Dispensing and practice use patterns, facilitators and barriers for uptake of ulipristal acetate emergency contraception in British Columbia: a mixed-methods study

BACKGROUND

Ulipristal acetate 30 mg became available as prescription-only emergency contraception in British Columbia, Canada, in September 2015, as an addition to over-the-counter levonorgestrel emergency contraception. In this study, we determined dispensing and practice use patterns for ulipristal acetate, as well as facilitators of and barriers to emergency contraception for physicians, pharmacists and patients in BC.

METHODS

In the quantitative component of this mixed-methods study, we examined ulipristal acetate use from September 2015 to December 2018 using a database that captures all outpatient prescription dispensations in BC (PharmaNet) and another capturing market sales numbers for all oral emergency contraception in BC (IQVIA). We analyzed the quantitative data descriptively. We conducted semistructured interviews from August to November 2019, exploring barriers and facilitators affecting the use of ulipristal acetate. We performed iterative qualitative data collection and thematic analysis guided by Michie's Theoretical Domains Framework.

RESULTS

Over the 3-year study period, 318 patients filled 368 prescriptions for ulipristal acetate. Use of this agent increased between 2015 and 2018. However, levonorgestrel use by sales (range 118 897-129 478 units/yr) was substantially higher than use of ulipristal acetate (range 128-389 units/yr). In the 39 interviews we conducted, from the perspectives of 12 patients, 12 community pharmacists, and 15 prescribers, we identified the following themes and respective theoretical domains as barriers to access: low awareness of ulipristal acetate (knowledge), beliefs and experiences related to shame and stigma (beliefs about consequences), and multiple health system barriers (reinforcement).

INTERPRETATION

Use of ulipristal acetate in BC was low compared with use of levonorgestrel emergency contraception; lack of knowledge, beliefs about consequences and health system barriers may be important impediments to expanding use of ulipristal acetate. These findings illuminate potential factors to explain low use of this agent and point to the need for additional strategies to support implementation.

"It's Worked Well for Me": Young Women's Reasons for Choosing Lower-Efficacy Contraceptive Methods

STUDY OBJECTIVE

To understand the diverse reasons why some young women choose contraceptive methods that are less effective at preventing pregnancy, including condoms, withdrawal, and emergency contraception pills, even when more effective contraceptive methods are made available to them.

DESIGN

In-depth interviews with young women at family planning clinics in July-November 2016. Interview data were thematically coded and analyzed using an iterative approach.

SETTING

Two youth-serving family planning clinics serving predominantly Latinx and African American communities in the San Francisco Bay Area, California.

PARTICIPANTS

Twenty-two young women ages 15-25 years who recently accessed emergency contraception to prevent pregnancy.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Young women's experiences using different methods of contraception, with specific attention to methods that are less effective at preventing pregnancy.

RESULTS

Young women reported having previously used a range of higher- and lower-efficacy contraceptive methods. In interviews, they described affirmative values that drive their decision to use lower-efficacy methods, including: a preference for flexibility and spontaneity over continual contraceptive use, an emphasis on protecting one's body, and satisfaction with the method's effectiveness at preventing pregnancy. Some young women described using a combination of lower-efficacy methods to reduce their pregnancy risk.

CONCLUSION

Young women make contraceptive decisions on the basis of preferences and values that include, but are not limited to, effectiveness at preventing pregnancy. These reasons are salient in their lives and need to be recognized as valid by sexual health care providers to ensure that young women receive ongoing high-quality care.

Men's knowledge, attitude, and barriers towards emergency contraception: A facility based cross-sectional study at King Saud University Medical City

Background

Male partners have a considerable role in influencing women’s contraceptive decision making to reduce the chance of unintended pregnancy. Most studies are focused on women’s knowledge and barriers for emergency contraception (EC) use. There is limited research on this topic from the male perspective. This study aimed to gather baseline data on men’s knowledge, attitudes and barriers about EC.

Methods

Descriptive analytic cross-sectional study was conducted from Dec 2019 –May 2020 at the King Khalid University Hospital (KKUH); a teaching facility with general and subspecialty medical services in King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Data were collected using a structured pretested questionnaire and analyzed using SPSS version 23.0. Descriptive statistics and Chi square tests were used. Multivariate logistic regression analysis was used to find significant predictors for EC awareness and use. A p value < 0.05 was considered statistically significant.

Results

A total of 461 participants completed the questionnaire (response rate 86%). The majority (82%) of the participants were unaware of EC; with only 18% having some knowledge. Knowledgeable men had positive attitudes (73.5%) about EC as compared to non- knowledgeable ones (55.0%). Factors found to be associated with less knowledge of EC were cultural [0.46, 95%CI 0.22. 0.96] and religious unacceptability [OR 0.51, 95%CI 0.29, 0.89)]. Higher level of education [OR 1.83, 95%CI 0.94, 3.53] was associated with more knowledge regarding EC. The study showed that correct information about using contraceptives within 3 days of unprotected sex [OR 4.96, 95%CI 1.81, 13.60]; availability without prescription [OR 5.06, 95%CI 1.68, 15.30], EC advertisement [OR 4.84, 95%CI 0.96, 24.27] and receipt of information from family/friends [OR 18.50, 95%CI 5.19, 65.93] were factors that contributed to men using EC.

Conclusion

The current knowledge of EC among men is limited. Social determinants affect these levels of knowledge, as well as the usage of EC. Factors that were associated with the use of ECPs were correct knowledge, advertisement, availability and receipt of information from family/friends. The findings highlight the need to educate men on this important topic to avoid unintended pregnancy, keeping in view cultural and social values. Future qualitative studies are needed to understand the male perspective.

Exploring young women's reasons for adopting intrauterine or oral emergency contraception in the United States: a qualitative study

BACKGROUND

The recent focus on increasing access to long-acting reversible contraceptive methods has often overlooked the diverse reasons why women may choose less effective methods even when significant access barriers have been removed. While the copper intrauterine device (IUD) is considered an acceptable alternative to emergency contraception pills (ECPs), it is unclear to what extent low rates of provision and use are due to patient preferences versus structural access barriers. This study explores factors that influence patients' choice between ECPs and the copper IUD as EC, including prior experiences with contraception and attitudes toward EC methods, in settings where both options are available at no cost.

