Changes in providers' views and practices about emergency contraception with education

Emergency Contraception Knowledge, Attitudes, and Barriers Among Men: A Cross-Sectional Study

Background Emergency contraception (EC) plays a pivotal role in the prevention of unintended pregnancies following unprotected sexual intercourse. Men's awareness regarding emergency contraception is pivotal for informed decision-making and for enhancing reproductive health in this context. This study investigated Syrian men's awareness and perspectives on emergency contraception to inform diverse reproductive health initiatives. Methods We conducted a cross-sectional study in Syria, from June 2022 and April 2023. Our study included male participants aged 18 years or older who held Syrian nationality and volunteered to participate. The data collection involved administering a questionnaire comprising three sections (knowledge, attitude, and barrier assessment), encompassing a total of 30 questions. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY). Results Most participants were aged 18-25 (65.7%) and single (75.4%) and held a university degree (79.3%). The knowledge of emergency contraception was low (36.1%), with the Internet and social media (77.5%) being the primary sources of information. While 89% held positive attitudes toward emergency contraception, only 37.3% supported nonprescription availability. Age, income, and desire for children were associated with knowledge, attitudes, and the use of emergency contraception. Men aged 26-35 exhibited the highest positive attitude (8.11±1.83). Those desiring no children showed higher attitude scores (7.42±2.04). Income was positively associated with knowledge (adjusted odds ratio {AOR}=1.75 and confidence interval {CI}=1.02-2.99) and emergency contraception use (AOR=2.87 and CI=1.27-6.48). Conclusion This study underscores the knowledge gap regarding emergency contraception in Syrian men. Despite positive attitudes, awareness remains limited, particularly among those of childbearing age. Targeted education and improved accessibility to emergency contraception can enhance its use among men, particularly in those with low socioeconomic status and younger age groups.

Opinions of West Texas pharmacists about emergency contraception

BACKGROUND

The pharmacist's role in dispensing emergency contraception (EC) has become controversial due to the intersection of personal and professional ethics. Therefore, to examine the issue of EC availability, we surveyed a sample of West Texas pharmacists. West Texas is a religiously and politically conservative region where no methods of EC have been made available.

OBJECTIVE

to survey a sample of pharmacists in West Texas about their experience, beliefs, and knowledge of EC both before and after a presentation of the current literature about EC.

METHODS

We asked a convenience sample of 75 pharmacists about their experience, beliefs, and knowledge of EC both before and after a presentation of the current literature about EC.

RESULTS

Sixty-four (85%) pharmacists agreed to complete the study questionnaire. None carries EC in his/her pharmacy, and scientific understanding of EC was generally poor. Fourteen percent stated EC conflicts with their religious views, 17% considered it a method of abortion, 11% would not be willing to fill an EC prescription written by a doctor. 58% would be willing to offer EC over the counter. The presentation encouraged more to offer it over the counter, but in general did not significantly change their beliefs.

CONCLUSION

Our sample of West Texas pharmacists demonstrated very little experience with, a general lack of knowledge about, and some personal and religious objections to EC.

Providers' knowledge of, attitude to and practice of emergency contraception

OBJECTIVES

Barriers to widespread use of hormonal emergency contraceptives (EC), such as lack of knowledge and prejudices held by health-care providers, still exist today. This study was initiated to evaluate the knowledge, attitudes and prejudices of family-planning (FP) providers.

METHODS

This survey was conducted in FP units of primary-health-care centers in Istanbul. A total of 180 providers were interviewed in 80 units to whom a questionnaire was administered by face-to-face technique.

RESULTS

One-hundred and fifty-two of the providers stated that they had heard of EC. The correct timing and dose interval of EC were known by 50% of them. The participants held the belief that EC caused abortion (39.4%), and that it was harmful for the fetus (31.1%). Other prejudices were the possibility of increased unprotected sexual intercourse (78.9%) and a tendency for men to give up condom use (75%); female providers were more prejudiced concerning these statements. The providers' tendency towards the provision of counseling was significantly related to their prejudices (p = 0.011, p = 0.033) and to the application rate (p = 0.000). Conclusion Providers need more detailed information about EC. During FP training courses, the providers should be encouraged towards counseling EC which would increase the application rate of the users and decrease their own prejudices.

Exploring emergency contraception knowledge, prescription practices, and barriers to prescription for adolescents in the emergency department

OBJECTIVE

The objective of this study was to assess the proportion of emergency medicine physicians who had prescribed emergency contraception pills to adolescents, to identify potential barriers to emergency contraception pill prescription for adolescents, and to assess physician knowledge of emergency contraception pills.

