Emergency contraception: Knowledge and perceptions in a university population

"A Lot of My Friends Don't Know How It Works": Student Activists Describe Gaps in College Students' Emergency Contraception Knowledge

INTRODUCTION

Despite the high potential need for emergency contraception (EC) among college students, lack of accurate knowledge may decrease the likelihood of its use in this population. We examined knowledge about EC methods, potential outcomes of use, and access among college students in the United States.

METHODS

We recruited college students from a listserv devoted to EC campus activism for an online survey about EC knowledge (N = 150) and conducted 24 follow-up in-depth interviews. We describe the share of respondents that correctly answered each question and provide additional context and insight from interview respondents.

RESULTS

Gaps in EC knowledge were noted in our sample of college student EC activists. Awareness of different methods of EC was not universal; 38% of the sample was unaware of ulipristal acetate (ella®) and 61% was unaware of the intrauterine device inserted after intercourse as EC. Many respondents also incorrectly perceived additional barriers to acquiring EC such as minimum age or an ID requirement to purchase EC (64% and 49%, respectively). Interview respondents describe how medical providers, such as student health services and pharmacists, can pose barriers to EC access through either their actions or how college students expect they will act.

CONCLUSIONS

We document several gaps in knowledge surrounding EC in college students, even in an activist sample. Additional efforts to inform students about the variety of available EC methods and address mistaken perceptions about barriers to access may allow college students to better meet their needs for EC.

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.

Messaging and access strategies for improving emergency contraceptive knowledge and uptake among Italians

OBJECTIVES

Over-the-counter emergency contraception (EC) purchase was legalised in Italy in 2015. Knowledge and access gaps, however, remain. The goal of this study was to explore women's and men's EC informational and access needs.

METHODS

As part of a larger reproductive study, researchers conducted 42 in-depth interviews (May-June 2019) with English-speaking women and men aged 18-50 years (mean ± standard deviation, 29.1 ± 7.9 years) living in or near Florence, Italy, and using the Italian health care system. Researchers completed qualitative data analysis to identify emergent themes related to EC knowledge, attitudes and access. HyperRESEARCH aided data organisation and analysis. Researchers used a comparative method to contextualise data and identify emergent themes.

RESULTS

Findings demonstrated that peer communication and experiences served as influential factors in others' EC use. This propagated misinformation, reducing participants' confidence in EC efficacy and safety. Women described the relevance of relationship type in whether to engage men in EC discussion, while men desired an active supportive role. Finally, participants described various messaging and access channels to increase EC knowledge and access.

CONCLUSION

Findings offer practical recommendations to guide social marketing and behaviour change interventions to increase EC access among women and men in Italy. The utility of pharmacists to individuals wishing to access EC is explored.

Contraceptive values and preferences of adolescents and young adults: A systematic review

OBJECTIVE

We sought to systematically review the literature on values and preferences for contraception among adolescents and young adults globally.

STUDY DESIGN

We searched ten electronic databases for articles from January 1, 2005 through July 27, 2020 regarding end-users' values and preferences for contraception. We included studies that report specifically on people up to 25 years old.

RESULTS

Fifty-five studies out of 7,846 met our inclusion criteria. These studies included participants aged 10-25 years and were conducted in 16 countries. Through open coding, we identified 18 content areas. The five most commonly discussed content areas were: (1) general preferences regarding contraception, (2) contraceptive method benefits, (3) contraceptive method drawbacks, (4) the influence of the social context, and (5) the influence of myths and misconceptions, including safety and side effects, on contraceptive choice. Privacy and autonomy were important overarching themes, along with safety of the method. These considerations affected participants' access to and use of contraception.

CONCLUSION

Various social, cultural, and method-specific factors influence a young person's values and preferences around contraceptive methods. Understanding their values and preferences can help providers and programs improve contraceptive care for young people.

Adolescent emergency contraception usage, knowledge, and perception

OBJECTIVE

We sought to describe the current usage patterns, knowledge regarding, and perception of emergency contraception in adolescent patients.

STUDY DESIGN

We surveyed female patients ages 14 to 21 seen at the Pediatric and Gynecology Clinic regarding emergency contraception. We posed questions to understand adolescent awareness, personal usage, and means of obtaining emergency contraception. We also explored respondent knowledge of emergency contraception and potential barriers to access.