METHODS

We telephone-interviewed 17 patients seeking EC from three San Francisco Bay Area youth-serving clinics that offered the IUD as EC and ECPs as standard practice, regarding their experiences choosing an EC method. We thematically coded all interview transcripts, then summarized the themes related to reasons for choosing ECPs or the IUD as EC.

RESULTS

Ten participants left their EC visit with ECPs and seven with the IUD as EC option. Women chose ECPs because they were familiar and easily accessible. Reasons for not adopting the copper IUD included having had prior negative experiences with the IUD, concerns about its side effects and the placement procedure, and lack of awareness about the copper IUD. Women who chose the IUD as EC did so primarily because of its long-term efficacy, invisibility, lack of hormones, longer window of post-coital utility, and a desire to not rely on ECPs. Women who chose the IUD as EC had not had prior negative experiences with the IUD, had already been interested in the IUD, and were ready and able to have it placed that day.

CONCLUSIONS

This study highlights that women have varied and well-considered reasons for choosing each EC method. Both ECPs and the copper IUD are important and acceptable EC options, each with their own features offering benefits to patients. Efforts to destigmatize repeated use of ECPs and validate women's choice of either EC method are needed to support women in their EC method decision-making.

The knowledge and perceptions of the first year medical students of an International University on family planning and emergency contraception in Nicosia (TRNC)

BACKGROUND

Informing the individuals on family planning including emergency contraception is a significant step for preventing unintended pregnancies. Although there is a number of studies on family planning and emergency contraception globally and in Turkey, no such data are available in the Turkish Republic of Northern Cyprus. The objective of this study was to evaluate the knowledge and perceptions on family planning and emergency contraception of the first year students of an international medical school in Nicosia, Northern Cyprus and to increase awareness for developing new policies on the issue.

METHODS

The data of this cross-sectional study were collected in February 2016 by a questionnaire of 36 questions. Of the 229 students, 189 (82.5%) completed the questionnaire. The data were evaluated by SPSS 18.0 statistical program. The differences of variables were evaluated by Chi square test, p < 0.05 being accepted as significant.

RESULTS

The distribution of participants from 23 countries according to nationality revealed three leading countries: Nigeria, Turkey and Syria. Of the students, 53.6% knew the definition of family planning. The sources of information were mainly school, the internet and media, with a total of 60.9% of the participants who stated having prior information on the subject. Awareness of contraceptive methods was indicated by more than 90% and emergency contraception by 66.1% of the participants. However, the students were unable to differentiate between modern and traditional family planning methods; 85.6% did not have knowledge of the most effective period for emergency contraception and 63.1%, of the definition of emergency contraceptive pills.

CONCLUSIONS

In conclusion, the knowledge and awareness level of the first year medical students on family planning and emergency contraception was insufficient. Family planning and emergency contraception education should be provided for the students at the first year of all faculties as well as medical schools and relevant programs should be included in the curricula of medical education.

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.

Italian Adolescents and Emergency Contraception: A Focus Group Study

STUDY OBJECTIVE

Using a qualitative method, the purpose of this study was to: (1) obtain information directly from the adolescents on their attitudes and knowledge regarding emergency contraception; and (2) investigate the presence of differences between male and female participants' attitudes and knowledge.

DESIGN AND PARTICIPANTS

This study consisted of 24 single-sex focus groups with 160 adolescents (male = 46.3% (74 of 160); female = 53.7% (86 of 160)) aged 15-19 years conducted among high schools in 3 regions of Italy.

RESULTS

Data were analyzed through thematic analysis taking into account gender differences and 2 main themes emerged. The first was labeled "Adolescents' attitudes toward emergency contraception" and it was divided into 3 subthemes: You should be aware; It's a life line; and Everything but a child. The second theme was labeled "Adolescents' knowledge toward emergency contraception" and it was divided into 3 subthemes: False myths; Baseline information; and Just take it.

CONCLUSION

Italian adolescents believed it is important to prevent the risk of unprotected sex by using contraceptive methods and their motivation to use emergency contraception is related to critical attitudes toward the consequences of irresponsible/ineffective contraception. Although adolescents have an awareness of emergency contraception, more comprehensive knowledge is needed. These findings can inform specific interventions aimed at educating adolescents in need of emergency contraception.

Sex differences in the awareness of emergency contraceptive pills associated with unmarried Korean university students' intention to use contraceptive methods: an online survey

BACKGROUND

Awareness of emergency contraceptive pills (ECP) associated with an intention to use other contraceptive methods has rarely been investigated. This study compared the ECP awareness of males and females and its associations with intention to use four other contraceptive methods (condoms, oral contraceptive pills, and withdrawal and rhythm methods) in unmarried university students in Korea. This study explores the importance of ECP awareness in university students' contraceptive education.

METHODS

A descriptive cross-sectional study design was employed, in which 1372 unmarried university students (men, n = 755, women, n = 617) answered a Web-based survey. Sex differences in ECP awareness and four contraceptive intentions, and associations between ECP awareness and contraceptive intentions between sex were analysed using independent t-tests and χ (2) test. Variables yielding significant associations with contraceptive intentions (p < 0.05) were included in a logistic regression using the adjusted odds ratio (AOR) to estimate the impact of ECP awareness on students' contraceptive intentions.

RESULTS

Awareness of ECP was found in 88.2 % of participants, which was generally positive. There were significant sex differences in some ECP awareness and students' contraceptive intentions, and in the associations between previous ECP use and ECP awareness between male and female university students. In men, the belief that "ECP can cause sex with multiple partners" was associated with intention to use the rhythm method (AOR = 1.61, 95 % confidence interval [CI] = 1.02-2.56). For women, the belief that "ECP is necessary in case of condom breakage" was associated with intention to use the withdrawal (AOR = 058, 95 % CI = 0.37-0.93) or rhythm (AOR = 0.36, 95 % CI = 0.16-0.84) methods, and "ECP should be prescribed by a doctor" was associated with the intention to use the rhythm method (AOR = 0.45, 95 % CI = 0.26-0.77).

