Emergency contraception--clinical and ethical aspects

Over-the-counter emergency contraception in Italy: ethical reflections and medico-legal issues

Although more than ten years have passed since the marketing of Ulipristal acetate in Europe, emergency contraception remains a complex issue with many scientific, legal, ethical and social implications. The topic is an example of the differences that can exist between scientific evidence, the certainties on which law is based, and social implications. This paper shows the incompleteness of the scientific reconstruction on the effects of emergency hormonal contraceptives and the dangerousness of the decision to alienate the supply of over-the-counter drugs from the general rules of health care. This report shows the incompleteness of the scientific reconstruction on the effects of emergency hormonal contraceptives and the dangerousness of the decision to alienate the supply of over-the-counter drugs from the general rules of health care. Various ethical and medico-legal issues will be addressed, also focusing attention on underage women whose sexual and reproductive health requires not abandoning them, but actually taking charge of them without medicalizing their choices.

Ectopic Pregnancy Following Levonorgestrel Emergency Contraception: Report of Two Cases

Abstract Ectopic pregnancy (EP) is likely to occur as an unwanted complication after unprotected intercourse in spite of levonorgestrel emergency contraception (LNG-EC).   Its incidence has been increasing recently. We present 2 cases of tubal EP  after the oral use of levonorgestrel, treated by  laparoscopy.The first unruptured EP with unclear ultrasound findings, because of   uterine ventrofixation  after the caesarean section (CS) . The second case is a ruptured EP after LNG –EC   on day 24 of the period  with mild  haemoperitoneum with severe peritoneal irritation. The fundamental question is whether levonorgestrel participates in the etiology of EP. The etiology of EP involves many factors. Levonorgestrel mechanisms of action give us grounds to believe theoretically that it increases the risk of EP and participates as an etiological factor.  

Ethical principles--emergency medicine

Neither law nor religion, bioethics absorbs and applies elements of both. Its theories, principles, and methods stem from various philosophical schools. Practitioners use case-based reasoning to apply bioethics to clinical situations, usually giving most weight to patients' autonomy and values, but also incorporating other relevant bioethical principles, including those encompassed in professional oaths and codes. Emergency clinicians must be able to recognize bioethical dilemmas, have action plans based on their readings and discussions, and have a method through which to apply ethical principles in clinical settings. This article provides an overview of ethical considerations and guidelines for emergency clinicians.

Awareness and perceptions of emergency contraception among retail pharmacists in Kuwait

OBJECTIVE

To describe the awareness and perceptions of hormonal emergency contraception (EC) among retail pharmacists.

SETTING

Private retail pharmacies in Kuwait City.

METHOD

A self-administered questionnaire was developed to elicit pertinent demographic information as well as awareness of and concerns about EC and administered to the senior pharmacist in 51 randomly selected private retail pharmacies.

MAIN OUTCOME MEASURE

Proportion of pharmacists aware of EC and who had recommended EC.

RESULTS

The respondents had a mean (SD) age of 34.2 (7.7) years; 58.8% were male, and all but one were non-Kuwaiti. The median practice experience of the pharmacists was 6 years. Oral contraceptives and male condoms were universally available in the pharmacies, but none stocked emergency contraceptives, female condoms, or diaphragms. Twenty respondents (39.2%; 95% confidence intervals 25.5-53.9%) said they were aware of EC, and 4 (7.8%) that they had ever offered EC. Nine (17.6%) respondents saw EC as offering no advantages over other contraceptive measures and effectiveness was perceived to be low. Most cited concerns were of encouraging irresponsible behaviour and women relying on EC in place of regular contraceptive measures. Religious opposition (41.2%), lack of awareness by clients (51.0%) and lack of awareness by health providers (35.3%) were seen as the most significant obstacles to provision of EC.

CONCLUSION

Knowledge of EC is poor among community pharmacists in Kuwait. Action is needed to address this deficit and to make EC more accessible to women who wish to use it.

