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Ke J, Cai J, Liu X, Chen L, Liu T, Ruan Z, Zhao C. Clinical implications and future prospects of levonorgestrel and piroxicam as a combined emergency contraceptive regimen. Int J Clin Pharmacol Ther 2024; 62:229-230. [PMID: 38329915 DOI: 10.5414/cp204537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 02/10/2024] Open
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Kabunga A, Kigongo E, Acanga A, Tumwesigye R, Auma AG, Musinguzi M, Kambugu CN, Okalo P, Abal JA, Namata H, Mwesigwa D. Qualitative study on stigma as a barrier to emergency contraceptive pill use among university students in the Lango subregion, Uganda. BMJ Open 2024; 14:e079478. [PMID: 38418237 PMCID: PMC10910632 DOI: 10.1136/bmjopen-2023-079478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/20/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVE The aim of the current study was twofold: to understand the nature and extent of stigma and to learn the reasons behind the decision not to use emergency contraceptive pills among university students in the Lango subregion of Uganda. DESIGN An exploratory qualitative study design. SETTING The study was carried out among university students in Lango subregion of Uganda. PARTICIPANTS 40 female university students across four universities. MAIN OUTCOME MEASURES Stigma. RESULTS Participants (n=40) aged 19-26 exhibited generally positive attitudes towards emergency contraceptive pills, recognising them as empowering and essential. Stigma, however, emerged as a substantial barrier manifested in societal judgements and negative perceptions. Themes included the positive attitude towards emergency contraceptive pills, perceptions of peers and the general public, and perceptions of health service providers. CONCLUSION Stigma significantly impedes emergency contraceptive pill use among university students in the Lango subregion, Uganda. Positive attitudes towards the pills contrast with societal judgements and provider stigmatisation. Tailored interventions addressing knowledge gaps, societal perceptions and healthcare system challenges are crucial for improving emergency contraceptive pill acceptability and utilisation among university students.
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Affiliation(s)
| | | | - Alfred Acanga
- Department of Public Administration and Management, Lira University, Lira, Uganda
| | | | | | | | | | | | - Judith Akello Abal
- Department of Commerce and Business Management, Lira University, Lira, Uganda
| | - Halimah Namata
- Department of Mental Health, Makerere University, Kampala, Uganda
| | - David Mwesigwa
- Department of Public Administration and Management, Lira University, Lira, Uganda
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Choi YJ, Lee SH, Yi J, Nho WY. Emergency contraceptive provision in the emergency department and risk analysis for delayed utilization in South Korea. Medicine (Baltimore) 2023; 102:e36195. [PMID: 38013329 PMCID: PMC10681593 DOI: 10.1097/md.0000000000036195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023] Open
Abstract
In certain nations, the emergency department (ED) has been designated as the primary center to provide emergency contraception (EC). However, analyses of ED visits for EC are limited. Moreover, ED-based research that focuses on time is limited to only a few surveys. The aims of this study were to examine the characteristics of ED visitors for EC and the interval between the coitus and arrival at the ED, and to analyze the factors associated with delays in visiting the ED. This retrospective cohort study involved patients at 2 urban tertiary academic hospitals in South Korea. All patients who presented to the ED for EC between January 2019 and December 2021 were analyzed. The median age of the participants was 26 years. The most common variables were age of 20 to 29 years (42.0%), evening visits (34.9%), weekends or public holidays (62.6%), single status (89.2%), and visits after contraceptive failure (79.1%). The mean time interval was 7.49 hours, and 77.4% of all patients visited the ED within 12 hours. Patients who received public sex education presented earlier (P < .001). ED visits after nonconsensual sexual incidents represented significantly delayed presentations (P < .001). Regression analysis revealed that both the lack of public education and the occurrence of nonconsensual coitus were associated with incident-to-ED visit intervals of >12 hours. Most patients received emergency contraceptive pill (ECP) within the recommended timeframe. In particular, nationwide school-based public sex education positively affected early ECP access. In contrast, ECP provision was delayed for patients who experienced nonconsensual coitus. Strategies for timely ECP access should account for possible concerns about stigmatization and privacy.
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Affiliation(s)
- Yoon Jung Choi
- Department of Emergency Medicine, CHA Gumi Medical Center, Gumi, Republic of Korea
| | - Soo Hyung Lee
- Department of Emergency Medicine, CHA Gumi Medical Center, Gumi, Republic of Korea
- Department of Emergency Medicine, School of Medicine, CHA University, Pocheon, Republic of Korea
| | - Jeongsik Yi
- Department of Emergency Medicine, CHA Gumi Medical Center, Gumi, Republic of Korea
- Department of Emergency Medicine, School of Medicine, CHA University, Pocheon, Republic of Korea
| | - Woo Young Nho
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Belachew TB, Negash WD, Belay DG, Aragaw FM, Asratie MH, Asmamaw DB. Emergency contraceptive knowledge and associated factors among abortion experienced reproductive age women in Ethiopia: a multilevel analysis using EDHS 2016 data. BMC Pregnancy Childbirth 2023; 23:775. [PMID: 37946102 PMCID: PMC10634145 DOI: 10.1186/s12884-023-06091-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Emergency contraceptives (EC) are used to avoid unintended pregnancy, hence avoiding its incidence and its effects. In Ethiopia, emergency contraception is commonly accessible, especially in the big cities. However, there is virtually little understanding of or awareness of EC and Ethiopia has a high abortion rate. Therefore this study was aimed to assess the magnitude and associated factors for emergency contraceptive knowledge in Ethiopia. METHODS The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A total weighted sample of 1236 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of emergency contraceptive knowledge. Statistical significance was determined using Adjusted Odds Ratio (AOR) with 95% confidence interval. RESULTS Overall magnitude of emergency contraceptive knowledge was observed to be 17.19% (95% CI: 15.18, 19.40) with intra-class correlation (ICC) 57% and median odds ratio (MOR) 6.4 in the null model. Women's age 25-34 (AOR = 2.6; 95% CI: 1.2, 5.5), and 35-49 (AOR = 1.5; 95% CI: 1.06, 3.3), secondary and above educational level (AOR = 3.41; 95% CI: 2.19, 4.88), media exposure (AOR = 2.97; 95% CI: 1.56, 5.64), Being in metropolitan region (AOR = 2.68; 95% CI: 1.46, 4.74), and women being in urban area (AOR = 3.19; 95% CI: 1.20, 5.23) were associated with emergency contraceptive knowledge. CONCLUSION Emergency contraceptive knowledge in this study was low. Women age, educational level, media exposure, residency, and region were significantly associated with emergency contraceptive knowledge. Therefore, to enhance understanding and use of ECs in the current Ethiopian setting, it is imperative to ensure exposure to EC information, particularly in rural regions.