CONCLUSIONS

ECP awareness was associated with the intentions of students to use withdrawal or rhythm methods. The sex-specific approach in the examination of students' contraceptive intentions and their determinants was helpful.

Knowledge, attitude, practice, and determinants emergency contraceptive use among women seeking abortion services in Dire Dawa, Ethiopia

Background

Unplanned pregnancy from casual sex, unplanned sexual activity, and sexual violence are increasing. Emergency Contraceptives (EC) are used to prevent unplanned pregnancies thereby preventing the occurrence and consequences of unplanned pregnancy. Emergency contraception is widely available in Ethiopia particularly in major cities. Yet the use of EC is very low and abortion rate in cities is high compared to the national average.

Objectives

To assess knowledge, attitude and practice and determinants on the use of emergency contraception among women obtaining abortion service at selected health institutions in Dire Dawa, Eastern Ethiopia.

Methods

A facility based cross-sectional study was conducted on 390 women selected by multi-stage random sampling technique. The samples were generated from government and private for non profit health facilities. Participant’s knowledge and attitude towards emergency contraception were measured using composite index based on 7 and 9 questions, respectively and analyzed using mean score to classify them as knowledgeable or not, and have positive attitude or not. Practice was assessed if the women reported ever use of emergency contraception. Determinants of use of emergency contraception were analyzed using logistic regression.

Result

Out of 390 women interviewed, 162 women (41.5%) heard about EC, only 133 (34.1%) had good knowledge, and 200 (51.3%) of the respondents had positive attitudes towards to EC. Ever use of EC was reported by 38 (9.7%). Age, living arrangement, education, marital status, religion were found to be significantly associated with the use of emergency contraceptives. Women with poor knowledge were less likely to use EC compared to the knowledgeable ones [AOR = 0.027, 95% CI (0.007, 0.105)].

Conclusion

The study identified that most respondents lack adequate knowledge on the method of EC. In addition ever use of EC is very low.

Recommendations

Health professions should give attention in increasing knowledge and uptake of Emergency Contraception.

[Prick of conscience in the pharmaceutical profession]

The work of the pharmacist in a pharmacy requires from him not only to solve professional and economic issues, but often the ethical ones as well. For a patients good it is necessary to choose a morally correct decision, but the fulfilment of any patients wish according to his or her own ideas of good is not a law for the health worker. The paper describes the situations when the pharmacist when fulfilling the requirement of the patient (often in the form of a medical prescription) may feel prick of conscience. A questionnaire survey has revealed that prick of conscience confronts more often those who are being trained for the profession than those who already practise it. The right for prick of conscience is considered unfounded by some pharmacists with practical experience, whereas undergraduates view it as a possibility of expressing ones own attitude. The paper analyzes the issues which in both categories of respondents are considered to be prick of conscience: oral hormonal contraception, including postcoital contraception, and preparations produced from the cells of aborted embryos.

Awareness and attitudes towards emergency contraceptive pills among young people in the entertainment places, Vientiane City, Lao PDR

BACKGROUND

Emergency Contraception is not officially available to the public sector in Laos. The potential of emergency contraception to prevent unwanted pregnancies is well documented in developed countries, but in Laos no studies of ECPs exist. This study aimed to assess knowledge of and attitudes towards emergency contraceptive pills (ECPs) in Vientiane, the capital city of the Lao PDR.

METHODS

A cross-sectional survey was conducted among 500 young adults in entertainment venues by using the convenience sampling between May to July, 2007. Data were obtained through face-to-face interview. Participants were asked about socio- demographic characteristics, knowledge, attitudes related to ECPs, and source of information about ECPs. Data analysis was performed with chi-square test and logistic regression (p < .05).

RESULTS

Only 22.4 percent of respondents had heard of ECPs and of these only 17.9 percent knew the correct time-frame for effective use. Most of the respondents (85%) agreed on the need for ECPs to be available in Laos and 66.8 percent stated that they would use them should the need arise, if they were available. Among those who said they would not use ECPs, 63.8 percent were concerned about possible health effects, or other side effects. Awareness of ECPs was associated with increasing age (OR = 2.78, p = .025) and male sex (OR = 2.91, p = .010).

CONCLUSIONS

There is needed to provide effective health education about the method, timing of use, and how to obtain ECPs through both informal, peer channels, and also through formal channels such as health care providers.

Use of emergency contraception among women aged 15-44: United States, 2006-2010

Emergency contraception can be used by women after sexual intercourse in an effort to prevent an unintended pregnancy. Roughly one-half of all pregnancies in the United States are unintended (1,2). The FDA first approved emergency contraceptive pills in 1998, but there is evidence of limited use of hormonal contraceptives for emergency contraception since the 1960s (3,4). Now, there are at least four brands of emergency contraceptive pills; most are available over the counter for women aged 17 and over (5). Although insertion of a copper intrauterine device can be used for emergency contraception (1,4), this report focuses only on emergency contraceptive pills. This report describes trends and variation in the use of emergency contraception and reasons for use among sexually experienced women aged 15-44 using the 2006-2010 National Survey of Family Growth.

Emergency contraception: knowledge, attitudes and practices among married Malay women staff at a public university in Malaysia

There is a high rate of unintended pregnancies in Malaysia due to low contraceptive use. Only 30% of married women use modern contraceptive methods. Emergency contraception (EC) is used within a few days of unprotected sex to prevent pregnancy. The purpose of this study was to investigate the knowledge, attitudes, and practices regarding EC pill use among Malay women. A cross sectional study was conducted among married female staff using stratified random sampling from 15 faculties in the Universiti Putra Malaysia (UPM). Data about sociodemographic factors, reproductive health, knowledge, attitudes and practices regarding EC use were gathered using validated self-administered questionnaire. The response rate was 87%. Half the 294 subjects who participated had a low knowledge, 33.0% a moderate knowledge and 17.0% a good knowledge about the EC pill. Eighty-eight percent of respondents had a positive attitude and 12.0% a negative attitude toward EC. Eleven percent of respondents had previously used EC. Unplanned and unwanted pregnancies were reported by 35.0% and 14.0% of respondents, respectively. Most respondents lacked knowledge about the indications for using EC, its mechanism of action, when it can be used and its side effects. Our findings show a need to educate women about EC.