PARTICIPANTS AND METHODS

A cross-sectional, anonymous, Internet-based survey of members of the American Academy of Pediatrics Section of Emergency Medicine was conducted. Providers were included in analysis if they were attending physicians caring for children (<22 years of age) in the emergency department setting >30% of the time. Survey questions included demographics, emergency contraception pill prescription rates for adolescents, attitudes toward emergency contraception pills for adolescents, and emergency contraception pill knowledge questions.

RESULTS

A total of 1005 Section of Emergency Medicine members were contacted; 424 (42%) responded, and 133 did not meet inclusion criteria. Of the 291 eligible respondents, 282 had complete surveys. Eighty-five percent of the respondents stated that they had prescribed emergency contraception pills to adolescents, 71% within the previous year. Of those, 81% prescribed emergency contraception pills <5 times. The 5 most frequently cited barriers were concern for lack of follow-up (72%), time constraints (40%), lack of clinical resources (33%), discouraging regular contraceptive use (29%), and concern about birth defects (27%). Thirty-nine percent of respondents identified >/=5 barriers to emergency contraception pill prescriptions for adolescents. Forty-three percent incorrectly answered >50% of the questions. Physicians were more likely to report prescribing emergency contraception pills if they had answered >3 of the knowledge-based questions correctly and were less likely to report prescribing if they identified >5 barriers.

CONCLUSIONS

Although a large proportion of emergency department physicians reported prescribing emergency contraception pills to adolescents, the pills were prescribed infrequently. Factors associated with nonprescription were decreased knowledge of emergency contraception pills and identifying >5 barriers. Identification of these potential barriers and education regarding emergency contraception pills may ultimately improve adolescent access to emergency contraception pills in the emergency department.

Emergency contraception provision: a survey of Michigan physicians from five medical specialties

OBJECTIVE

Despite the controversy over expanding delivery options for emergency contraceptive pills (ECP), little is known about physicians' attitudes toward over-the-counter (OTC) provision of ECP, and prior research on physicians' practices often has focused on a single specialty. This study examined the attitudes and practices regarding advance provision and OTC status of ECP among physicians in five medical specialties likely to encounter patients in need of ECP.

METHODS

A mail survey of a random sample of 850 Michigan physicians in family/general medicine, internal medicine, obstetrics/gynecology, pediatrics, and emergency medicine was conducted. Respondents' ECP-related attitudes and practices were assessed, and differences by physician characteristics were examined using chi-square tests and multivariable logistic regression analyses.

RESULTS

Two hundred seventy-one physicians responded to the survey (response rate = 32%), with 42% of them favoring OTC provision of ECP and 40% opposing it. Half of respondents never routinely initiated discussions about ECP with their sexually active, female patients, and 77% of respondents did not routinely offer advance prescriptions. After adjusting for other factors, including medical specialty, older physicians ( > or =50 years) were significantly more likely than their younger counterparts to support OTC provision of ECP (OR = 2.9, 95% CI 1.7-4.9) or offer advance prescriptions (OR = 2.5, 95% CI 1.1-5.8). Physicians with a specialty in obstetrics/gynecology were 3.5 times (95% CI 1.3-9.8) as likely as physicians in family/general medicine to offer advance prescriptions for ECP, and female physicians were 2.5 (95% CI 1.05-6.0) times as likely as male physicians to offer advance prescriptions. Graduation from a medical school within the United States and practicing in a private practice were marginally associated with a lower likelihood of supporting OTC status of ECP (OR = 0.5, 95% CI: 0.2-1.0; and OR equals; 0.6, 95% CI 0.3-1.1, respectively).

CONCLUSIONS

Certain physician characteristics were significantly associated with their ECP-related attitudes and practices. The majority of physicians surveyed in this study did not offer advance prescriptions for ECP, and few had initiated discussions on ECP with patients, which may pose critical barriers to patients' timely access.

Emergency contraception: knowledge and attitudes of Turkish nursing and midwifery students

OBJECTIVES

To assess the knowledge and attitudes of emergency contraception (EC) among nursing and midwifery students of a university in the Eastern-Mediterranean region of Turkey.

METHODS

The survey was conducted among 210 nursing and midwifery students.

RESULTS

One hundred and twenty-five participants (59.5%) knew at least one method of EC. One hundred and fourteen participants (54.3%) had heard about emergency contraceptive pills (ECPs), but only 17 (8.1%) knew what they contained. Rates of hearing about ECPs were statistically higher in third and fourth classes than first and second classes, and in midwifery students than in nursing students (P < 0.001). In spite of their very unsatisfactory level of knowledge, 166 students (79.0%) thought that ECPs should be sold in pharmacies.

CONCLUSION

The nursing and midwifery students we assessed have a very insufficient knowledge of EC. Probably therefore, many are prejudiced against it. They should be much better acquainted with this modality of contraception since, after graduation, they will play an important role in the dissemination of information about EC in the population.

