowledge of the specific term 'emergency contraception' was lower. While some men understood the pills in ways that aligned to Global Health framings, many more men saw emergency contraceptive pills as another means of pregnancy prevention in line with other contraceptives. This included its conceptualisation as a contraceptive that facilitates pleasurable (condomless) and spontaneous sex. Gendered perceptions of women who use emergency contraceptive pills were bound in sexual stigma, and men indicated that emergency contraceptive pills were a directly observable form of contraception that they could pressure their partner into using. Understanding plural conceptualisations away from 'emergency' are necessary to create policies and programmes that account for men's involvement. This includes understanding how emergency contraceptive pills are located within people's sexual and reproductive lives and gendered power dynamics, to reflect the public's own rationales for and experiences using post-coital contraceptives.
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Affiliation(s)
- Joe Strong
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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Vogt EL, Chibber S, Jiang C, Owda R, Caldwell MT, Harris LH, Marsh EE. Trends in Encounters for Emergency Contraception in US Emergency Departments, 2006-2020. JAMA Netw Open 2024; 7:e2353672. [PMID: 38277150 PMCID: PMC10818211 DOI: 10.1001/jamanetworkopen.2023.53672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024] Open
Abstract
This cross-sectional study of female emergency contraception users examines emergency contraception–related emergency department use disparities and associations with policy changes.
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Affiliation(s)
- Emily L. Vogt
- University of Michigan Medical School, Ann Arbor
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Shani Chibber
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
- Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas
| | - Charley Jiang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Rieham Owda
- Complex Family Planning Section, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | | | - Lisa H. Harris
- Complex Family Planning Section, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Women’s and Gender Studies, College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor
| | - Erica E. Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
- Department of Women’s and Gender Studies, College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor
- Michigan Institute of Clinical and Health Research, University of Michigan, Ann Arbor
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Lee YM, Kim SE, Choi D, Lee DY. The current status of emergency contraception use in reproductive-aged Korean women: a population-based internet survey. Front Endocrinol (Lausanne) 2023; 14:1191096. [PMID: 37361519 PMCID: PMC10285287 DOI: 10.3389/fendo.2023.1191096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Objective This study was conducted to assess the current status of emergency contraception (EC) use in reproductive-aged Korean women. Materials and methods This study utilized a population-based, cross-sectional online survey using a self-completed questionnaire in women aged 20-44 years who had visited a clinic in the previous six months for contraception counseling. Reason for use, anxiety, and counseling for further contraception at EC use were analyzed according to age, history of childbirth, and contraceptive failure in EC users. Results Among 1,011 respondents, 461 (45.6%) had experience with EC use. Younger age, need for EC due to inadequate contraception, and high anxiety were highly prevalent among EC users. However, women in the 20s were less likely to get counseling for further contraception at EC use. Additionally, the proportions of women who used EC due to inadequate contraception during sexual intercourse and who experienced high anxiety were lower among women who had a history of childbirth. Women who had a history of contraceptive failure worried less about EC use. Conclusion Our findings offer insight for developing and improving individualized strategies for appropriate contraception, especially in young Korean EC users.
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Salcedo J, Cleland K, Bartz D, Thompson I. Society of Family Planning Clinical Recommendation: Emergency contraception. Contraception 2023; 121:109958. [PMID: 36693445 DOI: 10.1016/j.contraception.2023.109958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG (such as Plan B One-Step, My Way, Take Action), and oral ulipristal acetate (UPA) (ella). These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPA at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPA use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.
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Affiliation(s)
- Jennifer Salcedo
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, United States.