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.

Changes in contraceptive choice after emergency contraception

OBJECTIVE

To determine whether women use emergency contraception (EC) repeatedly instead of regular contraception methods if they have access to EC.

METHODS

Data from the records of 9201 women who underwent EC 11014 times in the years 2006 through 2008 at Hong Kong clinics were retrospectively analyzed. The χ(2) test was used to look for associations between demographic characteristics and repeated EC use and the Wilcoxon signed rank test was used to compare the significance of changes in contraceptive use over time.

RESULTS

A total of 10845 courses of EC pills and 168 intrauterine devices were provided to the 9201 women, 89.4% of whom used EC once and 8.5% twice within a year. Using EC more than twice was only associated with unstable relationships. The percentages of women using no contraceptives during intercourse decreased from 20.6% at baseline to 4.7% four to 6 weeks after EC, 4.0% at 6 months, and 3.4% at 12 months. The percentages of women using highly effective methods of contraception increased from 3.5% to 20.8%, 27.3%, and 27.7% at the same time points.

CONCLUSION

The low rate of repeated EC use and the positive changes in contraceptive choice after EC are reassuring.

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.

A qualitative exploration of emergency contraception users' willingness to select the copper IUD

BACKGROUND

The copper T intrauterine device (IUD) is an effective but underutilized method of emergency contraception (EC). This study investigates the factors influencing a woman's decision around which method of EC to select.

STUDY DESIGN

In-depth interviews with 14 IUD and 14 oral EC users aged 18-30 years accessing public health clinics.

RESULTS

Emergency contraception users associated long-term methods of contraception with long-term sexual relationships. Women were not aware of the possibility of using the copper IUD for EC. Cost was identified as a major barrier to accessing IUDs. Perceived side effects and impact on future pregnancies further influenced the EC method a participant selected.

CONCLUSIONS

Women think about contraception in the context of each separate relationship and not as a long-term individual plan. Most women were unaware of the copper IUD for EC. Furthermore, there is little discussion between women and their health-care providers around EC.

A study of the use of Primolut N tablet as a contraceptive in the Kumasi metropolis of Ghana

This study investigated the use of Primolut N tablet which contains norethisterone 5mg popularly called N-tablet by users as a pre-coital contraceptive by women in the Kumasi metropolis of Ghana. Clients who called at any of the twenty (20) selected Pharmacies in residential areas within the Kumasi metropolis demanding the drug, with or without valid prescriptions were interviewed using a guide. Of the two hundred and twenty (220) users interviewed, 94% demanded the drug for contraception and 6% for menstrual disorders. Sixty one percent of those demanding it for contraception were between the ages 20-25 years. Respondents preferred the use of norethisterone tablets as a contraceptive to other methods because it worked for them and they also found it easy and convenient taking a tablet just before coitus than taking daily oral contraceptive pills. Norethisterone is being used as a pre-coital contraceptive, though the efficacy, safety and reliability of the drug for that purpose is unknown. Until these are known, women must be discouraged from using the drug.

Cultural adaptation among Hispanic women as related to awareness and acquisition of emergency contraception

BACKGROUND

The study was conducted to examine the relationship between cultural adaptation (acculturation), contraceptive use, personal history of induced abortion, and emergency contraceptive (EC) awareness and acquisition among a sample of young sexually active Hispanic women.

STUDY DESIGN

A total of 959 Hispanic women between 16 and 24 years of age (mean±SD 20.71±2.42 years) completed a survey containing questions on EC acquisition and awareness, acculturation, contraceptive used at last intercourse and history of induced abortion. Data were analyzed using logistic regression analyses.

RESULTS

Acculturation (p=.017), income (p=.024) and education (p<.001) were positively associated with awareness of EC. Additionally, acculturation (p=.003) and a history of an induced abortion (p=.026) were positively associated with acquisition of EC.

CONCLUSIONS

Educational programs should make an effort to include Hispanic women with lower acculturation levels as increasing their knowledge about EC use and its mechanism of action may greatly reduce the number of unplanned pregnancies in this population.

Democracy in the country but not in the home? Religion, politics and women's rights in Chile

This article explores the influence of religious actors on the elaboration of two public policies that are key to the advancement of women's rights and have long formed part of the women's movement's agenda in Chile: the introduction of sexual education in secondary schools in the 1990s and the distribution of emergency contraception in the 2000s. Our analysis of how different actors-from a variety of ideological and power positions-have influenced the two policy debates suggests that their discourses and strategies are highly contingent on the political environment. While conservative religious forces retain an enormous capacity to hinder policy making and implementation in the arena of family and sexuality, the government's determination to confront such interference seems to have grown in a context of fewer authoritarian enclaves, a more pluralist society and a strong sexual and reproductive rights movement. The diversification of religious positions on issues of family and sexuality has also affected the room for manoeuvre in the policy arena.

Politics, religion and gender equality in contemporary Mexico: women's sexuality and reproductive rights in a contested secular state

This article explores the complexities of the interaction between politics, religion and gender equality in contemporary Mexico, by analysing recent developments in public debate, legal changes and implementation of government policies in two areas: 1) the inclusion of emergency contraception in public health services in 2004; and 2) the decriminalisation of abortion in Mexico City in 2008, which was followed by a massive campaign to re-criminalise abortion in the federal states. Three main findings emerge from our analysis: first, that women's sexual and reproductive autonomy has become an issue of intense public debate that is being addressed by both state-public policy and society; second, that the gradual democratisation of the Mexican political system and society is forcing the Catholic Church to play by the rules of democracy; and third, that the character and nature of the Mexican (secular) state has become an arena of intense struggle within which traditional political boundaries and ideologies are being reconfigured.

Sexual behaviour and contraception in people under the age of 20 in Alicante, Spain

OBJECTIVE

To describe and to analyse the relationship between patterns of sexually-risky behaviour and emergency contraception among young females attending a Family Planning Centre (FPC).

METHODS

Data was obtained from a systematic analysis of 384 health records.