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Affiliation(s)
- Tadele Biresaw Belachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women's and Family health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Yang Z, Shangguan L, Chen Y, Jiang R. Bilateral tubal pregnancy caused by taking emergency contraceptive pills in a Chinese woman. Asian J Surg 2023; 46:5145-5146. [PMID: 37429795 DOI: 10.1016/j.asjsur.2023.06.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023] Open
Affiliation(s)
- Zeshu Yang
- Chinese Medical Hospital of Wujin, Changzhou, Jiangsu Province, 213100, China
| | - Liqin Shangguan
- Chinese Medical Hospital of Wujin, Changzhou, Jiangsu Province, 213100, China
| | - Yan Chen
- Chinese Medical Hospital of Wujin, Changzhou, Jiangsu Province, 213100, China
| | - Rilei Jiang
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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Li RHW, Lo SST, Gemzell-Danielsson K, Fong CHY, Ho PC, Ng EHY. Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial. Lancet 2023; 402:851-858. [PMID: 37597523 DOI: 10.1016/s0140-6736(23)01240-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/22/2023] [Accepted: 06/13/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Levonorgestrel, a standard drug for emergency contraception (EC), is not effective if administered post-ovulation. A cyclo-oxygenase inhibitor could contribute synergistic effects. We investigated whether a single 40 mg oral dose of piroxicam as co-treatment with levonorgestrel improved emergency contraceptive efficacy. METHODS This was a randomised double-blind placebo-controlled trial carried out in a major community sexual and reproductive health service in Hong Kong. Women who required levonorgestrel EC within 72 h of unprotected sexual intercourse were recruited and block-randomised in a 1:1 ratio to receive a single supervised dose of levonorgestrel 1·5 mg plus either piroxicam 40 mg or placebo orally. Group assignment was concealed in opaque envelopes and masked to the women, clinicians, and investigators. At follow-up 1-2 weeks after the next expected period, the pregnancy status was noted by history or pregnancy test. The primary efficacy outcome was the proportion of pregnancies prevented out of those expected based on an established model. All women randomised to receive the study drug and who completed the follow-up were analysed. The trial was registered with ClinicalTrials.gov, NCT03614494. FINDINGS 860 women (430 in each group) were recruited between Aug 20, 2018, and Aug 30, 2022. One (0·2%) of 418 efficacy-eligible women in the piroxicam group were pregnant, compared with seven (1·7%) of 418 in the placebo group (odds ratio 0·20 [95% CI 0·02-0·91]; p=0·036). Levonorgestrel plus piroxicam prevented 94·7% of expected pregnancies compared with 63·4% for levonorgestrel plus placebo. We noted no significant difference between the two groups in the proportion of women with advancement or delay of their next period, or in the adverse event profile. INTERPRETATION Oral piroxicam 40 mg co-administered with levonorgestrel improved efficacy of EC in our study. Piroxicam co-administration could be considered clinically where levonorgestrel EC is the option of choice. FUNDING None.
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Affiliation(s)
- Raymond Hang Wun Li
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; The Family Planning Association of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Sue Seen Tsing Lo
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; The Family Planning Association of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kristina Gemzell-Danielsson
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Carol Ho Yi Fong
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Pak Chung Ho
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; The Family Planning Association of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; The Family Planning Association of Hong Kong, Hong Kong Special Administrative Region, China
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Pfeifer G, Stockburger M. The morning after: Prescription-free access to emergency contraceptive pills. J Health Econ 2023; 91:102775. [PMID: 37451144 DOI: 10.1016/j.jhealeco.2023.102775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 07/18/2023]
Abstract
We analyze the introduction of prescription-free access to morning-after pills-emergency contraceptives that aim to prevent unintended pregnancy and subsequent abortion after unprotected sexual intercourse. Exploiting a staggered difference-in-differences setting for Europe combined with randomization inference, we find sharp increases in sales and manufacturers' revenues of more than 90%. However, whilst not reducing abortions significantly, the policy triggers an unexpected increase in fertility of 4%, particularly among women aged 25-34. We elaborate on mechanisms by looking at within-country evidence from several EU countries, which suggests that fertility is driven by decreasing use of birth control pills in response to easier access to morning-after pills.
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Affiliation(s)
- Gregor Pfeifer
- University of Sydney, School of Economics, Social Sciences Building, NSW 2006, Australia; CESifo, Germany; IZA, Germany
| | - Mirjam Stockburger
- Justus Liebig University Giessen, Economics and Business Studies, Licher Straße 66, 35394 Giessen, Germany.
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Tanne JH. Combining anti-inflammatory drug with the morning after pill boosts effectiveness, study finds. BMJ 2023; 382:1920. [PMID: 37595973 DOI: 10.1136/bmj.p1920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
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Sapapsap B, Leelakanok N, Boonpattharatthiti K, Siritientong T, Methaneethorn J. A systematic review and meta-analysis of the prevalence and association between levonorgestrel and ectopic pregnancy. Expert Opin Drug Saf 2023; 22:929-941. [PMID: 37577925 DOI: 10.1080/14740338.2023.2247965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/12/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The use of levonorgestrel emergency oral contraceptives (EOCs) is one of the factors that may be associated with ectopic pregnancy. We aimed to investigate the incidence of ectopic pregnancy in EOC users and the association between EOCs and ectopic pregnancy. RESEARCH DESIGN AND METHODS We searched for articles that provided the incidence of and the association between levonorgestrel EOCs and ectopic pregnancy in women of reproductive ages in CINAHL Complete, Medline, OpenDissertations, Scopus, Science Direct, and Thai Journal Online. The risk of bias was assessed by Risk Of Bias In Non-randomized Studies or Risk of Bias 2. A meta-analysis was conducted using the random-effects model. RESULTS We retrieved 1839 nonredundant articles from the systematic search. The meta-analysis showed that the prevalence of ectopic pregnancy was not statistically different from zero (pooled prevalence estimate = 0.029%; 95%CI: -0.006, 0.065; N = 9; I2 = 0) and rare. In addition, levonorgestrel EOCs increased the risk of ectopic pregnancy (OR = 6.17; 95%CI: 3.78, 10.08; N = 5; I2 = 43%). CONCLUSIONS Women with extrauterine or ectopic pregnancy had higher odds of using levonorgestrel emergency oral contraceptives than those with intrauterine pregnancy. However, the prevalence of ectopic pregnancy is rare.
