Use Of Emergency Contraceptive Pills Research Articles

Knowledge, practices,and barriers to access of emergency contraceptive pills in married women and men:a multicenter clinic-based cross-sectional study from Karachi, Pakistan.

Emergency contraceptive pills (ECPs) are significantly underutilized in many parts of the world, especially in South-Asia. Within Pakistan, despite the population surge, the utilization of ECPs remains alarmingly low. The purpose of this study was to investigate the knowledge and practices regarding ECPs amongst married women and men in Karachi, Pakistan and the possible barriers hindering access to and use of these contraceptives. A multi-centric cross-sectional study was conducted in Karachi, Pakistan. Interviews were conducted with participants using validated questionnaire involving different sections on demographics, knowledge, practices, and barriers to ECP use. Categorical variables were summarized as frequencies and percentages while continuous variables were characterized using mean and standard deviation. A chi-square test of variance was used for association between knowledge scores and different categorical values. A p-value of < 0.05 at 95% CI was statistically significant. Over half of the respondents (52.5%) were not using any method of contraception. 11.1% of respondents had used ECP at some point in their life. 337 (85.8%) participants had low knowledge, 55 (14%) had moderate while only 1 (0.25%) had high knowledge regarding ECPs. There was no significant association of knowledge scores with gender, age, employment status or parity. However, participants who had received counseling for family planning in the past or had previously used ECPs had significantly higher knowledge regarding ECPs. A majority 58% (221) of the participants expressed concerns about the potential side effects and 128 (33.9%) of them believed that ECPs were in contradiction to their religious and moral values. Our study in Karachi, Pakistan, highlights critical challenges in ECP awareness, utilization, and family planning. Although the results show improved ECP usage than studies previously done in Pakistan, there is a further need to increase the reach of ECPs through a variety of methods. Persistent myths and misconceptions and a severe lack of awareness further hinders their use.

Emergency contraception access in Fijian community pharmacies: A descriptive study

ObjectiveTo assess pharmacists’ knowledge regarding emergency contraceptive pills (ECPs), their attitudes towards women obtaining ECPs, and ECP counselling and dispensing practices. MethodsAn online cross-sectional survey using Qualtrics was distributed via pharmacy emails and networks to recruit registered pharmacists working in community-based pharmacies. ResultsThere were 22 valid respondents, predominantly female pharmacists (68%), with an average of 7.5 years of registration. All pharmacists knew the correct time frame after unprotected sex for ECPs to be effective, and 73% knew how ECPs worked, but only 50% knew that there were no contraindications. Most pharmacists (86%) knew that ECPs should be available to all women and girls, but only 59% thought that a married woman should not have to get permission from her husband to buy ECPs. Information or education for clients on the correct use of ECPs was mainly provided by pharmacists (59%), mostly through verbal communication (96%). Only 5% of pharmacists had used the emergency contraception methods wheels. ConclusionsThere were gaps in pharmacists’ knowledge regarding ECPs. Biases, judgemental attitudes, and suboptimal practices existed. Implications for public healthTargeted education and training for pharmacists is needed to improve access to ECPs in Fiji.

Higher Learning Female Scholars’ Knowledge and Usage of Emergency Contraceptive Pills in Dodoma Tanzania

Background An emergency contraceptive pill (ECP) is one of the contraceptive methods that provide the last chance of preventing unplanned and unintended pregnancy once there is unsafe sexual intercourse. Higher learning scholars are at danger of getting an unwanted and unplanned pregnancy which poses a major public health concern and needs to be addressed. Therefore study examines higher-learning female scholars’ the level of knowledge and usage of Emergency Contraceptive pills in Dodoma Tanzania.  Methodology A Quantitative descriptive cross-sectional study and a multi-stage sampling technique were used to obtain 909 higher learning female scholars’ aged between 18 to 35 years old residing at Dodoma University, St. John, and College of Business Education in Dodoma, Tanzania. Data was collected using a self-administered questionnaire and analyzed using SPSS version 20  Results The Respondent rate was 99.7%. Among 906 respondents only 30.6% knew emergency contraceptive pills (ECP), 27.7% had never heard about emergency contraceptive pills and 19.5% had ever used ECPs. Among those with knowledge, 33.7% reported using emergency contraceptive pills while for those with no previous knowledge, 21.8% had used ECP. At CI of 95% and p&lt;0.05, the use of ECPs had statistical significance with age, level of education, marital status, ever heard of ECPs, level of knowledge, and sexual relationship.  Conclusion The results of the analysis of this study show that the level of knowledge and usage of emergency contraceptive pills among higher-learning female scholars’ in Dodoma Tanzania was low. At CI of 95, the use of ECPs had a statistical relationship with age, level of education, marital status, ever heard of ECPs, level of knowledge, and sexual relationship.