RESULTS

Of 261 patients approached, 253 completed the survey with a mean age of 16.7 ± 1.7 years. The majority of respondents (80.2%) had heard of oral emergency contraceptive pills. Among sexually active adolescents, 25.6 % reported personal use. Older adolescents (≥18 years) were more likely to have heard of emergency contraceptive pills, to know someone who used them, and to have used it themselves compared to younger adolescents (all p < 0.05). A minority of respondents knew that emergency contraception could be bought over the counter regardless of age or gender (44.3%) and that parental consent is not required (27.7%). Having ever been sexually active was associated with an increased odds of being correct with regards to the availability and timing of LNG EC. A history of LNG EC use was associated with an increased likelihood of understanding the mechanism of action and side effects of LNG EC.

CONCLUSIONS

Though adolescents in our population were aware of emergency contraception, only a small portion had used it themselves. Misunderstandings regarding the availability and safety of emergency contraception were common in our population.

IMPLICATIONS

Educating adolescents on the availability, safety, and mechanism of action of LNG EC may improve utilization of LNG EC in this population.

State of emergency contraception in the U.S., 2018

Emergency contraception is indicated in instances of unprotected sexual intercourse, including reproductive coercion, sexual assault, and contraceptive failure. It plays a role in averting unintended pregnancies due to inconsistent use or non-use of contraception. Options for emergency contraception vary by efficacy as well as accessibility within the U.S. This paper provides an overview of levonorgestrel (Plan B One-Step and generic counterparts), ulipristal acetate (sold as ella), and the copper intrauterine device (IUD, sold as ParaGard), including the mechanisms of action, administration, efficacy, drug interactions, safety, side effects, advantages, and drawbacks. It will also review current misconceptions about emergency contraception and access for subpopulations, including adolescents, immigrants, survivors of sexual assault, rural populations, and military/veteran women. This paper will address barriers such as gaps in knowledge, and financial, health systems, and practice barriers. Continuing areas of research, including the impact of body weight on the efficacy of emergency contraceptive pills and potential interactions between ulipristal acetate and ongoing hormonal contraceptives, are also addressed.

Discourses on the postcoital pill in young women

BACKGROUND

Emergency contraception (EC) is an effective postcoital contraceptive method for reducing the risk of unwanted pregnancy after unprotected intercourse. The estimated effectiveness of EC is between 70 and 89% if taken within 72 h following intercourse. Most of the studies carried out in Spain are quantitative and from the perspective of health professionals. In this study, we intend to explore the knowledge of, attitudes towards and discourse regarding the use of EC in women aged 15 to 25 years.

METHODS

Sample: A qualitative study including in-depth interviews with 19 women between 15 and 25 years of age was performed.

INCLUSION CRITERIA

Participants were natives of Spain or of a Latin American country. Segmentation criteria: Participants had experience in the use of EC.

DATA COLLECTION

Participants were selected by health care informants and by the snowball technique among university students.

DATA ANALYSIS

A thematic analysis was performed. Preliminary analyses were made during the course of the field work to adapt the script and to assess data saturation. A preliminary code tree was developed by two researchers, and the coding of the text was done with the Atlas.ti 5.0 software.

RESULTS

EC is perceived positively by women. They do not express issues with taking it, although some feel guilty. The reason for taking EC is to avoid unwanted pregnancy and abortion. Women also feel that EC should be used in moderation. False beliefs and misconceptions regarding EC are held: EC delivers an excess of hormones, induces abortion and causes severe side effects. Women mention that the health professionals who provide EC have moral beliefs. Women use it because of condom breakage associated with their first coital relations.

CONCLUSIONS

The results of this study have public health implications: The sexual-affective health education received by young people should incorporate clear information about the mechanism of action of the EC pill and its side effects together with empowerment strategies addressing guilt and moralistic messages. Programmes and training activities for health professionals must be designed to prevent the communication of inappropriate messages such as those that exaggerate the side effects of EC and those that promote fear and guilt, because they represent a barrier to the responsible use of this medication.

