Emergency contraception: Who are the users?

Emergency contraception in university students: prevalence of use and knowledge gaps

OBJECTIVE

Investigate prevalence of use and knowledge about emergency contraception (EC) among female university students from two higher education institutions.

METHODS

Cross-sectional study with 1,740 undergraduates in the city of Santa Maria (RS), from May to October 2017. Information was collected in a semi-structured and self-administered 24-question questionnaire. The investigated variables were grouped into sociodemographic characteristics, sexual behavior, and knowledge of EC. Logistic regression was used for univariate and multivariate analysis, considering variables that presented p < 0.05. The model was adjusted using the Hosmer-Lemeshow test.

RESULTS

The prevalence of EC use among undergraduates was 52.9%. However, only 11.9% of respondents received guidance on EC, especially on how to use it. Only 0.2% of the participants marked 120 hours as the maximum time of use, and 25.7% considered the EC to be abortive. EC use was associated with the age of first sexual intercourse.

CONCLUSION

EC use had a high prevalence among female university students, however, several gaps in method knowledge still exists and it demonstrates the importance of discussing this issue earlier and planning actions of an informative nature.

Emergency Oral Contraceptive Consultations in Pharmacies in a Rural Setting: An Epidemiological Analysis

BACKGROUND

Emergency contraception has been available in pharmacies across England since 2001.There is a paucity of evidence describing those women accessing the service, particularly in rural locations, where pharmacies are integral to improving healthcare accessibility.

METHODS

Routinely collected data from all pharmacy consultations for emergency contraception in Shropshire, England, were obtained and anonymized for the study period April 1, 2016 to January 31, 2019. Consultations were described by time, age of consultee, rationale for consultation, method dispensed (levonorgestrel or ulipristal acetate), referral for copper intrauterine device fitting, chlamydia screening where appropriate and reason for choosing pharmacy setting. Repeat attenders were also described separately.

RESULTS

3499 consultations occurred during the study period; 39% were aged between 16-20 years, and 52% attended following unprotected sexual intercourse. Levonorgestrel was initially most prescribed, however ulipristal acetate overtook it in 2018. Onward referral for copper intrauterine device and age-appropriate chlamydia screening took place in 3% and 4% of the eligible populations respectively. Women overwhelmingly chose the pharmacy setting owing to its convenience. Repeat attenders tended to be younger than single attenders, but otherwise similar.

CONCLUSION

Pharmacy-based emergency contraception is an important and well-utilized service in this rural location and continued funding and possible service expansion should be considered.

Bridge over troubled waters: considerations in transitioning emergency contraceptive users to hormonal methods

BACKGROUND

As emergency contraceptive pills (ECPs) become increasingly available through pharmacies, concerns about potential overuse of this product have emerged. In response, bridging women from ECPs to ongoing contraception was advanced as a solution.

STUDY DESIGN

We collected information in Ghanaian pharmacies on ECP users' sexual activity, use of contraceptive methods and reasons for buying ECPs. Further, two behavioral indicators were examined to determine whether a woman should consider using an ongoing contraceptive method: how often she has sex and how she uses ECPs.

RESULTS

Of the four types of ECP users, stratified by those two indicators, only women who have sex frequently and use ECPs as their main contraceptive method would be appropriate for, but not necessarily amenable to, bridging.

CONCLUSIONS

The challenges of bridging to meet the contraceptive needs of women are discussed in light of the characteristics of emergency contraceptive users and suggest that bridging is not as straightforward as initially conceived.

Can private pharmacy providers offer comprehensive reproductive health services to users of emergency contraceptives? Evidence from Nairobi, Kenya

OBJECTIVE

To evaluate the provision of reproductive health information and services to users of emergency contraceptives (ECs) by private pharmacists.

METHODS

The study involved intervention (9) and control (8) pharmacies, with baseline and endline assessments of EC provision through the use of mystery clients. Intervention pharmacies received weekly updates on EC, fliers with three key messages on EC, and information, education, and communication materials. Logistic regression models are estimated to predict the provision of reproductive health services to EC clients.

RESULTS

The differences between the control and intervention pharmacies with respect to the provision of additional information on EC and regular family planning services are in the expected direction but statistically insignificant. In contrast, the likelihood of providing information or referral for counseling or testing for sexually transmitted infections or HIV was lower in the intervention than in the control pharmacies but the difference was also not statistically significant.