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Affiliation(s)
- Bannawich Sapapsap
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Nattawut Leelakanok
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Kansak Boonpattharatthiti
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Tippawan Siritientong
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Janthima Methaneethorn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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Momo K, Maeda E, Hattori H, Isozaki H, Takita H, Morohoshi H, Ryu K, Hida N, Sambe T, Shirato N. Descriptive Study on a Nationwide Exploratory Questionnaire Survey of Emergency Contraceptive Pills and Their Sexual History and Knowledge in Japan. Biol Pharm Bull 2023; 46:1296-1303. [PMID: 37661409 DOI: 10.1248/bpb.b23-00268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
A shift towards obtaining emergency contraceptives without a prescription have been discussed in Japan. In response to this social background, we aimed at investigating the background of sexual intercourse, emergency contraceptive use, and knowledge of sexual and reproductive health education among women of reproductive age in Japan. In this study, we conducted a national wide cross-sectional questionnaire survey using a total of 4 web-based domains (background, sexual history, emergency contraceptives, and sexual and reproduction-related knowledge) composed of 50 questions. We obtained responses from a total of 4,631 participants of varying age groups (18-25, 26-35, and 36-45 years old) and 47 prefectures (84 to 118 from each prefecture). Among participant responses, 69.7% are sexually active, of which 49.0% had experiences of sexual intercourse with an unknown person. The responses from a total of 737 participants who have sexual intercourse, know of emergency contraceptives, and have experienced a situation that necessitated the use of emergency contraceptives, were analyzed. Of these participants, 46.4% (342/737) took emergency contraceptives, while 43.6% (321/737) participants did not take emergency contraceptives. Participants who have the knowledge for obtaining emergency contraceptives through the correct means were 52.6% (2438/4631). This study showed that approximately half of participants may not have correct knowledge of emergency contraceptives. In addition, approximately half of sexually active participants are facing unintended pregnancies due to a lack of sexual and reproductive awareness. Hence, comprehensive sex education is necessary to achieve social and regulatory changes centered on emergency contraceptives.
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Affiliation(s)
- Kenji Momo
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | - Erika Maeda
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
- Department of Pharmacy, Showa University Koto Toyosu Hospital
| | - Haruka Hattori
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
- Department of Pharmacy, Showa University Hospital
| | - Haruka Isozaki
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
- Department of Pharmacy, Showa University Northern Yokohama Hospital
| | - Hiroko Takita
- Department of Obstetrics and Gynecology, Showa University School of Medicine
| | - Hokuto Morohoshi
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine
| | - Kakei Ryu
- Clinical Research Institute of Clinical Pharmacology and Therapeutics, Showa University
| | - Noriko Hida
- Department of Clinical Pharmacy, Division of Clinical Research and Development School of Pharmacy, Showa University
| | - Takehiko Sambe
- Division of Clinical Pharmacology, Department of Pharmacology, School of Medicine, Showa University
| | - Nahoko Shirato
- Department of Obstetrics and Gynecology, Showa University School of Medicine
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Kmietowicz Z. Emergency contraceptive pills don't induce abortion, says US regulator. BMJ 2022; 379:o3073. [PMID: 36585020 DOI: 10.1136/bmj.o3073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Paradise SL, Landis CA, Klein DA. Evidence-Based Contraception: Common Questions and Answers. Am Fam Physician 2022; 106:251-259. [PMID: 36126006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary care clinicians are uniquely situated to reduce unintended pregnancy in the context of a patient's medical comorbidities, social circumstance, and gender identity. New evidence regarding contraception use has emerged in recent years. The copper intrauterine device is the most effective option for emergency contraception, with similar effectiveness found for the levonorgestrel-releasing intrauterine system, 52 mg, and both offer extended future contraception. Ulipristal given within 120 hours after unprotected intercourse is the most effective oral emergency contraceptive. Oral levonorgestrel, 1.5 mg, is slightly less effective than ulipristal, and is less effective in patients with a body mass index of more than 30 kg per m2 and if administered after 72 hours. The Yuzpe method, which uses a combination of oral contraceptives, is less effective than ulipristal or oral levonorgestrel, 1.5 mg, and has high risk of nausea and vomiting. Contraception methods based on fertility awareness are safe and have similar effectiveness as condom use and the withdrawal method. Patients who have migraine with aura have a higher risk of ischemic stroke, and combined oral contraceptives appear to increase this risk. Therefore, the Centers for Disease Control and Prevention recommends avoiding their use in these patients. Studies support the extended use of the levonorgestrel-releasing intrauterine system, 52 mg, for seven years, the copper intrauterine device for 12 years, and the etonogestrel subdermal contraceptive implant for five years. One levonorgestrel-releasing intrauterine device, 52 mg, (Mirena) was recently approved by the U.S. Food and Drug Administration (FDA) for seven years of use to prevent pregnancy. However, the intervals for the copper intrauterine device and the etonogestrel subdermal contraceptive implant are longer than approved by the FDA, and patient-clinician shared decision-making should be used. Subcutaneous depot medroxyprogesterone acetate, 104 mg, a newer formulation with prefilled syringes, can be safely self-administered every 13 weeks. Because bone density loss appears to be reversible, the American College of Obstetricians and Gynecologists recommends considering use of depot medroxyprogesterone acetate beyond two years despite an FDA boxed warning about increased fracture risk. Testosterone does not prevent pregnancy but is safe to use with hormonal contraception; thus, transgender and gender-diverse patients with a uterus can be offered the full range of contraceptive options.
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Affiliation(s)
| | | | - David A Klein
- David Grant Medical Center, Travis Air Force Base, California
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Yongpraderm S, Uitrakul S, Daengnapapornkul P, O-In R, Sinsangbun B. Knowledge and attitude toward emergency contraceptive pills among first-year undergraduate students in Southern Thailand. BMC Med Educ 2022; 22:593. [PMID: 35915451 PMCID: PMC9344757 DOI: 10.1186/s12909-022-03659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND First-year undergraduates are at risk of unexpected pregnancy due to changes in their lives. Adequate knowledge and attitudes towards emergency contraceptive pills (ECPs) are essential to help prevent pregnancy. The objective of this study was therefore to investigate knowledge and attitudes towards ECPs among first-year undergraduate students in a university in Thailand. METHODS This cross-sectional survey study was performed using developed questionnaires that were validated by four experts. The questionnaires were distributed to all first-year students at the university via an online platform. The characteristic data were descriptively analysed, and the knowledge data were analysed using the chi-square test, Mann‒Whitney U test and one-way ANOVA. RESULTS Data from a total of 335 students who responded to the questionnaires and met the eligibility criteria for the study were analysed. The mean knowledge score of all respondents was 7.76 ± 0.15 out of 15. The most correctly answered questions were those relating to the efficacy and safety of ECPs in pregnant women (78.5% and 72.2% correctly answered, respectively). In contrast, the least correctly answered questions were about the ECP regimens and using ECPs instead of combined oral contraception (COC) (30.4% and 34.9%, respectively). In addition, the results indicated that experience in using ECPs and in ECP education were significant factors in high knowledge scores. Moreover, most respondents trusted and would like to receive information on ECPs from health professionals in hospitals, academic institutions, or pharmacies. CONCLUSION The average knowledge of ECPs of first-year students in a university in Thailand was at a moderate level. More information about the regimens of the drugs and the use of ECPs instead of COC should be provided to students, particularly at universities or pharmacies, and should be performed by health care staff.