Evaluation of Emergency Contraceptive Pill Use with Health Management Information Systems Data in Pakistan.

According to the WHO, all clients should have access to a range of contraceptive methods, including at least one short-term, one long-term, one permanent, and one emergency method of contraception. While there are data on the contraceptive method mix available for many low- and middle-income countries, there are limited data on emergency contraception (EC). This is likely due to some surveys not routinely collecting this information, how survey questions are asked, dual method use, and/or low levels of reported use of EC pill (ECP). Even with low reported use in surveys, contraceptive social marketing statistics from DKT International. show a trend in recent years of increasing product sales of ECPs. To understand a more complete scope of ECP use, we use Pakistan as a case study and analyze Pakistan's Demographic Health Survey (DHS) surveys and Pakistan's Contraceptives Logistics Management Systems. Based on commodities dispensed data for ECPs in 2021, about 0.4 percent of all married women in Pakistan use ECPs. While there is currently a small proportion of women, it is growing and the use of ECPs is not zero as indicated by the DHS. Therefore, where available, countries should review their health management information systems data alongside survey data for ECP use.

Qualitative study on stigma as a barrier to emergency contraceptive pill use among university students in the Lango subregion, Uganda

ObjectiveThe 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...

Unveiling reproductive choices: Knowledge and practices of emergency contraceptive pills among the female factory workers in Sri Lanka

BackgroundIn Sri Lanka, the Emergency Contraceptive Pill (ECP) is categorized as a Schedule 2A medication, allowing it to be purchased over-the-counter without a prescription, but exclusively from licensed pharmacists. It is estimated that around 3 million ECPs are consumed by Sri Lankan women each year. This study aims to assess the knowledge and practices of Female Factory Workers (FFWs) on ECP and to unearth the association with unintended pregnancy and unsafe abortion. MethodsAfter receiving written informed consent, a structured interview schedule was administered among 585 FFWs attached to eight factories in a selected Export Processing Zone (EPZ). Data analysis was performed using SPSS software. ResultsOnly 26 % of FFWs were aware of the effective time period to take an ECP to prevent a pregnancy. Most (67 %) had the impression that a valid prescription is required to purchase ECP from the pharmacies. Around one-tenth of the FFWs (11.3 %, n = 66) had used ECP during their lifetime. Among the 65 respondents who reported having experienced unintended pregnancies, only 26.2 % (n = 17) had utilized ECPs. In contrast, among the 22 respondents who disclosed a history of abortion, only two women had ever employed ECPs. ConclusionThe study highlights the low knowledge and use of ECP among FFWs in Sri Lanka, contributing to unintended pregnancy and unsafe abortion. Results call for targeted interventions to improve knowledge and access to ECP, helping to reduce unintended pregnancy and improve reproductive health outcomes.

Do Indian women know about anduse the emergency contraceptive pill? An analysis ofnationally representative data from 2005-06 and2019-21.