RESULTS

Mean age of the sample subjects was 18.24 years (SD 1.47, range 13-20). Of these, 92% were single, 60% students and 83% were with the same partner. Age at first intercourse was 16.5 years (SD 1.52, range 11-20). Those who used condoms systematically totalled 72%. Mean number of sexual partners was 1.85 (SD 2.91, range 1-50). A total of 9% had become pregnant and 2% had had an abortion. Emergency contraception was resorted to by 26% of the young women on at least one occasion. Emergency contraception was related to younger age at first sexual intercourse (p < 0.001) and to a great number of partners (p = 0.011). Of the total number of subjects, 48.4% demonstrated sexually-risky behaviour. This behaviour was related to alcohol consumption (p < 0.0001) and to the existence of dysfunction (p < 0.001).

CONCLUSIONS

Spanish youngsters have enough knowledge regarding contraception. Condoms are mostly used on the occasion of a first sexual intercourse. However, the frequency of sexually-risky behaviour is still high due to the limited use of condoms in successive sexual relations with the same partner. Sexually-risky behaviour is also related to a high number of partners and to alcohol consumption on weekends.

Pharmacy students' knowledge, attitudes, and behaviors regarding emergency contraception

OBJECTIVES

To determine pharmacy students' knowledge, attitudes, and behaviors regarding emergency contraception.

METHODS

A cross-sectional survey was conducted among a convenience sample of students prior to a regular class period. The 16-item survey instrument included both multiple-choice and true/false questions to assess knowledge and Likert-type scale questions regarding attitudes and behaviors. Frequency and descriptive statistics were calculated for all variables.

RESULTS

Three hundred one pharmacy students were surveyed. Eighty-seven percent knew that Plan B had been approved by the Food and Drug Administration (FDA) for nonprescription use, yet 33% believed that it worked by disrupting a newly implanted ovum. On a scale from 1-5 on which 5 = strongly agree, the mean item score was 1.5 for whether nonprescription emergency contraception should be available without counseling by a pharmacist, yet only 26.7% believed they were competent instructing patients on the use of emergency contraception.

CONCLUSIONS

Additional education is needed to prepare pharmacy students to provide informed pharmaceutical care to patients seeking emergency contraception, especially given the passage of legislation making the pharmacy the point of access for some emergency contraception products.

Who is using emergency contraception? Awareness and use of emergency contraception among California women and teens

INTRODUCTION

Emergency contraception (EC) reduces women's risk for pregnancy after unprotected intercourse, and women's awareness of the method is increasingly important for expanding access. However, knowledge of EC alone does not predict use, and few population data exist to describe EC use among those aware of the method.

METHODS

Using data from the 2003 California Health Interview Survey, we measured EC awareness among 11,392 women ages 15-44, and EC use among 7,178 respondents who were aware of EC and at risk for pregnancy. Using chi(2) analyses and multivariable logistic regression, we examined population characteristics that epidemiologically predict EC awareness and use, including age, race/ethnicity, income, health insurance status, usual source of health care, immigration status, languages spoken at home, and urban versus rural residence.

RESULTS

Nearly 76% of respondents had heard of EC, but awareness was lower among teens, women of color, poor women, women with publicly funded health insurance, those without a usual source of care, immigrants, non-English-language speakers, and rural residents. Among women aware of EC, about 4% reported having used the method in the previous year; young age, low income, attending a community/government clinic for care or not having a source of care, and living in an urban area significantly increased the odds for using EC.

CONCLUSIONS

Among California women in 2003, awareness and use of EC remained low. However, similar rates of use were reported among racial, ethnic, and linguistic subgroups. Those most likely to report use of the method included population groups at high risk for unintended pregnancy.

Barriers to emergency contraception (EC): does promoting EC increase risk for contacting sexually transmitted infections, HIV/AIDS?

OBJECTIVE

The aim of this study was to focus on barriers, controversy and perceived risk associated with use of emergency contraception (EC) after unprotected sexual intercourse.

DESIGN AND METHOD

Data were extracted from the literature of the MEDLINE database service. Original articles, surveys, clinical trials and investigations are considered for this review.

RESULTS

After the introduction of over-the-counter and advance prescription provisions for easy access to EC, the rural-urban disparity in availability of EC poses a barrier to use of EC for rural dwellers. The socio-economically weaker section of the population is unable to purchase EC because of low or no income, although there is mounting pressure by the State for prevention of unintended pregnancy by use of EC. Some healthcare providers have objected to provide EC to the patient on the grounds of their conscience and morality. Some providers and users have also expressed concerns about the possibility of increase in irresponsible sexual behaviour because of easy access to EC. There may be some truth in their apprehension because nearly 3.2 million unintended pregnancies occur annually despite various contraceptive options available in USA and the extensive use of EC is directly proportional to the volume of unprotected sexual intercourse, which is too directly proportional to the quantum of risk for contacting sexually transmitted infections (STIs)/AIDS.

CONCLUSIONS

Emergency contraception is a one-off postcoital procedure and not to be opted after every sexual intercourse. Controversy about EC may be resolved if it is used within this limit. Extensive use of EC may increase risk for contacting STIs/AIDS.

How does a Belgian health care provider deal with a request for emergency contraception?

OBJECTIVE

To evaluate how Belgian health care providers deal with a request for emergency contraception.

METHOD

In 2002-2003 we conducted 12 focus groups with pharmacists, general practitioners and school physicians. A skilled moderator accompanied by an observer conducted the focus groups using a semi-structured screenplay.

RESULTS

All these health care providers agree with the free access to emergency contraception (EC), but experience considerable frustration with regard to the practical aspects and the legal framework. General practitioners (GPs) claim to spend a lot of time on requests for EC and they are concerned about the quality of the counselling provided in pharmacies. Pharmacists are creative when giving counselling in the pharmacy, but there is, nevertheless, a problem with a lack of privacy. School physicians are frustrated that there is no legal possibility to respond to a request for EC when they feel they are ideally placed to advise adolescents.

CONCLUSION

The over-the-counter sale of EC offers women better access, but many barriers still interfere with optimal care. Pharmacists experience a lack of skills to communicate with adolescents and a lack of privacy to give counselling. GPs have good intentions, but are confronted with a lack of willingness on the part of the patients and also financial barriers. School physicians want more possibilities to help adolescents.