Awareness of hormonal emergency contraception among married women in a Kuwaiti family social network

OBJECTIVE

Awareness and use of hormonal emergency contraception are not known in the Arab world. This study investigated awareness and perceptions of hormonal emergency contraception among women within a Kuwaiti extended family and their social contacts.

STUDY DESIGN

A cross-sectional survey was conducted using a self-administered questionnaire which was distributed to 66 married women within a Kuwaiti family's social network. The questionnaire provided a short explanation of hormonal emergency contraception and then elicited the respondent's prior awareness, concerns and perception on future availability.

RESULTS

The mean (S.D.) age of the respondents was 35.1 (6.3) years. Over 30% were currently using oral contraceptives; 28% were using no contraceptive method. Four women (6.1%) had heard of hormonal emergency contraception before, one had used it. Most respondents (65.2%) would not use or inform a friend about hormonal emergency contraception. Main concerns were risks to the health of the woman (83.3%) or the baby (54.5%) or that it was abortifacient (21.2%). However, 90.9% of respondents wanted hormonal emergency contraception to be available.

CONCLUSIONS

Awareness of hormonal emergency contraception is low among Kuwaiti women. Despite some concerns, they feel it should be made available. Health care providers and policymakers should address this situation.

A survey of knowledge, attitudes and practices relating to emergency contraception among health workers in Manisa, Turkey

OBJECTIVE

to determine knowledge, attitudes and practices relating to emergency contraception among health-care providers (general practitioners, nurses and midwives).

DESIGN

a cross-sectional design using face-to-face interview methods plus questionnaire in the work setting. Researchers were able to maintain privacy by using priority strategies.

SETTING

18 primary health-care units in Manisa, western Turkey.

SAMPLE

182 health-care providers (general practitioners [n = 72]; nurses and midwives [n = 110] were invited to participate in the study, but 26 of them declined.

PARTICIPANTS

156 health-care providers. As 16 participants had not heard of emergency contraception, 140 health-care providers (general practitioners [n = 51] and nurses and midwives [n = 89]) were included.

FINDINGS

of the health-care providers, almost one in 10 was unfamiliar with the term 'emergency contraception'. Only a few health-care providers knew how to use the intra-uterine contraceptive device (IUCD) for emergency contraception and the doses of emergency contraceptive pills. Some health-care providers included emergency contraception in routine consultations, but many did not support the use of emergency contraception in Turkey. Many of the providers thought that young people should not know about emergency contraception.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

knowledge among health-care providers about emergency contraception is inadequate. All health-care providers should know about emergency contraception and include it in routine contraceptive consultations. Thus, continuing education information programmes are required. Further research into the knowledge, practices and attitudes of health-care providers is needed to understand the underlying reasons for the hesitant attitudes among health professionals.

Emergency contraception - a human rights issue

Emergency contraception is the only resource that women can use to avoid becoming pregnant after having sexual intercourse without contraceptive protection. It could be a powerful means to prevent unwanted pregnancies and their devastating consequences for women's health, social wellbeing and life project, and for the unwanted child, if all people had ample access to good quality information, education and services for sexual and reproductive health. In spite of the preventive medicine value of emergency contraception, conservative sectors oppose its availability, appealing to moral values that are not universally shared in pluralistic societies. Excluding the only contraceptive that can be used after intercourse because some consider the mechanism of action to be unacceptable would mean restricting the right of choice of others, and imposing one particular belief or set of values on all members of the community, thus violating the freedom of conscience. Authorities have a moral obligation to protect human rights.

Emergency contraception: the politics of post-coital contraception

The literature and events related to the politicization of emergency contraceptive pills (ECPs) in the United States is reviewed. The basis of opposition to the regimen, rooted in the mode of action of ECPs, the confusion with mifepristone, and the challenges this presents for ECP advocates is also discussed. Legislative actions that impact availability of ECPs are described, as well as efforts to increase access and availability through innovate programs, legislation, and changes in medical practice. Recommendations for future research, service delivery, and public policy are also presented.