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.

Acceptance and use of emergency contraception with standardized counseling intervention: results of a randomized controlled trial

OBJECTIVE

The objective of this work was to evaluate the acceptance, use and recall of an optional advance prescription for emergency contraception (EC).

MATERIALS AND METHODS

This study used as randomized controlled trial evaluating contraceptive counseling intervention with women aged 16-44 years who were at risk for unintended pregnancy (N=737). Intervention participants (n=365) received contraceptive counseling with optional advance EC prescription. Control women (n=372) received no contraceptive or EC counseling. Among intervention participants, initial acceptance and use of EC in first 2 months were evaluated. Among all participants, differences were evaluated between recall of EC discussion and use of EC.

RESULTS

Among 365 intervention women, 336 received EC counseling and 51% of these 336 accepted advance EC prescription. At 2 months, among the women who had accepted EC, 6% had filled and used their prescription and 8% had filled but not used their prescription. At 12 months, intervention women were significantly more likely than controls to recall talking about EC (33% vs. 5%) and obtaining a prescription (38% vs. 6%), but there were no differences in the use of EC (6% vs. 6%).

CONCLUSION

When the option is available for EC counseling, approximately half of women accepted advance prescription for EC. However, few women who received information and/or an advance prescription remembered discussing EC, filled the prescription or used EC over 12 months.

Nonprescription Availability of Emergency Contraception in the United States: Current Status, Controversies, and Impact on Emergency Medicine Practice

In October 2004, the American College of Emergency Physicians Council joined more than 60 other health professional organizations in supporting the nonprescription availability of emergency contraception. This article reviews the history, efficacy, and safety of emergency contraception; the efforts toward making emergency contraception available without a prescription in the United States; the arguments for and against nonprescription availability of emergency contraception; and the potential impact nonprescription availability could have on the practice of emergency medicine in the United States.

An evaluation of the impact of a national health demonstration project on testing and management for Chlamydia trachomatis infections in two regions of Scotland

OBJECTIVES

To compare clinical practice relating to testing for, and management of, genital Chlamydia trachomatis infection in the Lothian and Grampian regions of Scotland as part of an evaluation of a Government-funded health demonstration project in Lothian, Healthy Respect.

STUDY DESIGN

Clinical audit against standards developed from a national clinical guideline.

METHODS

Clinical practice relating to testing for, and management of, genital C. trachomatis infection was assessed against standards for good quality care developed from a national clinical guideline (Scottish Intercollegiate Guidelines Network Guideline 42). Audit methods comprised: postal survey of primary care clinicians; review of referral letters from primary to secondary care; and review of primary and secondary care patient case records. Findings from Lothian and Grampian were compared.

RESULTS

Questionnaires were returned by 167 primary care clinicians in Lothian and 96 in Grampian. Clinicians in Lothian and Grampian gave similar responses relating to: testing of symptomatic patients (87 vs 88%); offer of testing for asymptomatic young patients (55 vs 55%); choice of antichlamydial agent (47 vs 42% azithromycin as first line); and follow-up strategies (50 vs 51% offer follow-up in primary care). Clinicians in Lothian were significantly more likely to participate in partner notification work (57 vs 44%; P=0.04) and to agree with statements reflecting 'perceived self-efficacy' in chlamydia-related care (57 vs 48%; P=0.006). Referral letters from primary to secondary care were reviewed for 31 women with genital symptoms in Lothian and 28 in Grampian. More women in Lothian were tested for chlamydia prior to referral (65 vs 39%; difference not significant). Review of primary care records for consultations in young people (145 in Lothian; 203 in Grampian) showed a higher level of chlamydia testing in Grampian (Lothian, 14%; Grampian, 34%; P<0.0001). However, review of secondary care records (n=39) showed a much higher level of testing in Lothian (Lothian, 75%; Grampian, 9%; P<0.0001). Review of secondary care records relating to proven chlamydia-positive women (n=159) suggested better care in Lothian in relation to ensuring antibiotic treatment (Lothian, 91%; Grampian, 74%; P=0.004), and use of the preferred antibiotic, azithromycin (Lothian, 78%; Grampian, 37%; P<0.0001). However, documented referral to a health adviser appeared to be better in Grampian (Lothian, 32%; Grampian, 48%; P=0.048).

CONCLUSIONS

During the period of activity of the Healthy Respect demonstration project, few differences were detected between clinicians in Lothian and Grampian with regard to chlamydia-related practice. In both regions, clinicians appeared to be very aware of the need to test for chlamydia in patients with relevant symptoms, but were less likely to offer opportunistic testing to young patients without specific symptoms. These findings suggest that Healthy Respect in Lothian has had little impact on clinicians. However, these findings must be considered within the context of a broader evaluation, and it is noteworthy that the few significant differences that were detected tended to suggest better practice in Lothian.