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Affiliation(s)
- Siranee Yongpraderm
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat, 80160, Thailand
| | - Suriyon Uitrakul
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat, 80160, Thailand.
| | - Pakwan Daengnapapornkul
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat, 80160, Thailand
| | - Rawiporn O-In
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat, 80160, Thailand
| | - Bunthita Sinsangbun
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat, 80160, Thailand
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Chimatiro CS, Mpachika-Mfipa F, Tshotetsi L, Hajison PL. School-going adolescent girls' preferences and views of family planning services in Phalombe district, Malawi: A descriptive, cross-sectional study. PLoS One 2022; 17:e0267603. [PMID: 35503775 PMCID: PMC9064102 DOI: 10.1371/journal.pone.0267603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/11/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Low uptake of family planning services by adolescent girls remains a public health concern. An estimated 120 out of every 1,000 girls aged 15 to 19 years are having unplanned pregnancies in the sub-Saharan region. Between January and June 2020, the Phalombe District of Malawi reported 3,030 adolescent pregnancies. At this stage, most Malawian schools were closed due to the COVID-19 pandemic. The high rate of adolescent pregnancies prompted the Ministry of Health to provide emergency contraceptives to reduce the number of unplanned pregnancies among adolescents. The provision of emergency contraceptives would be effective if girls were willing and able to access these family planning services. We thus explored the views of school-going adolescent girls regarding their preferences for modern family planning methods including emergency contraceptives in Phalombe, Malawi. METHODS This was a cross-sectional, descriptive study, where quantitative data were collected using a structured questionnaire. Participants included randomly sampled school-going adolescent girls from eight purposively selected secondary schools and eight randomly selected primary schools. All the schools were sampled from three purposively selected Traditional Authorities namely Nkhulambe, Jenala and Nkhumba which had reported high numbers of adolescent pregnancies. We analyzed the GeoPoints for schools and health facilities using ArcGIS, while adolescent girls' views were analyzed using STATA. RESULTS Participants included 388 adolescent girls, ranging in age from 10 to 19 years (median age = 15.5 years, SD = 1.9 years). Participants were hesitant to use contraceptives because they were afraid of being stigmatized and embarrassed, had to travel long distances to reach the service center, knew little about modern family planning and were afraid of medical complications. CONCLUSION The uptake of family planning services by adolescent girls can be improved by bringing healthcare services closer to schools and homes. Family planning services should employ health workers who are non-judgmental and who are able to remove the stigma associated with family planning. Health workers should at any given opportunity, address the misconceptions and beliefs that adolescents have towards contraceptives. Community sensitization and health talks should be done to improve adolescent girls' understanding of family planning services.
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Affiliation(s)
| | | | - Lumbani Tshotetsi
- Clinical Associate Program (Family Medicine), University of Pretoria, Pretoria, Hatfield, South Africa
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Abstract
This cross-sectional study examines whether the passage of Texas Senate Bill 8 was associated with an increase in requests for self-managed medication abortion.
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Affiliation(s)
| | | | - James G. Scott
- Department of Statistics and Data Sciences, University of Texas at Austin
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Khorsandi N, Chiccarelli E, Dumas SA, Pasternak RH. Louisiana Pharmacies' Availability of Emergency Contraception and Counseling Accuracy to Adolescent and Physician Callers. J Pediatr Adolesc Gynecol 2021; 34:693-698. [PMID: 33631348 DOI: 10.1016/j.jpag.2021.02.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/29/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE Adolescents face many barriers to obtaining emergency contraception (EC), despite it being an approved and recommended method to prevent unintended pregnancy. This study examined pharmacy-related barriers to adolescents' access to EC in Louisiana. DESIGN Prospective, telephone-call secret shopper study to pharmacies to assess same-day EC availability and barriers to purchase. SETTING A total of 182 pharmacies in 5 Louisiana cities. PARTICIPANTS Responses provided by pharmacists or other pharmacy staff assessed between July 2018 and November 2019. INTERVENTIONS Collected data from secret shopper phone calls and compared responses provided to callers between male and female callers and physician and adolescent callers. MAIN OUTCOME MEASURES Same-day levonorgestrel (LNG) availability, same-day ulipristal acetate (UPA) availability, age restrictions on purchase, requirement of parental consent for purchase, and type of staff member that advised the caller. RESULTS Of 364 calls to 182 pharmacies, 66% of pharmacists or other pharmacy staff reported same-day LNG access and 5% reported same-day UPA access. An inaccurate age restriction regarding EC purchase was reported in 15% of calls. Female callers were cited this age restriction more frequently than their male counterparts (20% vs 10%). Pharmacists were more likely than other pharmacy staff to counsel female callers compared to male callers (52% vs 27%) and physician callers compared to adolescents (50% vs 30%). CONCLUSIONS Many pharmacies in Louisiana have limited same-day availability of EC and often report inconsistent and inaccurate age and consent regulations for its use. Continued outreach and education to pharmacies is necessary to address these barriers to adolescent EC access.
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Affiliation(s)
- Nikka Khorsandi
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, Louisiana.