Intentions to use emergency contraception: The role of accurate knowledge and information source credibility

Background

Emergency contraception (EC) is a highly effective form of birth control that may lower rates of unintended pregnancy among young women. But efforts to disseminate EC to women are hampered by misinformation and inadequate information.

Purpose

The purpose of this study was to determine the sources from which young women learn about EC (including health care providers, friends/interpersonal sources, media sources, or no information sources), and to examine source credibility with the accuracy of EC knowledge and intentions to use EC.

Method

Using a computer-based survey, 339 college women (M age = 18.4) reported their EC information sources, knowledge about EC, and behavioral intentions to use EC.

Results

In total, 97% of participants had heard of EC from at least one source and 49% indicated they were highly likely to use EC in the future if needed. Results demonstrated that EC knowledge mediated the relationship between EC information source credibility and intentions to use EC.

Discussion

This study contributes important insights to a scarce literature on EC information sources and the factors that predict intentions to use EC.

Translation to Health Education Practice

Future EC promotion efforts should target health education sources instead of media or interpersonal sources to promote EC knowledge and use among young, sexually at-risk populations.

Emergency contraceptive pill users' risk perceptions for sexually transmitted infections and future unintended pregnancy

BACKGROUND AND PURPOSE

The availability of emergency contraception pills (ECP) over the counter (OTC) has the potential to reduce the incidence of unintended pregnancy; however, the increased risk for sexually transmitted infection (STI) acquisition, related to unprotected intercourse, has not been adequately addressed. The purpose of this study is to gain insight into risk perceptions for STIs and subsequent unintended pregnancy in women who have purchased ECP OTC.

METHODS

Twenty-one women, aged 18-24, attending a private university in an urban setting, who purchased and used ECP OTC participated in 1-h, individual interviews.

CONCLUSIONS

Narrative, descriptive findings indicated that these women did not consider themselves at risk for STI or unintended pregnancy, despite having used ECP OTC. Pregnancy prevention was paramount for these women, which overshadowed concerns regarding STIs.

IMPLICATIONS FOR PRACTICE

Women at risk for unintended consequences of sexual activity are not fully cognizant of those potential outcomes and do not take measures to prevent their occurrence. The availability of ECP OTC offers protection against unintended pregnancy; however, opportunities for health promotion and prevention counseling may be lost.

University Students' Sexual Health Knowledge: A Scoping Literature Review

Sexual health plays an important role in the well-being of university students. The literature shows that the majority of university undergraduates are sexually active and at high risk of contracting sexually transmitted infections (STIs); however, the breadth and degree of the literature on their sexual health knowledge is unclear. The purpose of this scoping review was to gain a deeper understanding of the state of research on the sexual health knowledge of university/college students globally. A 5-stage framework was used to guide the review and to characterize the literature on sexual health knowledge. Articles published in English between 2000 and 2014 were reviewed if they included university students as a population of interest and described the methods used to measure sexual health knowledge. Of the 2,386 articles retrieved, 91 met the criteria. The majority of the articles (n = 79) used a cross-sectional design to investigate students' knowledge about HIV/AIDS (n = 45), STIs (n = 23), HPV (n = 9), and contraception (n = 24). The review highlights gaps in the literature and in findings relating to the research dominance of various geographic locations, common research designs, the wide range of measurement tools used, and the variety of sexual health knowledge outcomes of interest. The review provides a useful description of the literature on sexual health knowledge among university/college students and some recommendations for moving the field forward.

Emergency contraception: Sources of information and perceptions of access among young adults

Emergency contraception (EC) can prevent pregnancy for up to 5 days after unprotected sex. Although EC has become increasingly available, little is known about perceptions of young adults regarding access to EC or whether information sources about EC relate to perceived access among young adults. Over a 1-week period in November 2013, a self-report survey was administered to 352 college students (67% women) at the student union of a large, public university in the southeastern United States. The survey assessed three aspects of EC: perceived access, information sources, and prior use. Twenty-one percent of participants had used EC. Participants reported relatively high perceptions of access to EC, with females reporting higher perceptions of access than males. Prior to the study, 7.4% of students had never heard of EC; the remaining students had heard of EC from an average of four sources. Among women, hearing of EC from media, interpersonal, or health education sources was significantly associated with greater perceived access (ps < .05). Among men, no specific information sources were associated with perceived access (ps > .10). Future EC awareness efforts for women should leverage all three of these sources, while future research should examine specific sources to focus on the content, quality, and frequency of messages.