Emergency contraception: an intervention on primary care providers

OBJECTIVE

We studied whether a single educational intervention can change provider knowledge, attitudes and practice patterns with respect to emergency contraception (EC).

MATERIALS AND METHODS

Primary care providers completed a preintervention survey prior to attending a lecture on EC, and again 6 months later. There were 50 physicians, 4 advanced practice nurses and 2 physician assistants in the final sample (internal medicine 48%, family medicine 34%, obstetrics-gynecology 9%, and pediatrics/adolescent medicine 9%).

RESULTS

Following the intervention, providers were more likely to agree that advance prescriptions should be given, disagree that the number of times EC is dispensed should be restricted and disagree that repeated EC use poses health risks. The proportion of providers who had ever given an advance prescription increased from 18% to 41% (p = .007), and there was a trend toward a greater proportion of providers initiating counseling about EC from 36% to 54% (p = .057).

CONCLUSIONS

A simple educational intervention was associated with a change in primary care provider attitudes and practice patterns regarding EC.

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.

Emergency contraception knowledge among women in a Boston community

This study assesses the baseline knowledge of emergency contraception (EC) in a Boston neighborhood. A written survey was distributed to women aged 18-44 years in the Boston neighborhood of Jamaica Plain. Of the 188 participants, 82% have heard of EC. Knowledge disparities by race/ethnicity groups were seen, with only 51% of Latina women and 75% of Black women having heard of EC compared with 99% of White women (p < .0001 and p = .002, respectively). Of the entire cohort, 39% knew that EC works by preventing pregnancy, 48% knew that it should be taken within 72-120 h of unprotected intercourse and 44% knew that it is only available by prescription in Massachusetts. Only 25% of women have ever discussed EC with a health care provider, and only 12% have ever received an advance prescription. A community education campaign aimed at reproductive-age women, health care providers and pharmacists has been tailored to address these knowledge deficits.

Emergency department post-coital contraception in Northern Ireland

BACKGROUND

The granting of a licence to Levonelle as an emergency hormonal contraceptive in the Republic of Ireland may require accident and emergency (A&E) departments to formally provide such a service. This article outlines the experiences of a Northern Ireland A&E unit.

AIMS

To examine the pattern of attendance of patients requesting emergency contraception at an A&E department and to assess if adequate standards of care are achieved.

METHOD

Retrospective case note review of 100 patients attending the A&E department requesting emergency contraception.

RESULTS

Sixty-one per cent of requests for emergency contraception were outside normal pharmacy opening hours. Seventy-seven per cent of these patients were less than 26 years old. Most (63%) attended within 24 hours of unprotected sexual intercourse. Forty-three per cent of the patients studied had used no contraception prior to this request. Recording of menstrual details and sexual behaviour as part of the consultation was variable.

CONCLUSIONS

A&E departments receive requests for emergency hormonal contraception particularly from younger women (<25 years). A&E staff must have appropriate training and support to manage these consultations effectively.

Emergency contraception: prescribing practices of general internists compared with other primary care physicians

Primary care physicians of all specialties should be familiar with prescribing emergency contraception (EC). We conducted a mail survey of 282 randomly sampled physicians in general internal medicine (31%), family medicine (34%) and obstetrics-gynecology (35%). Experience with prescribing EC significantly differed by specialty (63% of general internists, 76% of family physicians, and 94% of obstetrician-gynecologists, p < 0.0001). Controlling for year of graduation, gender, religion and practice location, family physicians [adjusted odds ratio (OR): 2.5, 95% confidence interval (CI): 1.2-5.2] and obstetrician-gynecologists (adjusted OR: 11.2, 95% CI: 4.0-31.3) were still significantly more likely to have ever prescribed EC than general internists. Efforts to increase awareness and knowledge of EC should be aimed at general internists since they provide primary care for many reproductive age women.

Controversies in adolescent hormonal contraception

Unintended pregnancy and abortion rates among US adolescents remain high although hormonal contraception is safe and effective in this population. Controversies affecting the provision of hormonal contraception for adolescents include the side effects of oral contraceptives, the possibility that progestin-only injectables lead to decreased bone health, and debate as to whether emergency contraception should be available to teens without a prescription. Each of these issues is addressed with a review of relevant literature.

Ectopic pregnancies following emergency levonorgestrel contraception

There are little or no data on the risk of ectopic pregnancy following levonorgestrel treatment as an emergency contraception. We encountered three cases of ectopic pregnancy following the use of levonorgestrel administered peri- or postovulation. Here we report these cases and discuss the clinical and epidemiologic implications of this association. Health providers should be alert to the possibility of an ectopic pregnancy in women who become pregnant or complain of lower abdominal pain after taking levonorgestrel.