| | - Elvira Chiccarelli
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - S Amanda Dumas
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Ryan H Pasternak
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Affiliation(s)
- Kyosuke Kamijo
- Department of Obstetrics and Gynecology, Iida Municipal Hospital, Iida, Japan
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
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Radley A, Anderson C. Emergency contraception from community pharmacies: looking back and looking forward. BMJ Sex Reprod Health 2021; 47:4-5. [PMID: 32900794 DOI: 10.1136/bmjsrh-2020-200767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Andrew Radley
- Directorate of Public Health, NHS Tayside, Dundee, UK
- School of Medicine, University of Dundee, Dundee, UK
| | - Claire Anderson
- Division of Pharmacy Practice & Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
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Ashcraft AM, Farjo S, Ponte CD, Dotson S, Sambamoorthi U, Murray PJ. Harder to get than you think: Levonorgestrel emergency contraception access in West Virginia community pharmacies. J Am Pharm Assoc (2003) 2020; 60:969-977. [PMID: 32830066 DOI: 10.1016/j.japh.2020.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Emergency contraception (EC) is the only noninvasive form of contraception available after risk exposure and is an important tool for preventing unintended pregnancy resulting from unprotected sex, sexual assault, or contraceptive failure. The U.S. Food and Drug Administration (FDA) removed age restrictions on levonorgestrel EC and made it available over-the-counter to everyone in 2013. Despite improved availability and accessibility since the change in FDA regulations, community pharmacies have not uniformly embraced the policy. West Virginia is a rural state with high rates of poverty and teen pregnancy. DESIGN The investigators called community pharmacies in West Virginia to assess the availability and accessibility of levonorgestrel EC in addition to the pharmacy staff's knowledge of effectiveness for this cross-sectional study. SETTING AND PARTICIPANTS The study sample consisted of 509 community pharmacies throughout the state. OUTCOME MEASURES A structured script was employed to conduct phone calls to community pharmacies with items assessing availability, accessibility, and knowledge of effectiveness. RESULTS At the time of the phone calls, levonorgestrel EC was reported to be available in 48.9% of the community pharmacies in West Virginia. Chain pharmacies were more likely to report EC as being in stock (0.76) than independent pharmacies (0.15.). Other measures of accessibility also favored chain pharmacies versus independent pharmacies. The overall accessibility of EC at West Virginia community pharmacies was derived from a binary composite variable of "completely accessible" or "not completely accessible" by combining 5 predetermined items. Overall, EC was completely accessible to callers in 0.27 of all pharmacies with significant differences by pharmacy type (0.47 of chain pharmacies as compared with 0.03 of independent pharmacies). CONCLUSION Accessible EC could reduce unintended pregnancy and help break the state's generational cycle of poverty and poor educational, social, and health outcomes. Pharmacists will be instrumental in expanding access to EC.
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Abstract
OBJECTIVE To assess the accessibility of ulipristal acetate (UPA) and copper intrauterine devices (IUDs) for emergency contraception (EC) in reproductive health centers in the Kansas City metropolitan area. STUDY DESIGN Using a secret shopper method, two female investigators called the reproductive health centers listed as EC providers on the nonprofit website bedsider.org that were located within 25 miles of the University of Kansas Medical Center. We categorized clinics as Title X providers vs. not according to the grantee list from the Office of Population Affairs. Investigators inquired about obtaining a UPA prescription by phone, the availability of the copper IUD for EC and time to first available appointment for EC. We evaluated correlates of EC access and provision with Fisher's Exact Tests. RESULTS We identified 40 clinics as potential EC providers. Some clinics reported that UPA could be prescribed by phone to existing patients (13/40, 32%), while others reported that women must meet with a provider first (15/40, 38%). Few clinics offered copper IUDs as EC (3/40, 8%). Title X clinic status did not predict provision of UPA by phone or copper IUDs as EC. The average time to next available appointment was 9±9 days to discuss EC and 13±9 days for a copper IUD. CONCLUSIONS Accessing the most efficacious forms of EC in a timely fashion presents many logistic challenges for women. IMPLICATIONS Healthcare systems should streamline protocols, train providers and improve rapid-access referral networks to facilitate timely provision of UPA and copper IUDs for EC.
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Affiliation(s)
- Valerie A French
- Department of Obstetrics and Gynecology, University of Kansas Medical Center.
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Abstract
Pharmacists’ ability to exercise “professional right of conscience” in dispensing emergency contraception, as well as the professionalism of pharmacists, has fallen under attack recently by the media, by state governments, and even by other healthcare professionals in published commentaries. This editorial discusses the controversy surrounding emergency contraceptives, the right of pharmacists to refuse to fill prescriptions that they consider morally objectionable, and the responsibility of pharmacists to provide medications in a timely and professional manner. The professionalism of pharmacy is also examined in light of the expanded scope of practice in which pharmacists increasingly find themselves practicing.
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Affiliation(s)
- Kelly Dowhower Karpa
- Department of Pharmacology, College of Medicine, Pennsylvania State University, Hershey, 17033-2360, USA.
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Gulland A. Tell women IUD is more effective than emergency contraceptive pill, says NICE. BMJ 2016; 354:i4920. [PMID: 27621365 DOI: 10.1136/bmj.i4920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Aims: To evaluate an intervention aimed at improving knowledge of, attitudes to, and practices regarding condoms and emergency contraception (ECP) among Swedish high school students. Methods: An intervention study with quasi-experimental design. A strategic sample of classes from two vocational high school programs was divided into an intervention group and a comparison group. All students completed questionnaires before and after the intervention, which included sexual education lessons by a nurse-midwife and medical students, free condoms on request and access to telephone counseling. Results: Of the 461 eligible students, mean age 17 years, 390 (85%) completed the pre-test and 326 (71%) the post-test. Three out of four (77%) had experienced sexual intercourse. The majority (76%) had used contraception, mostly condoms at first intercourse. The students already had good knowledge of condoms with no change after the intervention, but attitudes improved and condom use increased. Knowledge of, and attitudes towards ECP improved but use remained stable (29%). The most important source of information about ECP changed from ``friends'' to ``school'' after the intervention. More than one out of four (28%) had opted for free condoms but only 3% had requested telephone counseling. Conclusions: Condom use increased after the intervention whereas the use of ECP remained stable. Knowledge of ECP improved and the attitudes towards both condoms and ECP became more positive. Participation of nurse-midwives and medical students, skill rehearsal, and improved access to condoms may be useful elements in sexual education.
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Affiliation(s)
- Margareta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Paez E. Emergency Contraceptives and the Beginning of Human Animals. Bioethics 2016; 30:433-439. [PMID: 26764238 DOI: 10.1111/bioe.12242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Emergency contraceptives may sometimes prevent implantation, thereby causing the death of the embryo. According to some positions contrary to abortion, because the embryo is a human animal, there are usually decisive moral reasons not to use them. In this article, I will show that objecting to the use of emergency contraceptives on those grounds is unjustified. If organisms are real existents, then according to the most plausible conception of what is required for a group of cells to compose one, the embryo cannot qualify as a single organism. On the other hand, if organisms are virtual objects, then whether or not the embryo qualifies as one is morally irrelevant. I conclude that even if those positions are right about the morality of abortion, they are not entitled to oppose the use of emergency contraceptives.