U.S. Men's Perceptions and Experiences of Emergency Contraceptives

Research suggests that men should be included in reproductive health decision making to help enhance positive health outcomes for their partners. Men affect the use of contraception and what method is used. Men's decisions may be affected by different factors such as gender, education, and the nature of their sexual relationship. A qualitative study was conducted to explore males' experiences and perceptions about emergency contraception (EC), and the meanings males assign to EC. Semistructured in-depth focus groups were held with 15 men who engage in heterosexual activity recruited from a university setting in the United States. Participants expressed egalitarian views of the contraception decision-making processes, a sense of responsibility regarding reproductive decision making, and that society has a negative stigma toward those who use EC. However, there was a lack of knowledge regarding the copper intrauterine device, which was not viewed as a method of EC. Exploring the role and needs of men in reproductive health care discussions and research is an important and growing area. Recommendations are provided for health care practitioners, policy, and future research around men and EC.

Knowledge and use of emergency contraception in college women

Despite the value of emergency contraception (EC) in reducing unintended pregnancy, use in college women has not been widely studied. This exploratory descriptive study, using a web-based survey, described knowledge and use of EC in 2,007 college women and identified associations between selected personal characteristics and EC use. Most women (72.2%) knew EC could be obtained over the counter and was most effective within 72 hr of intercourse (93%). Women inaccurately thought EC was effective through the first trimester of pregnancy (87.1%) and could cause birth defects (27.8%). Among sexually active women, 37% reported use. Experiencing a false alarm pregnancy, knowing that EC was available over the counter, and being Asian/Pacific Islander were positively associated with use. Additional studies should explore the utility of EC in other populations and efforts should be stepped up to provide accurate information about access and mechanism of use.

Emergency Contraception: Awareness, Perception and Practice among Female Undergraduates in Imo State University, Southeastern Nigeria

Background:

Limited knowledge and practice of contraception is a global public health problem. Unintended pregnancies are the primary cause of induced abortion. When safe abortions are not available, as in Nigeria with restricted abortion laws, abortion can contribute significantly to maternal mortality and morbidity. Adequate information on the awareness and the use of emergency contraception is necessary for planning interventions in groups vulnerable to unwanted pregnancy.

Aim:

The aim of the following study is to access the awareness, perception and practice of emergency contraception among female undergraduates in Imo State University, South Eastern Nigeria.

Subjects and Methods:

A questionnaire based cross-sectional survey using female undergraduates selected randomly from Imo State University, Owerri.

Results:

A total of 700 students participated in the study. Awareness of emergency contraception was very high (85.1%) (596/700). The awareness was significantly higher amongst students in health related faculties than in the non-health related faculties (P = 0.01). The main sources of information were through friends (43.1%) (317/700) and lectures (22.1%) (192/700). High dose progestogen (postinor-2) was the most commonly known type of emergency contraception (70.8%) (422/596). Only 58.1% (346/596) of those who were aware of emergency contraception approved of their use. The major reasons given by the 41.9% (250/596) who disapproved of their use were religious reasons (50.4%) (126/250) and that they were harmful to health (49.2%) (123/250). Two-third (67%) (46 9/700) of the students were sexually active and only 39.9% (187/469) of them used emergency contraception. High dose progestogen (postinor-2) was again the most commonly used method (70.8%) (422/596). The most common situation in which emergency contraception was used was following unprotected sexual intercourse (45.5%) (85/144). Only 34.6% (206/596) of those who were aware of emergency contraception identified correctly the appropriate time interval for its effectiveness.

Conclusion:

Although the awareness of emergency contraception was high amongst female undergraduates, the attitude and practice are still poor. The inclusion of reproductive health education as part of the undergraduate school curriculum might help to change students’ attitude toward emergency contraceptives.

Prevalence of pregnancy experiences and contraceptive knowledge among single adults in a low socio-economic suburban community in Kuala Lumpur, Malaysia

BACKGROUND

This study aimed to investigate the prevalence of pregnancy experience and its association with contraceptive knowledge among single adults in a low socio-economic suburban community in Kuala Lumpur, Malaysia.