Awareness of emergency contraception: a follow-up report

BACKGROUND AND METHODOLOGY

This study aimed to ascertain whether recent campaigns aimed at increasing awareness and use of progestogen-only emergency contraception (POEC) have been effective, by comparing the understanding and awareness of POEC in those attending the termination of pregnancy (TOP) clinic in 2006 to an earlier cohort studied in 2003. Questionnaires were handed to all women attending the TOP clinic during a 4-week period in September/October 2006. Questionnaires were collected before women left the clinic.

RESULTS

All women (n = 77) attending the clinic received questionnaires; 72 were returned. Most (96%) of the women were familiar with POEC, compared with 78% of the 2003 cohort. 79% of the women felt confident about the ease of availability of POEC compared to 60% in 2003. More (51%) had used POEC in the past compared with 37% of the 2003 group. Only 46% knew the correct time limit for effectiveness of POEC compared to 59% in 2003. Time limit awareness was lower among the 16-20-year-old age group compared to the 21-25-year-old group. Most respondents (89%) said that they would consider using POEC in the future.

DISCUSSION AND CONCLUSIONS

Awareness and use of POEC have improved since 2003 but accurate knowledge has not. There is confusion regarding the correct time limit for effectiveness of POEC, especially amongst the 16-20-year-old age group. Public awareness campaigns appear to have been effective in increasing awareness and availability of POEC in Fife, Scotland. More emphasis is needed on the appropriate and effective use of POEC, especially targeted to the 16-20-year-old age group.

[Knowledge and attitudes about using emergency contraceptives among young college students]

OBJECTIVE

to identify the knowledge and attitudes regarding the use of emergency contraceptives (the day-after pill) with a gender viewpoint, among young college students affiliated to Instituto Mexicano del Seguro Social.

METHOD

a cross-sectional survey was applied to 583 freshmen college students at the Health Sciences University Center of the University of Guadalajara. The quantitative probe included: knowledge about emergency contraceptives (EC) and attitudes concerning the use of EC. The qualitative probe included reasons for taking or not taking EC.

RESULTS

95 % of the population had heard about EC, and 80 % considered it as a useful contraceptive method. The knowledge about the correct use of EC as well as its acceptance was greater in men than in women. Women proved to be more reflexive when mentioning a number of reasons to justify the need for further information about EC. The reasons not to take EC were linked to moral criteria aspects. Men were more knowledgeable and more prone to using it.

CONCLUSIONS

the knowledge and attitudes concerning the use of EC were different among men and women. Almost all had heard about EC, half of them knew how to use it correctly and 25% showed unfavorable attitudes about taking it due to ethical and moral concerns.

Physicians' intention to educate about emergency contraception

BACKGROUND AND OBJECTIVES

Our objective was to examine the intention of academic primary care physicians to educate women about emergency contraception (EC) and whether differences in their intention varies with patient situation, knowledge and attitudes about EC, gender, or specialty.

METHODS

As part of a larger cross-sectional survey about intention to prescribe EC with 96 faculty physicians from one Southern and three Midwestern universities, we analyzed factors associated with intention to educate patients about EC. Physicians were from departments of family medicine, obstetrics-gynecology, and pediatrics.

RESULTS

The main outcome variable was intention to educate about EC. Attitudes and perceived peer expectations on educating about EC predicted physicians' intentions to provide EC education to their patients. Neither knowledge about EC nor physician demographics predicted intention to educate. Almost one in five respondents were reluctant to provide education to sexually active adolescents. Physicians who had high intention to educate were more likely than others to believe that educating about EC enhances a woman's reproductive options and that EC education reduces unintended pregnancy and abortion. Providers with low intention to educate were more likely to consider EC education to be inconvenient and to take too much clinic time.

CONCLUSIONS

To maximize training programs, physicians' attitudes, beliefs, and professional expectations should be examined when designing and initiating educational interventions.

[Postcoital contraception or abortion? A longitudinal study of young women]

BACKGROUND

The use of postcoital contraception or emergency contraception has increased in many countries. This has been linked to an expected reduction in the abortion rates, but so far there is no evidence of such an association. A possible explanation could be that women who are in the risk zone for abortion typically do not use emergency contraception. The aim of study was to investigate possible differences between the two groups.

MATERIAL AND METHODS

768 Norwegian women (a representative sample) were followed up from they were 15 to 27 years. Data were collected through surveys on; emergency contraception and induced abortion, sociodemographic characteristics, family relationships, and individual aspects previously reported to be associated with an increased risk of induced abortion (education level, conduct problems and depression).

RESULTS

Women who use emergency prevention are recruited (more often than expected) from families with a high income (OR 2.0; 95 % CI 1.3 - 2.9), but otherwise have no characteristics that discriminate them from the rest of the population. Induced abortion was however associated with risk factors such as depression (OR 3.2; 95 % CI 1.7 - 6.0) and deviant peer groups (OR 2.5; 95 % CI 1.3 - 4.8), and they rarely have education at a university- or college level (OR 0.2; 95 % CI 0.1 - 0.7).

INTERPRETATION

Emergency contraception appears to be used by others than those with typical risk factors for abortion. One should consider targeted preventive interventions to increase the use of emergency contraception in groups at-risk for induced abortion.

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.

Knowledge of and perceived access to emergency contraception at two urgent care clinics in California

BACKGROUND

California allowed women access to emergency contraception (EC) without a physicians' prescription in 2002.

METHODS

To assess knowledge of and perceived access to EC among California women outside of family planning settings, we administered a computerized survey to women, age 18-45 years, who could become pregnant, in the waiting areas of two urgent care clinics in San Francisco in 2005.

RESULTS

Four hundred forty-six women were enrolled. Most women [87%; 95% confidence interval (95% CI), 83-89%] in this well-educated (48% had college degrees), ethnically diverse sample knew that a postcoital contraceptive exists. However, many women (32%; 95% CI, 28-37%) did not know EC is currently available in California. Only 49% of women knew that using EC will have no adverse effect on their future fertility and only 15% knew that EC will not cause a miscarriage or birth defects if used by a woman who is pregnant. Seven percent thought EC was not at all effective and 27% thought EC was somewhat or very unsafe. Eight percent had EC at home for future use.