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Halligan S. Family Planning--an evolving service. Nurs N Z 2016; 22:18-19. [PMID: 27183691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Hussainy SY, Ghosh A, Taft A, Mazza D, Black KI, Clifford R, Gudka S, Mc Namara KP, Ryan K, Jackson JK. Protocol for ACCESS: a qualitative study exploring barriers and facilitators to accessing the emergency contraceptive pill from community pharmacies in Australia. BMJ Open 2015; 5:e010009. [PMID: 26656987 PMCID: PMC4679989 DOI: 10.1136/bmjopen-2015-010009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The rate of unplanned pregnancy in Australia remains high, which has contributed to Australia having one of the highest abortion rates of developed countries with an estimated 1 in 5 women having an abortion. The emergency contraceptive pill (ECP) offers a safe way of preventing unintended pregnancy after unprotected sex has occurred. While the ECP has been available over-the-counter in Australian pharmacies for over a decade, its use has not significantly increased. This paper presents a protocol for a qualitative study that aims to identify the barriers and facilitators to accessing the ECP from community pharmacies in Australia. METHODS AND ANALYSIS Data will be collected through one-on-one interviews that are semistructured and in-depth. Partnerships have been established with 2 pharmacy groups and 2 women's health organisations to aid with the recruitment of women and pharmacists for data collection purposes. Interview questions explore domains from the Theoretical Domains Framework in order to assess the factors aiding and/or hindering access to ECP from community pharmacies. Data collected will be analysed using deductive content analysis. The expected benefits of this study are that it will help develop evidence-based workforce interventions to strengthen the capacity and performance of community pharmacists as key ECP providers. ETHICS AND DISSEMINATION The findings will be disseminated to the research team and study partners, who will brainstorm ideas for interventions that would address barriers and facilitators to access identified from the interviews. Dissemination will also occur through presentations and peer-reviewed publications and the study participants will receive an executive summary of the findings. The study has been evaluated and approved by the Monash Human Research Ethics Committee.
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Affiliation(s)
| | - Ayesha Ghosh
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
| | - Angela Taft
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Kirsten Isla Black
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rhonda Clifford
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Sajni Gudka
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Peter Mc Namara
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
- Deakin University and Flinders University, Melbourne, Victoria, Australia
| | - Kath Ryan
- School of Pharmacy, University of Reading, Reading, UK
| | - John Keith Jackson
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
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Flynn CO, Wilson RF. When states regulate emergency contraceptives like abortion, what should guide disclosure? J Law Med Ethics 2015; 43:72-86. [PMID: 25846040 DOI: 10.1111/jlme.12197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
State laws dictating "informed consent" about surgical and chemical abortions sometimes ensnare emergency contraceptives (EC), as the science surrounding EC shows. Courts evaluating mandated disclosures gravitate to professional norms rather than the information most women would value: basic factual information about EC so that they can decide for themselves whether to use these drugs.
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Affiliation(s)
- Cameron O'Brien Flynn
- Member of the California Bar, a graduate of the Washington and Lee University School of Law, and a former Law Fellow with the University of Illinois College of Law
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Abstract
Emergency contraception has the potential to greatly reduce the number of unintended pregnancies. Experiences in the use of emergency contraception have rarely been reported in the literature. Thirteen young women (a subset of a larger study cohort), were individually interviewed in a variety of settings about their personal experiences in relation to the use of emergency contraception. A thematic analysis of the transcribed data was undertaken. Barriers and facilitators to its use are explicated using excerpts from individual interviews with participants. Some young women had positive experiences, however many experiences were negative and reflected difficulties with access and availability of emergency contraception, as well as poor provider attitudes. Positive experiences generally occurred where services were responsive to the needs of young people or when a provider was well known to the young woman. Their experiences underscore the need to understand the situational stress and sometimes difficult arrangements needed to obtain this method of contraception. To optimise young women's experiences of emergency contraceptive use, a number of strategies need to be implemented. These include improvement of information about emergency contraception for young women and their partners; for health professionals; and for the broader community. Of critical importance is the need to include strategies to improve access to emergency contraception. A number of recommendations to achieve this within current health care delivery sectors in Australia, as well as suggestion forfuture access are provided.
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Affiliation(s)
- Helen Calabretto
- School of Nursing & Midwifery, University of South Australia, Adelaide, Australia
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Wilkinson TA, Vargas G, Fahey N, Suther E, Silverstein M. The authors reply. J Adolesc Health 2014; 55:149. [PMID: 24952913 DOI: 10.1016/j.jadohealth.2014.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/15/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Tracey A Wilkinson
- Department of Pediatrics, Keck School of Medicine/Children's Hospital of Los Angeles, Los Angeles, California
| | - Gabriela Vargas
- Brown University, Hasbro Children's Hospital, Providence, Rhode Island
| | | | - Emily Suther
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Michael Silverstein
- Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
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Adrian C, Kim I, Chu V, Kaneshiro B. Accuracy of information on emergency contraception on the Internet. J Reprod Med 2013; 58:291-296. [PMID: 23947078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess the quality of information on the Internet regarding Plan B, the Yuzpe method, and the copper intrauterine device (IUD). STUDY DESIGN An Internet search was performed using 4 common search engines with the terms morning after pill, emergency contraception, and Plan B. The first 20 websites generated by each search were evaluated. Websites were excluded if they were not informational sites. Descriptive analysis was performed. RESULTS Fifty-one websites were unique and relevant to the study criteria. The majority of sites reported that Plan B should be taken within 72 hours of unprotected intercourse (92.2%) and could be obtained without a prescription (54.4%). The Yuzpe method and the copper IUD were less likely to be mentioned, though the information presented tended to be accurate. CONCLUSION The majority of information regarding emergency contraception on the Internet is accurate, suggesting that the Internet could be used to increase emergency contraceptive knowledge for patients.
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Affiliation(s)
- Celeste Adrian
- Department of Obstetrics and Gynecology, University of Hawaii, Honolulu, USA.
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McCarthy M. US is to allow sales of emergency contraceptives without restrictions. BMJ 2013; 346:f3837. [PMID: 23760973 DOI: 10.1136/bmj.f3837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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McCarthy M. US approves "morning after" pill without prescription for women 15 years or older. BMJ 2013; 346:f2909. [PMID: 23645902 DOI: 10.1136/bmj.f2909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sychareun V, Hansana V, Phengsavanh A, Phongsavan K. Awareness and attitudes towards emergency contraceptive pills among young people in the entertainment places, Vientiane City, Lao PDR. BMC Womens Health 2013; 13:14. [PMID: 23514104 PMCID: PMC3606843 DOI: 10.1186/1472-6874-13-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 03/14/2013] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Vanphanom Sychareun
- Faculty of Postgraduate Studies, University of Health Sciences, Ministry of Health, P.O. Box 7444, Vientiane, Lao PDR
| | - Visanou Hansana
- Faculty of Postgraduate Studies, University of Health Sciences, Ministry of Health, P.O. Box 7444, Vientiane, Lao PDR
| | - Alongkone Phengsavanh
- Faculty of Postgraduate Studies, University of Health Sciences, Ministry of Health, P.O. Box 7444, Vientiane, Lao PDR
| | - Keokedthong Phongsavan
- Obstetrics-Gynecology Section, Sethathirath Hospital, Ministry of Health, Vientiane, Lao PDR
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Abstract
Pharmacists who refuse to provide certain services or treatment for reasons of conscience have been criticized for failing to fulfil their professional obligations. Currently, individual pharmacists in Great Britain can withhold services or treatment for moral or religious reasons, provided they refer the patient to an alternative source. The most high-profile cases have concerned the refusal to supply emergency hormonal contraception, which will serve as an example in this article. I propose that the pharmacy profession's policy on conscientious objections should be altered slightly. Building on the work of Brock and Wicclair, I argue that conscientious refusals should be acceptable provided that the patient is informed of the service, the patient is redirected to an alternative source, the refusal does not cause an unreasonable burden to the patient, and the reasons for the refusal are based on the core values of the profession. Finally, I argue that a principled categorical refusal by an individual pharmacist is not morally permissible. I claim that, contrary to current practice, a pharmacist cannot legitimately claim universal exemption from providing a standard service, even if that service is available elsewhere.