METHODS

A cross-sectional survey was conducted in 2012 among the Kerinchi suburban community. Of the total 3,716 individuals surveyed, young single adults between 18 and 35 years old were questioned with regard to their experience with unplanned pregnancy before marriage. Contraceptive knowledge was assessed by a series of questions on identification of method types and the affectivity of condoms for the prevention of sexually transmitted diseases.

RESULTS

A total of 226 female and 257 male participants completed the survey. In total, eight female (3.5%) participants reported experience with an unplanned pregnancy before marriage, and five male (1.9 %) participants had the experience of impregnating their partners. The participants had a mean total score of 3.15 (SD = 1.55) for contraceptive knowledge out of a possible maximum score of five. Female participants who had experienced an unplanned pregnancy had a significantly lower contraceptive knowledge score (2.10 ± 1.48) than who had never experienced pregnancy (3.30 ± 1.35), p<0.05. Likewise, male participants who had experienced impregnating their partners had a significantly lower contraceptive knowledge score (1.60 ± 1.50) than those who did not have such experience (3.02 ± 1.59), p<0.05.

CONCLUSION

The results showed evidence of premarital unplanned pregnancy among this suburban community. The low level of contraceptive knowledge found in this study indicates the need for educational strategies designed to improve contraceptive knowledge.

What do we know about males and emergency contraception? A synthesis of the literature

CONTEXT

Unintended pregnancy rates are high in the United States. It is important to know whether improving males' access to emergency contraceptive pills may help prevent unintended pregnancy, especially in cases of -condom failure.

METHODS

A search of the PubMed, PsycINFO and Cumulative Index of Nursing and Allied Health Literature databases was conducted to identify studies published from January 1980 to April 2011 concerning males and emergency contraception. Forty-three studies met the specified criteria and examined relevant knowledge, attitudes, beliefs, intentions or behaviors, from the perspectives of males, clinicians or pharmacists.

RESULTS

The proportion of males who were familiar with emergency contraception ranged from 38% among teenagers to 65-100% among adults. Small proportions reported that they and their partner had used or discussed using emergency contraceptive pills (13-30%) or that they themselves had ever purchased them (11%). Most providers (77-85%) reported general knowledge about emergency contraceptives, but the proportions who knew the time frame within which the pills can be prescribed were smaller (28-63%). Most males approved of emergency contraceptive use following contraceptive failure (74-82%) or unprotected sex (59-65%), or in cases of rape (85-91%), but both pharmacists and college students reported concerns that females might feel pressured to use the method. No study examined clinicians' attitudes and behaviors (e.g., counseling or advance provision) regarding males and emergency contraception.

CONCLUSIONS

Studies are needed to determine whether male involvement in emergency contraception can reduce rates of unintended pregnancy and to assess health professionals' ability to counsel males about the method.

Contraceptive use among sexually active university students

AIMS

The purpose of this exploratory study was to investigate factors related to contraceptive use and nonuse among a group of sexually active women attending a university.

METHODS

From October 2006 to August 2007, 326 female students participated in a cross-sectional study at a large, public university. Women self-reported information on contraceptive behaviors via web-based and postal mail questionnaires. Among sexually active women, odds ratios (ORs) and 95% confidence intervals (Cls) were calculated to examine the association between various characteristics and the decision to use contraception. Reasons for contraceptive use and nonuse were also further explored.

RESULTS

Of sexually active women, 77.1% reported using contraception. The most popular methods of contraception used were oral contraceptives and male condoms. Twenty-five percent of women not using contraception indicated that cost was an issue. Women who reported that a healthcare worker had ever talked to them about contraception had 6.63 times the odds of currently using contraception (95% CI 2.30, 19.18).

CONCLUSIONS

The most common reason for contraceptive nonuse was related to cost. In addition to educating students on the availability of effective, low-cost methods of contraception, healthcare workers can take advantage of well-woman visits to discuss contraceptive use and methods that suit an individual's needs. Such interventions and personalized counseling may lead to higher continuation rates and increased user satisfaction.

The role of pharmacists and emergency contraception: Are pharmacists' perceptions of emergency contraception predictive of their dispensing practices?