CONCLUSIONS

Functional knowledge of EC remains limited in California. Public education campaigns are needed to allow women to benefit from pharmacy direct access to EC.

Variation in availability of emergency contraception in pharmacies

OBJECTIVE

The availability of emergency contraception (EC) depends on pharmacy stocking practices and pharmacist willingness to dispense the medication. We aimed to describe the availability of EC in areas governed by different state policies regarding pharmacist behavior.

STUDY DESIGN

A telephone survey was conducted between October 1 and December 31, 2005, of every pharmacy listed in the metropolitan areas of Atlanta, Philadelphia and Boston. We asked whether pharmacies could fill a prescription for EC within 24 h and, if not, why not.

RESULTS

We interviewed pharmacists at 1085 pharmacies (response rate of 75%). Overall, 23% were unable to fill a prescription for EC within 24 h. The rate of being unable to fill was 35% in Atlanta, 23% in Philadelphia and 4% in Boston (p<.001). Refusal rates were low: 4% overall; 8% in Atlanta; 3% in Philadelphia and 0% in Boston.

CONCLUSIONS

Variation in state policy predicted the availability of EC. The most common reason for not being able to fill a prescription within 24 h was not having the medication in stock.

The use of emergency contraception in young Polish women

BACKGROUND

The aim of this work was to assess the frequency of use of emergency contraception (EC) and the factors that influence young women in Poland to choose this method of contraception.

METHODS

The study included 1,154 randomly chosen young women of whom 843 were students of the four largest universities and 311 were pupils aged 18 and over of six randomly chosen secondary schools in the Gdansk region of Poland. A diagnostic review was made by means of a survey based on an anonymous self-administered questionnaire, that was handed directly to the respondents. The factors affecting EC choice were assessed. The characteristics of women who used EC and those who did not were described and compared.

RESULTS

The mean age of the respondents was 21.692.10. In a group of young sexually active women EC was used by only 14%, and among these the frequency with which it had been used varied from once to eight times. The students who most often turned to the EC were from institutions of higher education, came from large cities, and did not have a steady partner. Women in Poland have a general familiarity with the possibility of using EC, but there is insufficient exact knowledge of the way it works, as evidenced by the high proportion of women (68.3%) who regarded the EC as a means of early termination of pregnancy.

CONCLUSIONS

EC is not routinely employed in Poland. Thus there is a need for thorough and comprehensive sexual education which covers EC.

Emergency contraception in Honduras: knowledge, attitudes, and practice among urban family planning clients

Emergency contraception (EC) has the potential to improve women's reproductive health significantly. In Honduras, where nearly one-fourth of pregnancies are unplanned, the need for EC is substantial. To increase awareness of this option, nongovernmental organizations launched countrywide EC outreach activities in 2001-03. We conducted pre- and postintervention cross-sectional surveys among a total of 2,693 family planning clinic clients to assess EC knowledge, attitudes, and practice at baseline and at two years postintroduction. EC awareness increased over time, but remained at just 20 percent at follow-up. Respondents generally demonstrated a positive attitude and low rates of concern about EC. Awareness of and willingness to use EC were strongly associated with age, educational status, and city of residence. Public-sector acceptance of the method is essential to increase awareness of and access to EC. This study is intended to fill an information gap regarding EC in Latin America and the Caribbean and to be useful in determining educational messages and target audiences for future awareness campaigns in Honduras.

Women's contraceptive decision-making: juggling the needs of the sexual body and the fertile body

The contradictions faced by women in the area of fertility management justify an in-depth qualitative study of contraceptive use. The experience of needing emergency contraception (EC) is an opportunity to study decision-making about fertility management. Thirty-two in-depth interviews were conducted with users of EC recruited in Melbourne, Australia. Women were juggling the needs of the sexual body and the fertile body. The sexual body was expected to be available in women's relationships, and the fertile body required protection from pregnancy in the present and preservation for the future. The needs of these two bodies were very often in conflict and women chose to resolve this conflict in subtly different ways; three strategies were identified. Some women chose to make sexual availability and security from pregnancy a priority; others felt forced to sacrifice sexual availability and security from pregnancy; and a final group chose to make the protection of the fertile body for the future a priority. This study provides a starting point for developing a context- based, woman-centered understanding of the experience of fertility management for women in developed countries.

Turkish adolescents' knowledge on and attitude toward emergency contraception

OBJECTIVE

Adolescents tend to be at risk for unwanted pregnancies, so detecting their level of knowledge on emergency contraception and providing them information is important to prevent such pregnancies. Hence, in two faculties at Gazi University, this study aimed to detect freshman students' level and need of knowledge on emergency contraception and to evaluate their attitude towards emergency contraception.

MATERIALS AND METHODS

The study was performed with freshman students of the Occupational Education Faculty and the Technical Education Faculty. A questionnaire including questions about demographic properties, obstetrical history, status of contraceptive use, level of knowledge and opinions on emergency contraception was administered to the students. Data was analyzed statistically with the computer program EPI Info 6.0.

RESULTS

A total number of 385 adolescents were included in the studys; 157 of whom were males (40.8%) and 228 of whom were females (59.2%). To the question "is there any way to prevent a possible pregnancy after an unprotected sexual intercourse?", 166 students replied "yes" (50.5%), 39 "no" (11.9%) and 124 "I do not know" (37.7%). Of 166 students replying "yes," 114 (68.7%) listed a possible contraceptive method. The mostly cited method was "morning after pills" (n = 62; 54.4%), followed by curettage (n = 15; 13.2%). Among all students, 158 (49.8%) informed us that they were aware of the presence of "morning after pills" whereas 159 (50.2%) claimed they were not. Eighty-six male students (70.5%) and 115 female students (72%) emphasized that they would use emergency contraception upon necessity.

CONCLUSION

Half of the participants were familiar with various options to prevent pregnancy after an unprotected sexual intercourse episode, but they lacked specific knowledge about possible methods and ways to use them. Thus, it is essential that information about emergency contraception be included in adolescents' educational programs and that adolescents be provided with easily accessible medical services.

Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only

PURPOSE

This study measures the impact of the advance provision of emergency contraception (EC) among family planning clients at 31 clinics in California.

METHODS

We randomized over 9000 clients to receive a packet containing either two 0.75-mg levonorgestrel pills (Plan B) or an identical packet containing EC information only. We conducted follow-up interviews on a subset of 1130 clients selected to optimize the age and ethnicity distribution. The interviews collected information on EC use, contraception, risk-taking behaviors and EC attitudes.

RESULTS

Clients who received EC in advance were significantly more likely to have used EC (19%) than women who received information only (12%) (p=.0009). There were no significant differences between the contraceptive and risk-taking behavior of the two treatment groups. Study respondents of all ages and ethnicities expressed positive attitudes about EC. Nevertheless, even with EC on-hand, many respondents who reported unprotected intercourse decided not to take EC.

CONCLUSION

More research should be done on the reasons women decide not to use EC even when readily available.

Preventing and Terminating Unwanted Pregnancies in Turkey

PURPOSE

To determine the methods used to prevent pregnancy by women seeking abortion of unwanted pregnancy, their knowledge and use of emergency contraception, and reasons for wanting the abortion.

DESIGN

The sample was 144 randomly selected women, who requested abortion for termination of their pregnancies at two hospitals in Izmir, Turkey, during the study period.

METHODS

A questionnaire was completed by the researcher in face-to-face interviews.

FINDINGS

In this sample 43.8% had had previous abortions; 77.1% used some method of family planning; 7.0% used emergency contraceptives. The methods selected after unprotected sexual intercourse by these women included vaginal douche (37.5%), waiting to see whether the menstrual cycle would begin (27.0%), going to a hospital or maternal-child health center (24.3%), and two other alternatives (4.2%). One-fifth of the women said that, if they get pregnant again, they will have another abortion.

CONCLUSIONS

The number of unwanted pregnancies is high and many women seek abortions as a birth control method. Women in this sample needed information about effective methods for preventing pregnancy.

Awareness of and Attitude toward Hormonal Emergency Contraception among Married Women in Kuwait

OBJECTIVE

To describe the awareness of and attitudes toward hormonal emergency contraception among women in Kuwait.

METHODS

A cross-sectional survey was conducted among married women at obstetrics/gynecology outpatient clinics at the government Maternity Hospital in Kuwait. A pretested Arabic self-administered questionnaire was distributed to the women in March 2005. The questionnaire provided a short explanation as to what was meant by hormonal emergency contraception and then elicited whether the respondent was aware of it, what concerns she had, and whether she thought it should be made available in Kuwait.

RESULTS

One hundred three questionnaires were completed. Respondents were mostly Kuwaiti (78%) and non-Bedouin (78%) with postsecondary school education (74%) and a mean (SD) age of 33.1 (7.8) years and a mean (SD) number of children of 2.8 (1.9) About half of the women were not currently using contraceptive methods; 40% of contraceptive users were taking oral contraceptive pills. Bedouin women were more likely than non-Bedouins to use breastfeeding as a contraceptive measure (p = 0.012). Ten women (9.7%, 95% CI 4.8-17.1) reported having heard of hormonal emergency contraception, mostly from informal sources, 1 had used it, and 7 knew of other women who had used it. Only 8 (7.8%) respondents were willing to use or inform a friend about hormonal emergency contraception, but 89.3% thought it should be available in the health system.

CONCLUSIONS

Awareness of hormonal emergency contraception is low among women in Kuwait. Despite concerns and apparent negative attitudes, women believe it should be made available in the health system.

[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.

Changes in young women's awareness, attitudes, and perceived barriers to using emergency contraception

BACKGROUND

In a 1996 survey, most young women ages 13-20 years from an urban, hospital-based clinic and a drug treatment center had inadequate awareness of emergency contraception (EC), and perceived several barriers to its use. Since that time, the FDA has approved two products for EC, media coverage has increased, and physicians have provided more counseling about EC.

PURPOSE

The purpose of this study is to compare the awareness, attitudes, and perceived barriers to using EC among a sample of young women from 1996 with a different sample of women from 2002.

METHODS

We recruited 139 young women (mean age 16.7 +/- 1.8 yrs) from the same adolescent clinic and drug treatment center as the 1996 sample. They had similar demographic characteristics, with the majority (63%) being African-American or multi-ethnic; 85% had ever been sexually active. They were interviewed using a questionnaire about their sexual and contraceptive history as well as their knowledge of and experience with EC. They then watched a 4(1/2) minute video and received a 5-minute didactic review of EC. Following the educational intervention, participants' knowledge, attitudes, and perceived barriers to using EC were assessed. The questionnaire used to guide the interviews was nearly identical to that used in 1996.

RESULTS

Between 1996 and 2002, the percentage of participants reporting that they had ever heard of EC grew (44% vs. 73%, P < 0.001), as well as the percentage reporting that they had ever used EC (4% vs. 13%, P = 0.02). Of those participants who had ever heard of EC, fewer 1996 participants knew where to obtain it compared to 2002 participants (78% vs. 95%, P = 0.002) and fewer 1996 participants knew the correct time limits for use (20% vs. 51%, P < 0.001). The above data were collected prior to a didactic review session about EC. After receiving information about EC, the percentage of participants reporting a positive attitude toward EC grew between 1996 and 2002 (72% vs. 96%, P < 0.001). Young women also had fewer concerns about safety and side effects in 2002. The 1996 participants were more likely to report barriers to using EC compared to the 2002 participants. In 1996, EC side effects and impact on fertility were the most commonly perceived barriers to EC use. However, in 2002 the frequency of all reported barriers decreased and cost had become the number one perceived barrier.

CONCLUSION

Since 1996, young women at an urban hospital-based adolescent clinic and drug treatment center increased their awareness, use, and positive attitudes towards EC, as well as decreased their perceived barriers to using EC. Educational interventions that focus on improving knowledge among younger adolescents, specifically about correct time limits and identifying ways to find affordable EC, will address the most common knowledge deficits and perceived barriers to EC use among adolescents.