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Affiliation(s)
- Zuzana Deans
- University of Bristol – Centre for Ethics in Medicine, 3rd Floor Hampton House Cotham Hill Bristol BS6 6AU, UK.
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Flaherty C, Ely GE, Akers LS, Dignan M, Bonistall Noland T. Social work student attitudes toward contraception and the HPV vaccine. Soc Work Health Care 2012; 51:361-381. [PMID: 22489559 DOI: 10.1080/00981389.2011.642945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of the current study was to examine social work student attitudes toward the social work profession's perspective on certain aspects of reproductive health in the United States: contraception, emergency contraception, and the Human Papillomavirus (HPV) vaccine. Students at a large, public, land grant university were surveyed to determine whether their personal attitudes were in line with the National Association of Social Workers (NASW) stance on reproductive health outlined in the NASW policy statement on family planning and reproductive health. The relationship between levels of religious activity and attitudes toward these aspects of reproductive health was also examined. Results suggest that almost all of the respondents support public funding for family planning. Furthermore, almost all students indicate willingness to refer clients for general contraception. However, results related to emergency contraception indicate that 72% of students disagree that it should be available for adolescents over the counter, even with parental consent, which is inconsistent with the NASW perspective. Sixty-four percent of students report believing that the HPV vaccine is unsafe. Further, as levels of religious activity increased, acceptance of some of these aspects of reproductive health decreased. Implications for social work practice, education, and directions for future research are discussed.
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Affiliation(s)
- Chris Flaherty
- College of Social Work, University of Kentucky, Lexington, Kentucky 40506-0027, USA
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Paradis M. [Unwanted pregnancy. Emergency contraception at school. Before acting, we need to know how to listen]. Perspect Infirm 2011; 8:33-34. [PMID: 22097422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Beaulieu R, Kools S, Kennedy HP, Humphreys J. Misconceptions about missed conceptions: the meanings of emergency contraceptive pills use among young adult couples. J Fam Nurs 2011; 17:463-484. [PMID: 22084483 DOI: 10.1177/1074840711424158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
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.
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Krakowiak-Redd D, Ansong D, Otupiri E, Tran S, Klanderud D, Boakye I, Dickerson T, Crookston B. Family planning in a sub-district near Kumasi, Ghana: side effect fears, unintended pregnancies and misuse of a medication as emergency contraception. Afr J Reprod Health 2011; 15:121-132. [PMID: 22574499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Barekuma Collaborative Community Development Project (BCCDP) performed a study regarding family planning in communities in the Barekese sub-district near Kumasi, Ghana in July 2010. Eighty-five women, ages 15-49 years, in three communities were interviewed with a modified version of the 2008 Ghana Demographic and Health Survey. While virtually all women recognized at least one family planning method, half of all recent or current pregnancies were unintended and 20 percent of women had a previous abortion. Unexpectedly, 27 percent of women had misused norethisterone tablets (Primolut N or "N-tablets"), a synthetic progesterone, as emergency contraception. Women had a variety of concerns about family planning methods, including one-third having a fear of side effects for hormonal methods (particularly heart palpitations), as well as unfamiliarity with and particular aspects they did not like for most methods. However, women were interested in learning more about side effects as well as modern fertility awareness-based methods. There is an urgent need for interventions aimed at regulating and implementing the correct use of Primolut N tablets, addressing real and perceived side effects of family planning practices through properly trained community health nurses and introducing modern methods of fertility awareness such as Standard Days Method and the Two-day Method in the Barekese sub-district.
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Affiliation(s)
- Daisy Krakowiak-Redd
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Salt Lake City, UT 84108, USA.
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Peiró Peiró AM. [The mature minor's decisions' in health]. Med Clin (Barc) 2011; 137:140-1. [PMID: 21296367 DOI: 10.1016/j.medcli.2010.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 11/29/2022]
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Lindahl SH. Contraception update. Adv NPs PAs 2011; 2:31-34. [PMID: 21329230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Sarah H Lindahl
- Association of Physician Assistants in Obstetrics and Gynecology, USA
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Pillai S. Case discussion:to treat or not to treat? J R Nav Med Serv 2011; 97:117-118. [PMID: 22372017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Worku H, Teklu S. Knowledge, attitudes and practices (KAP) regarding emergency contraception among drug dispensers working in retail outlets of Addis Ababa. Ethiop Med J 2011; 49:7-15. [PMID: 21456467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Emergency contraception (EC) refers to contraception used as an emergency procedure to prevent pregnancy following unprotected intercourse. As the success of EC depends on availability and timely administration, the knowledge, attitudes and practices (KAP) towards EC of staff working in pharmacies and drugstores is of particular importance. OBJECTIVE Assess KAP regarding EC of dispensers working in pharmacies and drugstores of Addis Ababa. METHODS A cross-sectional descriptive study was conducted on drug dispensers (n=303) working in pharmacies and drug stores of Addis Ababa. RESULTS Eighty four percent of respondents (n=256) were aware of EC, but the remainder had never heard ofit. Although nearly 80% of aware respondents had a knowledge and attitude score of more than 50%, only 25% had knowledge and 35% had an attitude score of more than 75%. Amongst aware respondents, 32% had prescribed EC. CONCLUSION The knowledge, attitude and practice of drug dispensers in Addis Ababa regarding EC was inadequate. There is a need to address these deficiencies, as drug dispensers are the most easily accessible professionals for clients requiring EC services at any time of the day and on any day of the week.
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Affiliation(s)
- Haliemariam Worku
- Department of Obstetrics and Gynecology, Addis Ababa University, School of Medicine, Ethiopia
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Liambila W, Obare F, Keesbury J. Can private pharmacy providers offer comprehensive reproductive health services to users of emergency contraceptives? Evidence from Nairobi, Kenya. Patient Educ Couns 2010; 81:368-373. [PMID: 20934833 DOI: 10.1016/j.pec.2010.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 08/30/2010] [Accepted: 09/01/2010] [Indexed: 05/30/2023]
Abstract
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.