CONCLUSION

Pharmacy providers in the country face institutional challenges in providing reproductive health services to EC clients.

PRACTICE IMPLICATIONS

The challenges could be addressed through pre-service training, targeted in-service training, sensitization of clients, and point-of-sale materials such as brochures, posters and package inserts.

Adolescent and young adult women's use of emergency contraception

STUDY OBJECTIVE

To determine differences in the use of emergency contraception (EC) between adolescent (11-17 years old) and young adult women (18-24 years old) in an insured, population based cohort.

DESIGN AND PARTICIPANTS

Females 11-24 years old were divided into two groups: adolescents (11-17) and young adults (18-24) at their first captured EC prescription fill. A medical record review followed.

MAIN OUTCOME MEASURES

The main outcomes of our study were reason for EC use, timing of EC use, and repeat use. Chi-square tests were used to compare dichotomous variables between groups by age and for ever vs repeat use. An independent t-test was used to compare continuous variables. A person-time analysis was used to compare rates of repeat use.

RESULTS

344 women were identified as having filled at least one prescription for an EC drug. Among ever users, adolescents were more likely than young adults to cite no contraception as their reason for seeking EC (30% for 11-17 and 24% for 18-24 year olds; P = 0.38). For both ever and repeat users, young adults reported condom failure as their main reason for seeking EC. We calculated t-tests on the hours since unprotected sex. For adolescents the mean was 42 hours and for young adults the mean was 34 hours (P = 0.13). Both are within the recommended 72-hour window for administration and were not significantly different. The rate of repeat use was essentially the same for both age groups.

CONCLUSIONS

We found that adolescent use of EC was similar to young adult use and support the recommendation that 17-year-olds have behind-the-counter access to EC.

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

OBJECTIVE

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

STUDY DESIGN

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

RESULTS

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

CONCLUSION

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

Práticas contraceptivas entre jovens universitárias: o uso da anticoncepção de emergência

Com o objetivo de caracterizar o comportamento contraceptivo, especialmente o uso da anticoncepção de emergência, entre mulheres jovens de alta escolaridade, foi enviado por e-mail um questionário estruturado a todas as graduandas de um curso de enfermagem de uma universidade pública na cidade de São Paulo, no mês de junho de 2006. Do total de 300 alunas que foram convidadas a participar do estudo, 196 responderam ao questionário. Quase metade das entrevistadas com vida sexual já havia utilizado a anticoncepção de emergência (44,9%), basicamente adquirida em farmácias e por iniciativa própria, devido a falhas no método usual ou esquecimento, além da insegurança em relação à eficácia do anticonceptivo utilizado. Por meio de análise de regressão logística múltipla, verificou-se que o uso da anticoncepção de emergência foi associado a ter tido dois ou mais parceiros sexuais, a conhecer alguém que já tinha utilizado-a e a já ter deixado de usar o preservativo masculino em alguma relação sexual.

Characteristics of women who seek emergency contraception and family planning services

OBJECTIVE

The purpose of this study was to compare the demographic characteristics and sexual risk behaviors of women who seek emergency contraception (EC) and general family planning (FP) services.

STUDY DESIGN

This cross-sectional study included 227 women aged 17-43 years who were being evaluated for either EC or FP in an outpatient setting from 2003-2004. Descriptive statistics and odds ratios were included.

RESULTS

The EC group, compared with the FP group, had higher proportions of women with education beyond high school (62% vs 52%; P = .02), and not married (79% vs 42%; P < .01). The groups also differed by age, race, and income. The EC group was more likely to have been unprotected at their last intercourse (odds ratio, 5.56; 95% CI, 2.22, 14.29) and less likely to have a previous sexually transmitted infection (odds ratio, 0.41; 95% CI, 0.17, 0.96).

CONCLUSION

The development of EC education programs for women is important for increasing awareness for diverse groups of women and their healthcare providers.

Is the faculty of family planning and reproductive health care guidance on emergency contraception being followed in general practice? An audit in the West Midlands, UK

BACKGROUND AND METHODOLOGY

In 2003, the Faculty of Family Planning and Reproductive Health Care (FFPRHC) of the Royal College of Obstetricians and Gynaecologists published guidance on emergency contraception (EC). A literature search revealed no published work describing doctors' actions when prescribing EC. In order to assess the extent to which the FFPRHC Guidance is being followed in general practice, an audit of the medical notes of women requesting EC between January 2003 and December 2004 in six general practice surgeries located in the West Midlands, UK was conducted. From the medical notes, discussions between health care professionals and patients requesting EC regarding ongoing contraceptive needs, the risk of sexually transmitted infections (STIs) and the availability of the emergency intrauterine device (IUD) were recorded.