The emergency contraceptive pill (ECP) is a post-coital contraceptive method that prevents unintended pregnancy and is useful in specific circumstances. This study examined the awareness and use of the ECP in India, as there is scarce evidence in this area to guide policy development. This study used data from the 2005-06 (n=124 385) and 2019-21 (n=724 115) rounds of the National Family Health Survey of India. Bivariate analysis and multivariate logistic regression were applied to explore how demographic characteristics including age, education (none, primary, secondary, higher), wealth quintile, place of residence (urban, rural), marital status, parity, desire for children, whether current pregnancy was wanted, whether the women had had an abortion in the past 5 years, and whether current use of contraceptive methods affected the likelihood of knowledge and use of ECP. In the past 15 years, knowledge of ECP has increased by 37 percentage points but still remains relatively low at 48%. Less than 1% of the sample (0.55%) used ECP. Women aged 30-34 years, from wealthier and more educated backgrounds, living in urban areas, and currently using condoms had a higher likelihood of using ECP in comparison with women from age group 15-19 years, those from the poorest backgrounds, those with no education, those living in rural areas and those not using any contraceptive method, respectively. In comparison to married women, never-married women exhibited a higher awareness of ECP but lower use. More efforts must be made to improve awareness of the ECP, especially among adolescents, those with less education, poorer women and those in rural areas. The government is taking steps to improve access to ECP, and India's female community health workers, the ASHAs, could be further supported to enhance awareness of ECP.

Knowledge, attitudes, and practices toward emergency contraceptive pills among community pharmacists and pharmacy customers: A cross-sectional study in urban Vietnam

ObjectivesThis study aimed to investigate Vietnamese community pharmacists and pharmacy customers' knowledge, attitudes, and practices about emergency contraceptive pills (ECPs). Study designWe recruited 400 pharmacists and 396 customers via a nonprobability convenience sampling technique. We used univariate and multivariate linear regression models to determine factors associated with the knowledge and attitudes toward ECPs among pharmacists and customers. We selected variables in the multivariate models through the Bayesian Model Averaging method using R software (version 4.2.3). ResultsIn medicine outlets, levonorgestrel and mifepristone (ECPs) were highly available. The average knowledge scores on ECPs among pharmacists and customers were 9.98 ± 2.00 and 6.24 ± 2.33, respectively. Many pharmacists did not have adequate knowledge of ECPs’ mechanism of action, dosage, and contraindications. Customers lacked knowledge about their legislation, effectiveness, and side effects. The attitudes toward ECPs among participants were relatively positive. Reliable information sources about ECPs (such as the package leaflet, courses, and books) played an essential role in increasing ECP knowledge and attitudes (p < 0.001). The availability of ECPs (p < 0.001), being educated (p < 0.01 and 0.01), and daily sales (p < 0.001) were significantly associated with pharmacists’ knowledge/attitudes. Age, education level, marital status, and occupation were significantly associated with customers’ knowledge. Participants’ knowledge of was significantly associated with their attitude toward ECPs (p = 0.02 and p < 0.001, respectively). ConclusionsThe knowledge of ECPs among pharmacists was relatively good, while that of customers was poor. There is a need to have policies and interventions to enhance the knowledge and attitudes toward ECPs for both pharmacists and customers. ImplicationsCommunity pharmacies are ideal settings to dispense contraceptive methods, especially over-the-counter ECPs. Community pharmacists can help ensure the availability of ECPs in medicine outlets, increase women’s access to ECPs, and counsel customers on up-to-date and comprehensive knowledge about these medications, thereby guaranteeing rational ECP use.

Emergency contraception – pharmacists’ knowledge and attitude on emergency contraceptives’ dispensing practices