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Affiliation(s)
- Wilson Liambila
- Reproductive Health Program, Population Council, Nairobi, Kenya
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Parey B, Addison L, Mark JK, Maurice B, Tripathi V, Wahid S, Antoine R, Sahai A. Knowledge, attitude and practice of emergency contraceptive pills among tertiary level students in Trinidad: a cross-sectional survey. W INDIAN MED J 2010; 59:650-655. [PMID: 21702237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The objective of this study was to estimate the general knowledge, attitude and practice of Emergency Contraceptive pills (ECs) among tertiary level students in Trinidad. METHOD A 32-item questionnaire was constructed to assess knowledge, attitudes and practice of EC. There were 76 medical and 160 non-medical students who volunteered to fill-up the questionnaire. This survey was conducted by graduate students under supervision of the Department of Mathematics and Computer Science, UWI, St Augustine. RESULTS Eighty-four per cent of the students were less than 25 years of age, 64% were Christians and 92% were single. Sixty-three per cent were female and there were more females in the non-medical group than the medical students group but the numbers were not significant. Eighty-one per cent used condoms as the main type of contraception. Only 63% had heard of ECs before and only 9% had heard of ECs from medical sources. Among the factors that related to attitude towards EC, only two factors were significant. Sixty-two per cent of students felt that increased EC use would increase promiscuity (p = 0.013) but 59% also felt that ECs should be made more easily available (p = 0.014). CONCLUSION The general level of their knowledge about ECs was poor. The general attitude of students towards ECs was positive. This study will help policy-makers by providing evidence-based knowledge to promote EC use among university students.
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Affiliation(s)
- B Parey
- Department of Mathematics and Computer Science, Faculty of Science and Agriculture, The University of West Indies, St Augustine Campus, Trinidad and Tobago, West Indies
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Cossío-Díaz JR. [The "morning after pill": the impact of the Supreme Court ruling in the medical field]. GAC MED MEX 2010; 146:251-256. [PMID: 20964067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
This article summarizes the Court's ruling regarding the constitutionality of the Official Norm "NOM-046-SSA2-2005". Jalisco's Governor challenged the validity of the referred norm arguing that it was against articles 4, 5, 14, 16, 20, 21, 29, 31-V, 49, 73, 74, 89-I, 123, 124 y 133 of the Federal Constitution. The Supreme Court disregarded Governor's claim and determined that the members of the National Health System are obliged to offer and give the "day after pill" to sexual violation victims. According to article 5 of General Health Law, the National Health System includes private and public hospitals, whether they are local or federal. This means that all these health institutions have the obligation to observe the dispositions contained in the appealed Official Norm Given the significance of the Court's ruling in the medical sphere, in this article the most relevant issues of the Court decision and its implications are analyzed.
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Affiliation(s)
- José Ramón Cossío-Díaz
- Suprema Corte de Justicia de la Nación y Departamento de Derecho del Instituto Tecnológico Autónomo de México, México D.F., México.
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Abstract
OBJECTIVE To evaluate the existing data to estimate the rate of ectopic pregnancy among emergency contraceptive pill treatment failures. DATA SOURCES Our initial reference list was generated from a 2008 Cochrane review of emergency contraception. In August 2009, we searched Biosys Previews, the Cochrane Database of Systematic Reviews, Medline, Global Health Database, Health Source: Popline, and Wanfang Data (a Chinese database). METHODS This study included data from 136 studies, which followed a defined population of women treated one time with emergency contraceptive pills (either mifepristone or levonorgestrel) and in which the number and location of pregnancies were ascertained. RESULTS Data from each article were abstracted independently by two reviewers. In the studies of mifepristone, 3 of 494 (0.6%) pregnancies were ectopic; in the levonorgestrel studies, 3 of 307 (1%) were ectopic. CONCLUSION The rate of ectopic pregnancy when treatment with emergency contraceptive pills fails does not exceed the rate observed in the general population. Because emergency contraceptive pills are effective in lowering the risk of pregnancy, their use will reduce the chance that an act of intercourse will result in ectopic pregnancy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kelly Cleland
- Office of Population Research, Princeton University, Wallace Hall, Princeton, NJ 08540, USA
| | - Elizabeth Raymond
- Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA
| | - James Trussell
- Office of Population Research, Princeton University, Wallace Hall, Princeton, NJ 08540, USA
- The Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - Linan Cheng
- Shanghai Institute of Planned Parenthood Research, Xie Tu Rd, Shanghai 200032, People’s Republic of China
| | - Haoping Zhu
- Minhang Central Hospital, Shanghai Jiaotong University, Shanghai 201100, People’s Republic of China
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Snyder D. A reasonable time, place and manner restriction: Medicare reimbursement law should require pharmacists to fill prescriptions regardless of personal belief. Am J Law Med 2010; 36:652-681. [PMID: 21302849 DOI: 10.1177/009885881003600405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
“[T]he [First] Amendment embraces two concepts—freedom to believe and freedom to act. The first is absolute but, in the nature of things, the second cannot be.”
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Affiliation(s)
- Brian T Nguyen
- Warren Alpert Medical School, Division of Medicine, Brown University, Providence, RI 02912-9107, USA.
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Zeteroğlu S, Sahin G, Sahin HA, Bolluk G. Knowledge and attitudes towards emergency contraception of health-care providers in a region with a high birth rate. EUR J CONTRACEP REPR 2009; 9:102-6. [PMID: 15449822 DOI: 10.1080/13625180410001715672] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the knowledge of, attitude towards and practices of emergency contraception among health-care providers at a university hospital located in a region with a high birth rate. METHODS The survey was conducted among 214 health-care providers working at a university hospital located in eastern Turkey. RESULTS Two hundred participants completed the questionnaire. Of the respondents, 26.0% said that they did not know anything about emergency contraception, while the remaining 74.0% said that they knew about at least one of the methods of emergency contraception. But among these, the knowledge of 38.5% of the participants about emergency contraception was accurate and that of 61.5% was inaccurate. Thirty-four percent of the respondents stated that they had previously required personally to use emergency contraceptive methods. The most commonly used emergency contraceptive methods were oral contraceptives (69.1%) and intrauterine device (14.7%). None of the respondents knew anything about mifepristone and levonorgestrel. CONCLUSION There is a knowledge deficit among health-care providers who play a significant role in the dissemination of the information about emergency contraception.
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Affiliation(s)
- S Zeteroğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yüizüncü Yil University, Van, Turkey
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