RESULTS

A total of 718 emergency contraceptive pill consultations were analysed. The median age for presentation was 24 years. The 20-24 years age group accounted for the most consultations (30.9%). In 40% of consultations there was no evidence of future contraceptive needs having been discussed. Only 20 (2.8%) consultation notes contained evidence that STIs had been discussed. Chlamydia tests were undertaken in only 15/718 (1.7%) consultations. In only 10 (1.4%) of the consultations was the IUD discussed with the patient as an alternative form of EC.

DISCUSSION AND CONCLUSIONS

This audit suggests that the FFPRHC Guidance on EC is not being followed in general practice, and therefore patients requesting EC may not be receiving the highest standard of care.

Emergency contraception among Finnish adolescents: awareness, use and the effect of non-prescription status

BACKGROUND

Adolescents need to be aware that there is a method of preventing pregnancy even after an unprotected intercourse. Limited information is available on the awareness of young adolescents and the effects of selling emergency contraception (EC) over-the-counter, and the findings are controversial. The aims of this study were to investigate awareness and use of EC among Finnish girls aged 12-18 years in 1999-2003, and to assess the effect of the 2002 non-prescription status on the use.

METHODS

A self-administered questionnaire was sent to a population-based sample of 12-18-year-olds girls in 1999, 2001, and 2003. Response rate was 83% in 1999 (N = 4,369), 79% in 2001 (N = 4,024) and 77% in 2003 (N = 3,728), altogether N = 12,121. Logistic regression model was used to examine the association of unawareness and use of EC with socio-economic background and health behaviour.

RESULTS

In 2001, nearly all 14-18-year-olds and a majority of 12-year-olds were aware of EC. Among 12-14-year-olds, a slight increase in awareness between 1999 and 2003 was observed but this was not related to non-prescription status. Health-compromising behavior (alcohol use, smoking), dating and having good school achievement were related to higher awareness of EC.Nine percent of 14-18-year-olds had used EC once and 1% three times or more. No statistically significant change in EC use was found after non-prescription status. EC use increased with increasing alcohol consumption, particularly at age 14. Smoking, dating, and poor school achievement were related to increased use as well as not living in nuclear family. A lower use was observed if living in rural area or father's education was high. Mother's education was not related to use.

CONCLUSION

Adolescent girls were well aware of the existence of emergency contraception even before the non-prescription status. Over-the-counter selling did not increase the use.

The profile of emergency contraception users in a chlamydia prevalence study in primary care in Belgium

INTRODUCTION

We describe the use of emergency contraception (EC) and its association with sociodemographic, contraceptive and behavioural characteristics in a sample of family practice attendants in Belgium.

METHODS

The study was part of a large Chlamydia trachomatis (CT) prevalence study in general practice. Sexually active women under 40 who consulted their general practitioner for routine gynaecological care were enrolled in the study. Participants completed a questionnaire on sociodemographic variables, urogenital symptoms, sexual history and sexual behaviour, and delivered a sample for CT testing. Logistic regression analysis was performed to identify determinants of a history of EC use in women in this sample.

RESULTS

Of 815 questioned women, 23.5% had ever used EC. EC users were a heterogeneous group with respect to educational level, age and ethnicity. The use of emergency contraception was associated with the level of urbanisation, condom use, not having children yet, young age of first sexual intercourse, having had multiple partners in the past year, a history of unintended pregnancy, and current or previous STI.

DISCUSSION

Information on availability and correct use of EC, and on the need for additional testing for STI, are necessary to help primary care attendees to preserve their future reproductive health.

[Emergency contraception: user's profile in primary care emergency services]

OBJECTIVES

To establish the emergency contraception (EC) users profile and whether she perceives this type of contraception as an emergency. Design. Cross sectorial study (over one year period: March 2002-March 2003).

SETTING

Emergency Services in Primary Care. Usera and Carabanchel; 11th Area; Madrid.

PARTICIPANTS

Women requesting EC in these centres.

MAIN OUTCOME MEASURES

A questionary was filled out for all participants with their age, how many hours had spent since sexual intercourse took place (within 24 h), usual method of contraception used, previous use of EC, level of education, and reason for this request.