Abstract Objectives Emergency contraceptives have the potential to reduce health complications in women with unintended/unwanted pregnancies. Access to availability and use of emergency contraceptive pills (ECPs) is influenced by pharmacist knowledge and attitudes, and there are limited data in Nigeria on pharmacists’ ECPs dispensing practices. This study assessed pharmacists’ knowledge, attitude and practice towards the use of emergency contraceptives. Methods A cross-sectional study conducted among 100 community pharmacists in Ibadan metropolis, Nigeria with the use of a self-administered structured questionnaire. The questionnaire contained Likert-type 17-item knowledge, 9-item attitude and 15-item practice scales. The scales utilised 5–7 graded responses. The scaled score was graded as good and poor knowledge, positive and negative attitude and high, moderate or low-level practice of emergency contraception. The ability to predict the level of practice of emergency contraception, based on the pharmacist’s knowledge and attitude towards the use of ECP, was determined with hierarchical multiple regression as P &amp;lt; 0.05. Key findings Good knowledge of emergency contraceptives was displayed by 51.5% of the pharmacists, and 51.9% had a positive attitude towards the use of ECPs. The level of ECP dispensing practices was high among 43.4% of pharmacists and low among 30.1% of pharmacists. More than 30% of the pharmacists offer a high level of educational services practice for ECPs. Pharmacists’ knowledge (β = 0.348, P = 0.002) and attitude (β = −0.302, P = 0.007) were predictive of the dispensing practice of ECPs. Conclusion The community pharmacists have good knowledge of emergency contraceptive use and showed a positive attitude towards the dispensing of emergency contraceptive pills.

Patterns of use of emergency and oral contraceptives from an online service in the United Kingdom during the COVID-19 pandemic: A quantitative study of routinely collected data

ObjectivesOur study aimed to describe users of a free online contraception service, compare online emergency contraceptive pill (ECP) users with online oral contraceptive (OC) users, and describe patterns of use of online ECP and OC over time, including transition from ECP to more effective forms of contraception. Study designAnalysis of routinely collected, anonymized data from a large, publicly funded, online contraceptive service in the United Kingdom from April 1, 2019 to October 31, 2021. ResultsThe online service provided 77,447 prescriptions during the study period. About 84% for OC and 16% for ECP, of which 89% were ulipristal acetate. ECP users were younger, lived in more deprived areas, and were less likely to be of white ethnicity than OC users. About 53% ordered OC only, but 37% ordered both ECP and OC. Among those prescribed both OC and ECP (n = 1306), 40% had one method as dominant, 25% appeared to move from one method to the other (11% ECP to OC, 14% OC to ECP), and 35% continued to use both methods. ConclusionsOnline services are accessible to diverse young populations. While the majority of users order OC only, our study suggests that where there is free, online access to both OC and ECP, and those ordering ECP are always offered free OC, transition to more effective ongoing forms of contraception is uncommon. Further research is needed to understand whether online access to ECP increases its attractiveness and reduces likelihood of transition to OC. ImplicationsThis study demonstrates that free, online contraceptive services are accessible to ethnically and socioeconomically diverse users. It identifies a subgroup of contraceptive users who combine use of OC and ECPs over time, and suggests that improved access to ECP may alter contraceptive choices.

Perception of Condoms and Emergency Contraceptive Pill Use among Students in the University of Bamenda

Background: Globally, university students fall in the youth group prone to unattended sexual risks which may lead to unwanted pregnancy and STI/HIV. In Cameroon, more than a third of maternal deaths occur among adolescent girls and young mothers. Unwanted pregnancies results from the infrequent use of modern contraceptive methods and is one of the main causes of death in this population. Condoms are barrier contraceptive that have a beauty of dual protection-against pregnancy and transmission of STI/HIV, meanwhile emergency contraceptives has just one function which is protection against unwanted pregnancy. Aim: To assess the perception of condoms and emergency contraceptive pill use among students in the university of Bamenda, Cameroon. Materials and Methods: A university-based cross-sectional study was conducted among students in the University of Bamenda, North West Region of Cameroon, a cosmopolitan area approximately about 19 km from Bamenda main town (Commercial Avenue). The study was carried out over a period of three months. Data were collected using a structured interviewer questionnaire administered through Google form. Data collected were extracted into excel sheet and analysed with SPSSv23. Results: The study included 719 students (318 males and 401 females). The rate of male and female condom use was 28.5% and 8.1% respectively. The mean age of our study populations was 24.5 ± 4.97 years with 52.7% of population between 20 to 24 years of age. Knowledge about condoms was high at 98.3%, however, 91.9% of participants have never used the female condoms before. Highest factor recorded for non-utilisation of the male and females condoms were reduction in sexual pleasure (47.4%) and lack of knowledge on usage (44.1%) respectively. 95% of students have knowledge on Emergency Contraceptive Pills (ECPs) but just an average (52.4%) have used it before. Fear of side effects (47.4%) was the main reason for not using ECPs. Conclusion: There is a very high knowledge about condom and emergency contraceptive pill among students. However, the rate of usage recorded was very low with highest source of information being the media/internet and lowest among relatives/family.