BACKGROUND

Pharmacists can play a critical role in the access to emergency contraception (EC). We assessed if knowledge and attitudes were predictive of EC dispensing among a statewide sample of Florida pharmacists, who have legal authority to refuse to dispense medications.

STUDY DESIGN

In 2008, surveys were mailed to a random sample of 1264 pharmacists registered with the Florida Board of Pharmacy. Data from 272 pharmacists (22% response rate) were analyzed using bivariate and multivariate logistic regression.

RESULTS

Fifty-six percent of respondents incorrectly answered that EC causes birth defects, and 46% replied that it causes abortion. Only 22% said that EC can be purchased in advance of need. Many felt uncomfortable dispensing to adolescents (61%) and men (58%). Knowledge about EC was the most important predictor of dispensing [odds ratio (OR)=1.57, 95% confidence interval (CI) 1.22-2.03]. In particular, pharmacists who reported that EC does not act as an abortifacient were more likely to dispense it (OR=4.64, 95% CI 2.15-10.00).

CONCLUSIONS

Correct information about EC was the most important predictor of pharmacists' dispensing EC. To expand availability of EC, pharmacists will have to become better informed.

Emergency contraception and RU-486 (mifepristone): do bioethical discussions improve learning and retention?

To systematically investigate whether the inclusion of a bioethical discussion improves the learning and retention of biological content, students in two sections of an introductory zoology class were taught the biology behind emergency contraception and RU-486. Students in one section of the course participated in a bioethical discussion, whereas students in the other section participated in a content-only discussion. Pre- and postsurveys, response paragraphs, and a final exam were collected and used to examine the learning and retention of content knowledge. Results suggested that students who participated in a bioethical discussion of emergency contraception and RU-486 learned and retained information better than students who received content-only instruction. Interestingly, students who participated in the bioethical discussion also appeared to be more confident in their answers. The results of this study may inform the teaching practices and goals of science educators who would like to incorporate a discussion of bioethical issues into their curriculum but often feel that content coverage is paramount.

Misconceptions about missed conceptions: the meanings of emergency contraceptive pills use among young adult couples

Emergency contraceptive pills (ECP) are a safe and efficacious backup method of birth control. Despite widespread availability, ECP is underutilized by young women. While partner level of involvement has been shown to influence contraceptive behavior, there is a dearth of knowledge regarding any possible association between partner influence and ECP use. To better understand the reasons for the seemingly underuse of ECP, a grounded theory study was conducted to elucidate the relationship of couple dynamics and knowledge of, attitudes toward, and decision making regarding the use of ECP in coupled young adults. Consistent with contemporary constructivist grounded theory methods, several categories were identified including the meanings associated with ECP use. This article presents an elaboration of this particular finding. The meanings that participants ascribed to ECP use represented a continuum of value attributes regarding ethics, safety, efficacy, and responsibility.

Satisfaction and discontinuation of contraception by contraceptive method among university women

This study examined the association between contraceptive method and satisfaction and discontinuation. Few studies have examined these issues in the university setting and how they may potentially impact unintended pregnancy rates. This study examined data from 172 college women aged 18-36 years enrolled in the Study on Contraceptive Knowledge in Students, a cross-sectional study conducted at a large, public university. Logistic regression was used to model the association between current type of contraceptive method used (non-coital dependent vs. coital dependent) and satisfaction as well as previous type of contraceptive method used and discontinuation of that method. Nearly 80% of contracepting women currently used a non-coital dependent method. After adjustment for age, race, and location where contraception was obtained, current non-coital dependent users were significantly more likely to be satisfied with their contraceptive method compared to women using coital dependent methods (OR = 4.73, 95% CI: 1.64, 13.63). After adjustment for age, race, and history of pregnancy, women who used non-coital dependent methods of contraception were 91% less likely to have discontinued their method compared to women who used coital dependent methods (OR = 0.09, 95% CI: 0.04, 0.20). Healthcare workers and public health professionals can counsel women on using contraceptive methods that best suit their needs. By doing so, patient satisfaction and consistent contraceptive use may improve and lead to a decrease in unintended pregnancies.