RESULTS

89 women. Drops out: 0. Average age: 23.7+/-48 years (range: 16-40 years). 79.8% of them came to medical emergency services in less than 24 h after sexual intercourse. Usual anticonceptive method was the condom (88.8%), 2.2% used hormones, 9% no contraceptive method at all and none of them had used the intrauterine device. 34.8% were previous users of EC. Education levels: 2.2% of women only could read and write, elementary school (37.1%), secondary school (34.8%) and high school (25.8%). Reasons for requesting EC: 91% condom failure, 7.9% not to have used any contraceptive method, and 1.1% wrong use of natural birth control methods. Among the women who had went to the emergency services within the 24 h of the sexual intercourse the 77.4% of all of them had requested EC previously and the 93% of those had requested EC for the first time (P=.032). Likewise all of them with high school level and who could write and read, the 93.9% with elementary school level, and the 71% with secondary studies went to the emergency services within the 24 h of the non protected sexual intercourse (P=.05).

CONCLUSIONS

Most of the women were young, they perceived the unprotected sexual intercourses as an emergency, the condom was the most frequently used anticonceptive method, they requested EC due to condom breakage. In 1/3 of the cases the EC had been requested previously and this group and the young women with secondary studies one were who requested it later.

Trends in the use of emergency contraception: An epidemiological study in Barcelona, Spain (1994–2002)

We conducted a retrospective review of the medical records of women requesting emergency contraception (EC) at our emergency department over a 9-year period (1994-2002). EC accounted for 5.9% of all visits (n = 95,288) and increased from 1.26% in 1994 to 9.82% in 2002 (p < 0.001). Reasons for EC were condom problems in 79.5% of cases. EC was used only once by 93% of women. The mean daily number of visits was significantly higher in August (2.46), July (2.01) and September (2.02) than in other months (p < 0.05), and was more frequent on Sunday (3.26), Saturday (2.92) and Monday (2.05) compared to other week days (p < 0.001). New Year's Day and the St. John's Night registered the highest number of visits (mean of 17.2 and 11.7, respectively), with significant differences compared to the remaining days of the year (p < 0.001).

As often as needed: appropriate use of emergency contraceptive pills

Previous research has established that emergency contraceptive pills are safe and have the potential to reduce unintended pregnancy; however, policy makers, providers and even women themselves have expressed concern about repeat use of the method. Evidence regarding the safety, efficacy and frequency of repeat use show that the method is safe and effective, even when used multiple times. Reported rates of repeat use are actually lower than would be expected, and needed, based on the frequency of unprotected intercourse and contraceptive failure reported in most countries. Healthcare providers should encourage use of emergency contraceptive pills as a backup after recognizable failure of barrier methods or other hormonal contraceptive methods, and should expect that women may need emergency contraceptive pills multiple times during their reproductive years.

Emergency contraception: who are the users?

The objective was to describe the demographic and sexual characteristics of clients attending a Sexual Health Clinic for emergency contraception (EC). Information about women attending the Parramatta Sexual Health Clinic (PSHC) who received EC between January 1999 and July 2002 was derived from the clinic database. Age-matched controls were randomly selected. Univariate and logistic regression analysis was performed to establish which factors were associated with use of EC. Two hundred and sixty-seven women requesting EC, and an equal number of controls, were studied. Factors that were independently associated with EC use were being a student, (OR=1.7 [95% CI 1.02-2.69]) and having a regular sexual partner (OR=2.3 [95% CI 1.14-4.73]). Women requiring EC were significantly less likely to have had a sexually transmitted infection (STI) (OR=0.3 [95% CI 0.16-0.60]) or a previous pregnancy (OR=0.2 [95% CI 0.09-0.67]) than controls. We concluded that users of EC are at low-risk for STIs, but need counselling about safer sex.

The benefits and risks of over-the-counter availability of levonorgestrel emergency contraception

Removing the prescription requirement for Plan B will help ensure that the product plays a larger role nationally in the reduction of unintended pregnancy and abortion-important public health goals. Over-the-counter (OTC) sale of Plan B should present no serious safety issues. OTC consumers are able to understand and follow the instructions for proper use of Plan B. Efficacy of the OTC product is likely to be the same as, or better than, the prescription product, given more timely access to treatment. Based on the results of a growing body of literature and foreign marketing experience, the risk of unintended health consequences also appears to be minimal. There is no evidence to suggest that American women will abuse Plan B as an OTC product.