Factors Responsible for the Decline Contraceptive Prevalence rate in Nepal

This study is based on the factors responsible for the decline in the use of contraceptives in Nepal since 2006. The main objective of this study is to identify potentially responsible factors contributing to the reduction of CPR in Nepal. This study is based on a secondary resource. For the purpose of this study, data and information has been collected from various sources such as demographic and health survey reports, published national and international articles and reports in related contexts. The Family Planning Program is a priority program of the Government of Nepal, established with the objective of ensuring that individuals and couples fulfill their reproductive needs and rights using quality family planning methods based on voluntarily informed choices. The use of temporary contraceptives in Nepal has not increased over the past few years and has remained stable rate since 2011 and 2016. This does not mean an overall decline in the prevalence of contraceptives because of the prevalence rate of any method of contraception has increased (53%) in 2016 from 50 percent in 2011 and 48 percent in 2006. Since 2006, the uses percentage of modern contraceptive methods has not increased, this study is focused on the causes of low or stable contraception rate. Still, the current supply of contraceptives has not able to meet the high demand of contraceptive users. The demand for contraceptives was 67 percent in 2016.The reasons for the decline in contraceptives in Nepal could be (a) Spousal Separation (especially in the reproductive age group), (b) increasing use of traditional methods, (c) legalization of abortion and (d) use of emergency contraception. Results show that 47 percent of married women discontinued the use of family planning methods because of their husband being away from home. Similarly, 9.8 percent of married women were traditional method users. After the legalization of abortion, the number of abortions has been gradually increasing over the year and the use of emergency contraceptive pills is also increasing day by day.

Knowledge and attitude toward emergency contraceptive pills among first-year undergraduate students in Southern Thailand

BackgroundFirst-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.MethodsThis 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.ResultsData 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.ConclusionThe 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.

Emergency Contraceptive Pill Use and its Impact on Condom Utilization Among University Students: A Cross-Sectional Study.

PurposeEmergency contraceptive pills (ECPs) prevent unplanned pregnancy but not sexually transmitted infections (STIs), and the practice of ECP may affect condom use. This study, therefore, aimed to assess ECP use and its impact on condom utilization among female students of private universities in Nekemte town, western Ethiopia.MethodsAn institution-based cross-sectional study was conducted on 400 female students in three different private universities from February 1 to 28, 2019. Study samples were selected through simple random sampling technique. Data collected from a structured self-administered questionnaire were analyzed using SPSS version 23.0. Bivariate and multivariate logistic regression were performed to determine factors associated with condom utilization, and statistical significance was set at 95% confidence interval (CI) using a p-value of <0.05 as a cutoff point.ResultsThe response rate was 95.3% (381/400). Overall, 51.4% (196/381; 95% CI = 45.1%, 57.7%) had awareness of ECP. Besides, 186 (48.8%) students reported history of sexual intercourse, of which 115 (61.8%) have ever practiced ECP and 96 (51.6%) have ever used condom. However, only 11 (5.9%) have ever utilized ECP and condom concurrently. Use of ECPs (adjusted odds ratio (AOR) = 0.32; 95% CI = 0.164, 0.632; p = 0.001), belief that condom prevents STI (AOR = 3.17; 95% CI = 1.045, 8.646; p = 0.041) and thought that ECP does not prevent STI (AOR = 2.217; 95% CI = 1.172, 4.59; p = 0.032) had statistically significant association with condom utilization.ConclusionThe practice of ECP was average, while dual method contraception use was low in the study area. History of ECP use and beliefs that ECP is not effective to prevent STI or condom protects against STI were factors associated with condom use.