Provision of emergency contraception at student health centers in California community colleges

BACKGROUND

Approximately half of all pregnancies in the United States are unintended, with the highest rates reported among college-age women. The availability of emergency contraception (EC) pills can be an important component of efforts to reduce unintended pregnancy. Student health centers at community colleges can uniquely support student retention and academic achievement among college students by making EC available to reduce the rate of unintended pregnancy and prevent college drop-out. This article highlights findings from an assessment of EC provision in student health centers within the California community college system (n = 73).

METHODS

A web-based survey was used to explore the provision of EC, challenges and barriers of EC administration, promotion of EC availability, and attitudes toward EC.

FINDINGS

Descriptive statistics conducted revealed that more than 6 out of 10 (62%) student health centers provided EC, 77% of which dispense EC on site during clinic visits. The most common EC promotion methods were providing brochures at the health center (80%) and through information provided at family planning or primary care visits (73%). Challenges to EC administration included a perceived lack of awareness of EC among students (71%), followed by the notion that some students may overutilize EC (40%). Attitudes toward EC provision were more favorable among health center staff whose campuses offered EC than those who did not (p < .05).

CONCLUSION

This article provides recommendations for community college health centers to improve access and delivery of EC by addressing issues such as cost and offering more novel EC promotion methods.

Emergency contraceptive pill (ECP) use and experiences at college health centers in the mid-Atlantic United States: changes since ECP went over-the-counter

OBJECTIVE

To investigate the availability of emergency contraceptive pills (ECPs) at college health centers since ECP went over-the-counter (OTC) in 2006. Related issues, such as distribution procedure, existence of a written protocol, personnel involved, contraindications, follow-up procedures, methods of advertising, and staff attitudes, were examined.

PARTICIPANTS

The sample included 135 college and university health centers in the mid-Atlantic region of the United States.

METHODS

Data were collected via telephone survey with the use of a 42-item survey instrument.

RESULTS

Forty-three percent of schools reported distributing ECPs, for an average of 10.6 years. Major changes in ECP distribution and usage since ECP went OTC related primarily to protocol in ECP distribution, advertising for ECP services, and ECP accessibility to university students.

CONCLUSIONS

College health centers are responding to the OTC status of ECP in a number of ways, primarily relating to their distribution procedures and advertising techniques.

Diferenças regionais de conhecimento, opinião e uso de contraceptivo de emergência entre universitários brasileiros de cursos da área de saúde

O objetivo deste estudo foi avaliar as diferenças regionais de conhecimento, opinião e uso de anticoncepção de emergência entre universitários brasileiros. Questionário semi-estruturado abordando conhecimento, opinião, experiência com anticoncepção de emergência e comportamento sexual foi aplicado a adolescentes de universidades brasileiras. Para análise estatística utilizou-se o teste exato de Fisher e ANOVA. Diferenças foram significantes quando o valor de p < 0,05. Cerca de 96% (n = 588) dos estudantes já tinham ouvido falar sobre anticoncepção de emergência, 19% (n = 111) conheciam as situações nas quais está indicada, com diferenças inter-regionais; 42% das meninas que tinham vida sexual ativa já tinham feito uso do método; 35% (n = 207) dos estudantes consideravam contracepção de emergência abortiva e 81% (n = 473) achavam que traz riscos à saúde, sem diferença significativa entre as regiões nas questões relativas a uso e à opinião. As diferenças inter-regionais sobre conhecimento não impactaram no uso e na opinião dos adolescentes sobre anticoncepção de emergência. Programas nacionais devem ser conduzidos para melhorar o conhecimento sobre o método.

Emergency contraception - knowledge and attitudes in a group of Australian university students

OBJECTIVE

To explore first year Australian university students' knowledge and attitudes about emergency contraception and their understanding of the risk for pregnancy.

METHOD

A self-report questionnaire was completed by a convenience sample of 627 first year on-campus students from both health and non-health disciplines.

RESULTS

Knowledge about emergency contraception (EC) was generally poor including misunderstanding that it can only be used the 'morning after', as well as where it may be accessed. Its potential use was, however, more highly accepted as a preventative measure after unprotected sexual intercourse than abortion in the event of unplanned pregnancy. Women had better knowledge than men, and on a number of measures there were significant differences between these groups.

CONCLUSIONS

Poor knowledge about the timing, accessibility, action and side effects of EC may act as a barrier to its use in the event of unprotected sexual intercourse. Although EC has been available in Australia as a Schedule 3 medication since 2004, its availability from pharmacies is not well known, nor is access from other primary health care providers.