| | - Kelly Cleland
- American Society for Emergency Contraception, Lawrenceville, NJ, United States
| | - Deborah Bartz
- Department of Obstetrics and Gynecology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Ivana Thompson
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
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Gawron LM, He T, Lewis L, Fudin H, Callegari LS, Turok DK, Stevens V. Oral Emergency Contraception Provision in the Veterans Health Administration: a Retrospective Cohort Study. J Gen Intern Med 2022; 37:685-689. [PMID: 36042074 PMCID: PMC9481759 DOI: 10.1007/s11606-022-07596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/01/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND In the USA, oral emergency contraception (EC) use to prevent unintended pregnancy is increasing. Oral EC methods include levonorgestrel (LNG) and ulipristal acetate (UPA), with increased UPA efficacy over LNG in high BMI users and those beyond 3 days post intercourse. The Veterans Health Administration (VHA) provides oral EC at low or no cost, yet prescription-level Veteran data are lacking. OBJECTIVE To describe oral EC provision in VHA, including method type and Veteran user and prescriber characteristics. DESIGN A retrospective cohort study using VHA administrative data. PARTICIPANTS All VHA oral EC prescriptions from January 1, 2016, to December 31, 2020. MAIN MEASURES We linked Veteran-level sociodemographic and military characteristics and provider-level data with each prescription to identify variables associated with oral EC method. KEY RESULTS A total of 4280 EC prescriptions (85% LNG) occurred for 3120 unique Veterans over 5 years. While prescriptions remained low annually, the proportion of UPA prescriptions increased from 12 to 19%. Compared to LNG users, UPA users were older (34% vs 25% over age 35 years, p <0.001); more likely to identify as white (57% vs 46%) and non-Hispanic (84% vs 79%) (p <0.001); and more likely to have a BMI ≥ 25 (76% vs 67%, p <0.001). UPA prescriptions originated most frequently from VA Medical Centers (87%) and women's health clinics (76%) compared to community-based or other clinic types. In multivariable regression models, race, ethnicity, BMI ≥30, and prescriber facility type of a VA Medical Center or a women's clinic location were predictive of UPA prescription. CONCLUSIONS Oral EC provision in VHA remains low, but UPA use is increasing. LNG prescription occurs frequently in high BMI Veterans who would benefit from increased efficacy of UPA. Interventions to expand oral EC access in VHA are essential to ensure Veterans' ability to avert unwanted pregnancies.
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Affiliation(s)
- Lori M Gawron
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30N 1900E Rm 2B-200, Salt Lake City, UT, 84132, USA. .,VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
| | - Tao He
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lacey Lewis
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hannah Fudin
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Lisa S Callegari
- VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - David K Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30N 1900E Rm 2B-200, Salt Lake City, UT, 84132, USA
| | - Vanessa Stevens
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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Emergency Contraception: Access and Challenges at Times of Uncertainty. Am J Ther 2022; 29:e553-e567. [PMID: 35998109 DOI: 10.1097/mjt.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The UN Commission on Life-Saving Commodities for Women's and Children's Health identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation. AREAS OF UNCERTAINTY Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access. DATA SOURCES PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetrician and Gynecologists, the World Health Organization, The United Nations. THERAPEUTIC ADVANCES A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device. CONCLUSIONS EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts, threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.
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Mehta SD, Kulkarni AD, Pazol K, Koumans EH. Trends in Emergency Contraceptive Use Among Adolescents and Young Adults, 2006-2017. J Adolesc Health 2022; 71:86-93. [PMID: 35351354 PMCID: PMC10982874 DOI: 10.1016/j.jadohealth.2022.01.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/20/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE In 2013, age restrictions for adolescents on over-the-counter access were removed for "Plan B One-Step", a single oral medication option for emergency contraception use. Restrictions on generic options of the emergency contraceptive pill (ECP) were removed in 2014. METHODS National Survey of Family Growth data were used to assess the prevalence of ever use of ECPs among sexually experienced female adolescents and young adults (AYA) aged 15-24 years (2015-2017 sample), and trends in indicators of ECP use and acquisition (2006-2017 samples). Prevalence estimates were obtained by age subgroups for 15-17, 18-19, and 20-24 years. Statistical significance was determined using an alpha of .05 and 95% confidence intervals calculated around the point estimates. RESULTS The weighted estimate of sexually experienced female AYA in the United States ranged from 13.3 million in 2006-2008 to 12.7 million in 2015-2017. The prevalence of ever ECP use was 18.2% (95% CI 15.7-21.1) and 31.8% (95% CI 26.9-37.1) in 2006-2008 and 2015-2017, respectively. Ever use in 2015-2017 varied by age group, number of lifetime opposite-sex partners and abortions, and experience of nonconsensual sex. In 2008-2010, 46.1% (95% CI 36.0-56.5) of respondents last obtained ECPs at community health or family planning clinics, and 31.8% (95% CI 22.9-42.2) last obtained ECPs at a pharmacy compared to 18.1% (95% CI 12.0-26.4) and 70.1% (95% CI 60.6-78.1) respectively in 2015-2017. Prevalence of provider counseling about emergency contraception in female AYA regardless of prior sexual experience in the past 12 months remained at or below 5% from 2006 to 2017. CONCLUSION Increasing access to ECPs over-the-counter may have contributed to notable increases in reported ever use of ECPs and in the receipts from a pharmacy among AYA between 2006 and 2017. AYA may benefit if pharmacists and healthcare providers increase reproductive health counseling.
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Affiliation(s)
- Sagar D Mehta
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Aniket D Kulkarni
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Karen Pazol
- Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emilia H Koumans
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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