Trends in Emergency Contraceptive Use Among Adolescents and Young Adults, 2006–2017

PurposeIn 2013, age restrictions for adolescents on over-the-counter access were removed for “Plan B One-Step”, a single oral medication option for emergency contraception use. Restrictions on generic options of the emergency contraceptive pill (ECP) were removed in 2014. MethodsNational Survey of Family Growth data were used to assess the prevalence of ever use of ECPs among sexually experienced female adolescents and young adults (AYA) aged 15–24 years (2015–2017 sample), and trends in indicators of ECP use and acquisition (2006–2017 samples). Prevalence estimates were obtained by age subgroups for 15–17, 18–19, and 20–24 years. Statistical significance was determined using an alpha of .05 and 95% confidence intervals calculated around the point estimates. ResultsThe weighted estimate of sexually experienced female AYA in the United States ranged from 13.3 million in 2006–2008 to 12.7 million in 2015–2017. The prevalence of ever ECP use was 18.2% (95% CI 15.7–21.1) and 31.8% (95% CI 26.9–37.1) in 2006–2008 and 2015–2017, respectively. Ever use in 2015–2017 varied by age group, number of lifetime opposite-sex partners and abortions, and experience of nonconsensual sex. In 2008–2010, 46.1% (95% CI 36.0–56.5) of respondents last obtained ECPs at community health or family planning clinics, and 31.8% (95% CI 22.9–42.2) last obtained ECPs at a pharmacy compared to 18.1% (95% CI 12.0–26.4) and 70.1% (95% CI 60.6–78.1) respectively in 2015–2017. Prevalence of provider counseling about emergency contraception in female AYA regardless of prior sexual experience in the past 12 months remained at or below 5% from 2006 to 2017. ConclusionIncreasing access to ECPs over-the-counter may have contributed to notable increases in reported ever use of ECPs and in the receipts from a pharmacy among AYA between 2006 and 2017. AYA may benefit if pharmacists and healthcare providers increase reproductive health counseling.

Determinants of emergency contraceptive pill use in Bangladesh

Objective: To examine the determinants of emergency contraceptive pill use in Bangladesh. Methods: Data for this cross-sectional study came from 2017-2018 Bangladesh Demographic and Health Survey. Characteristics of 906 reproductive age women who were potential candidates for using emergency contraceptive pill were analysed in this study. Data were analysed using univariate and multivariate analyses. Stepwise binary logistic regression was employed as multivariate analysis. Results: Only 10.9% candidates were found to ever use emergency contraceptive pill. The odds of using emergency contraceptive pill for women visited by family planning field worker was significantly higher than that for those who were not visited by family planning field worker [odds ratio (OR) 1.94; 95% confidence interval (CI) 1.19–3.17; P=0.008], while the odds of using emergency contraceptive pill for women with high socioeconomic status was higher than that for those with low socioeconomic status (OR 3.10; 95% CI 1.61–5.97; P=0.001). Additionally, having some media access was linked to an increase in the odds of using emergency contraceptive pill (OR 3.01; 95% CI 1.33–6.83; P=0.008). Women empowerment related factors did not show any significant effect on emergency contraceptive pill use. Conclusions: The findings indicate that family planning programme has a great opportunity of playing an important role in increasing emergency contraceptive pill use in Bangladesh by increasing the knowledge and awareness of women about emergency contraceptive pill.

Over-the-counter provision of emergency contraceptive pills: a systematic review

ObjectiveTo synthesise evidence around over-the-counter (OTC) emergency contraceptive pills (ECPs) to expand the evidence base on self-care interventions.DesignSystematic review (PROSPERO# CRD42021231625).Eligibility criteriaWe included publications comparing OTC or pharmacy-access ECP with...