IMPLICATIONS

The lack of knowledge about EC may lead to its underutilisation and underlines the need for future educational strategies about EC as well as the need for health professionals who provide contraceptive services to discuss EC with clients. Health promotion campaigns which are both general as well as gender-specific may improve overall community knowledge about this method of contraception.

College students' perceptions of emergency contraception provision

BACKGROUND AND OBJECTIVE

The authors examined college students' perceptions regarding emergency contraception (EC) provision in light of the then pending U.S. Food and Drug Administration (FDA) decision about the over-the-counter (OTC) status of EC.

METHODS

We randomly sampled 7000 male and female students who were enrolled full-time at the University of Michigan during the winter 2006 semester. A total of 1585 (22.6%) students responded to our web-based survey and were included in these descriptive analyses.

RESULTS

Nearly all (94%) respondents knew of EC. When asked whether EC should be made available OTC, 60% of respondents agreed, 23% disagreed, and 17% were unsure. If EC were to be made available OTC, 34% of respondents indicated that they (or their partner) would purchase EC in advance of need, and 44% stated that they would purchase it only after unprotected sexual intercourse or contraceptive failure. Advance discussion and provision of EC is underused. Only 10% of all female respondents indicated that their current healthcare provider had spoken to them about EC in a routine health visit, and just 5% of female respondents were offered a supply of EC in advance of need.

CONCLUSIONS

Continued efforts are needed to ensure timely access to EC in this population.

Counseling about and use of emergency contraception in the United States

CONTEXT

Few nationally representative studies have examined the prevalence and predictors of emergency contraception use or of receipt of counseling about the method. The impact of the U.S. Food and Drug Administration's 2006 approval of behind-the-counter sales of the method to women aged 18 and older remains to be seen; therefore, understanding patterns of use and counseling before the 2006 policy change is necessary to assess its impact.

METHODS

Data collected from 7,643 women aged 15-44 participating in the 2002 National Survey of Family Growth were analyzed using multivariable logistic regression to assess predictors of receipt of counseling and use of emergency contraception.

RESULTS

Overall, 3% of women reported that a clinician had discussed emergency contraception with them in the past year, and 4% of those who had ever had sex with a man reported having used the method. Only 4% of those who had seen a gynecologist in the past year reported having received counseling. Women's likelihood of having received counseling was reduced if they were 30 or older (odds ratio, 0.2), and was elevated if they were Hispanic (4.1), black (2.6) or ever-married (2.4). Receipt of counseling in the last 12 months was the strongest predictor of ever-use (11.7).

CONCLUSIONS

Clinicians can play a pivotal role in ensuring that women have accurate information about how to access and use emergency contraception. However, efforts are needed to explore other ways to deliver this counseling.

Unintended childbearing and knowledge of emergency contraception in a population-based survey of postpartum women

OBJECTIVES

We examined the relationship between unintended childbearing and knowledge of emergency contraception.

METHODS

The Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) is a population-based survey of postpartum women. We analyzed data from the 2001 PRAMS survey using logistic regression to assess the relationship between unintended childbearing and emergency contraception while controlling for maternal characteristics such as age, race/ethnicity, education, marital status, family income, and insurance coverage before pregnancy.

RESULTS

In 2001, 1,795 women completed the PRAMS survey (78.1% weighted response proportion). Of the women who completed the survey, 38.2% reported that their birth was unintended and 25.3% reported that they did not know about emergency contraception before pregnancy. Unintended childbearing was associated with a lack of knowledge of emergency contraception (OR 1.43, 95% CI 1.00, 2.05) after controlling for marital status and age.

CONCLUSIONS

Women in Oregon who were not aware of emergency contraception before pregnancy were more likely to have had an unintended birth when their marital status and age were taken into account. Unintended birth was more likely among women who were young, unmarried, lower income, and uninsured. Given that emergency contraception is now available over-the-counter in the US to women who are 18 years of age or older, age- and culturally-appropriate public health messages should be developed to expand women's awareness of, dispel myths around, and encourage appropriate use of emergency contraception as a tool to help prevent unintended pregnancy and birth.