The emergency contraceptive pill in Brazil: High usage rates but schooling differences persist

ObjectivesThis paper aims to analyze usage rates for the emergency contraceptive pill (ECP) among women living in the city of São Paulo and their associated factors. Study designA population based cross-sectional survey was conducted in 2015 with a probabilistic sample of 4,000 women aged 15 to 44 living in São Paulo, Brazil. Response rate for households was 75% and 77% for eligible women. Binary logistic regression models were used to describe the association between each outcome and selected variables. ResultsA total of 51.4% of women living in the city of São Paulo had used ECP at least once in their lifetime. Women under 35 were more likely to use ECP, as were those with more than 9 years of schooling, having at least one live birth, not cohabiting with a partner, with more than two lifetime sexual partners and as length of sexual life decreased. Among ECP users, 32.6% used it only once, 47.5% used it 2 to 4 times, and 19.9% used it 5 or more times. ConclusionsOur findings suggest that ECPs have been incorporated into the contraceptive method mix for many women as a fundamental strategy for regulating fertility. Particularly young women, unmarried women and those who have had more partners seem to take greater advantage of ECP to prevent pregnancy. ImplicationsDespite the high use rate, lower levels of schooling are associated with lower levels of ECP use. There is a need for both policies to reduce schooling inequities and strategies to improve women's knowledge of reproduction and contraception.

The Role of Health Care Providers in Young Women's Attitudes about and Willingness to Use Emergency Contraceptive Pills.

Emergency contraceptive pills (ECPs) are an underused resource among adolescent and young adult women who have unprotected sex. This analysis examines young women's attitudes about and willingness to use ECPs, with particular attention to their experiences with health care providers. Sexually active young women (ages 15-25, assigned female at birth, N=212) completed a self-administered survey at 10 family planning clinics in the San Francisco Bay Area. Participants reported attitudes about ECP effectiveness, safety, effect on sex drive, and whether it should not be taken often, and their willingness to use ECPs in the next 3months. The predictors of interest were past and current contraceptive experiences with health care providers. Data were analyzed through descriptive statistics and multivariable logistic regression analyses controlling for sociodemographic characteristics, prior contraceptive use, pregnancy history, and pregnancy intentions. Most young women agreed that ECPs are effective at preventing pregnancy (75%) and safe to use (71%); few reported that they reduce sex drive (11%). Yet, the majority (62%) believed ECPs should not be taken often and only 35% reported willingness to use ECPs. In multivariable analyses, more positive health care experiences were associated with more positive attitudes about ECP safety, less concern that ECPs should not be taken often, and greater willingness to use ECPs (p<.05). Health care providers play an important role in the acceptance and provision of ECPs, especially for young women who prefer ECPs over other contraceptive methods. In particular, providers can use the contraceptive visit as an opportunity to destigmatize repeat ECP use.

“It prevents a fertilized egg from attaching…and causes a miscarriage of the baby”: A qualitative assessment of how people understand the mechanism of action of emergency contraceptive pills

ObjectiveThe mechanism of action (MOA) of emergency contraceptive pills (ECPs) is frequently mischaracterized. Our objective was to identify how members of the general public understand the mechanisms of ECPs. Study designWe recruited a convenience sample from social media for a survey about reproductive health attitudes and analyzed spontaneous descriptions of how ECPs work. We inductively coded responses to create themes and subthemes, and collapsed subthemes into three MOA categories based on previous research. ResultsAmong 1443 respondents, 533 mentioned an MOA in their description of ECPs. While nearly half of these responses (49.5%) stated that ECPs prevent pregnancy before fertilization occurs (in accordance with most biomedical ECP research), over 60% described a mechanism related to preventing implantation of a fertilized egg. Nine percent of responses described a postimplantation mechanism that would be considered abortion by mainstream medical standards. Some respondents conveyed significant confusion about the biological processes involved with pregnancy and pregnancy prevention. ConclusionConfusion about how ECPs work was common among our sample. The largest group of responses described a mechanism—preventing implantation of a fertilized egg—listed on the Food and Drug Administration (FDA)-approved ECP labels that does not reflect most relevant biomedical research. Mischaracterizations of ECPs’ mechanisms have been used to limit access to EC. These misunderstandings were common in our sample and may reflect poor quality sex education and public information, and confusion introduced by the FDA-approved labels. Additional research should identify whether public perception of ECPs’ mechanisms influences policy, health care provision, and use of ECPs.