Emergency Contraception Research Articles

What about access to birth control and emergency contraception now that abortion rights are overturned?

What about access to birth control and emergency contraception now that abortion rights are overturned?

Emergency Contraception: Access and Challenges at Times of Uncertainty.

The UN Commission on Life-Saving Commodities for Women and Children identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation. Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access. PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetricians and Gynecologists, the World Health Organization, The United Nations. A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device. EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts , threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.

Emergency contraception subsidy in Canada: a comparative policy analysis

BackgroundIn Canada, cost prohibits access to emergency contraception (EC) which may assist to prevent unintended pregnancy. The drug, ulipristal acetate (UPA-EC), is more clinically effective and cost-effective than the prior standard levonorgestrel (LNG-EC). We analyzed provincial EC subsidization policies and examined underlying decision-making processes.MethodsWe undertook documentary analysis of provincial EC subsidization policies in publicly available drug formularies. We conducted semi-structured interviews with key informants to explore the processes underlying current policies.ResultsQuebec is the only province to subsidize UPA-EC, whilst all ten provinces subsidize LNG-EC. As such, provincial EC subsidization policies do not align with the latest UPA-EC evidence. Interviews revealed that evidence was valued in the policymaking process and formulary decisions were made through interdisciplinary consensus.ConclusionsWe identify a gap between EC subsidization policies and the latest evidence. Institutional structures affect policies reflecting evolving evidence. Increasing interdisciplinary mechanisms may encourage evidence-based policies.

Awareness and acceptance of contraception in postpartum women at government maternity hospital, Tirupati

Introduction: Contraception is an important intervention to decrease unwanted pregnancies and promote healthy and better living among women. As the population continues to rise, there will be overcrowding, a limiting of resources, and the quality of life will decline. India, as the first country in the world, initiated the National Family Planning program in the year 1951 with the objective of “reducing the birth rate to the extent necessary to stabilize the population at a level consistent with requirement of national economy.”Methodology: It is a cross sectional questionnaire-based study carried out in the Department of Obstetrics and Gynaecology at Government Maternity Hospital, Tirupati. A total of 300 postpartum women were enrolled in the study who are briefed about study. After taking informed consent, they were interviewed based on a predesigned questionnaire they were allowed to choose any method of contraception they like. Their level of awareness, acceptance, and reason for refusal was assessed.Results: Among 300 women in the study group, more than 80% were in the age group of 15 to 30 years.51.7% women in urban areas, 48.3% women in rural areas. Majority of the women were Hindus. 89.3% women were literates and majority of them were house wives. Most of the women had only one living issue. It was observed that both were highest in educated working women, urban population. Acceptance was highest in women with 2 to 3 children. Maximum number of women were aware of female sterilization (90.1%), condoms (88%), intra uterine device (77.6%), OC pills (75.2%), POP’s (56%). Knowledge regarding emergency contraception was very low (2.9%).Conclusion: There is still date lack of awareness of contraception in some postpartum women. Regular counselling is a must to all pregnant women from every health care centre in a village to super speciality centres in cities. Information should be provided about various methods of contraception and patient should be able to choose a method of her choice.

Does it matter what type of IUD for Emergency Contraception?

Garigan, Thomas P. MD; Earwood, John S. MD; Wilkinson, Christopher T. DO, MS Author Information

Oral Emergency Contraception Provision in the Veterans Health Administration: a Retrospective Cohort Study

ABSTRACTBackgroundIn the USA, oral emergency contraception (EC) use to prevent unintended pregnancy is increasing. Oral EC methods include levonorgestrel (LNG) and ulipristal acetate (UPA), with increased UPA efficacy over LNG in high BMI users and those beyond 3 days post intercourse. The Veterans Health Administration (VHA) provides oral EC at low or no cost, yet prescription-level Veteran data are lacking.ObjectiveTo describe oral EC provision in VHA, including method type and Veteran user and prescriber characteristics.DesignA retrospective cohort study using VHA administrative data.ParticipantsAll VHA oral EC prescriptions from January 1, 2016, to December 31, 2020.Main MeasuresWe linked Veteran-level sociodemographic and military characteristics and provider-level data with each prescription to identify variables associated with oral EC method.Key ResultsA total of 4280 EC prescriptions (85% LNG) occurred for 3120 unique Veterans over 5 years. While prescriptions remained low annually, the proportion of UPA prescriptions increased from 12 to 19%. Compared to LNG users, UPA users were older (34% vs 25% over age 35 years, p <0.001); more likely to identify as white (57% vs 46%) and non-Hispanic (84% vs 79%) (p <0.001); and more likely to have a BMI ≥ 25 (76% vs 67%, p <0.001). UPA prescriptions originated most frequently from VA Medical Centers (87%) and women’s health clinics (76%) compared to community-based or other clinic types. In multivariable regression models, race, ethnicity, BMI ≥30, and prescriber facility type of a VA Medical Center or a women’s clinic location were predictive of UPA prescription.ConclusionsOral EC provision in VHA remains low, but UPA use is increasing. LNG prescription occurs frequently in high BMI Veterans who would benefit from increased efficacy of UPA. Interventions to expand oral EC access in VHA are essential to ensure Veterans’ ability to avert unwanted pregnancies.

Knowledge and Perception of Senior High School (SHS) Students about Emergency Contraceptive Use in the Garu and Tempane Districts

The perception and knowledge people have about family planning health services are likely to affect the kinds of decisions they are likely to make about the service. The main purpose of the study was to assess the knowledge and perception of Senior High School students about emergency contraceptive use in the Garu and Tempane Districts. A descriptive (cross-sectional) survey design adopted. A questionnaire was administered to a sample of 248 students, who served as respondents. The sample was selected using the multistage sampling procedure. The data analyses were done using frequencies, percentages, mean and standard deviation and the independent sample t-test. The results showed that students had knowledge about emergency contraceptives. The results also, provided evidence that the students had negative perception about emergency contraceptive use. Furthermore, it was evident that male and female students had similar perception about emergency contraceptive use. It was recommended that the Ghana Health Service (GHS) should intensify their sex education as part of their health education programmes for students in the Senior High Schools.

The impact of caller characteristics on levonorgestrel emergency contraception access in West Virginia community pharmacies

ObjectiveAccess to levonorgestrel (LNG) emergency contraception (EC) has increased since the FDA removed age restrictions on over-the-counter (OTC) LNG EC in 2013, but availability is highly variable and numerous barriers to access remain. The purpose of this study was to assess availability and accessibility of LNG EC at community pharmacies in West Virginia (WV). MethodsA mystery caller cross-sectional study was conducted to assess availability and accessibility of LNG EC. Inquiries were made by identified ‘research’ staff and by staff presenting as a 16 y/o. ResultsNearly half of community pharmacies reported having LNG EC in stock. Pharmacy staff were significantly more likely to tell research callers LNG EC was in stock (53%) and more likely to report willingness to order it (50%) than ‘teen’ callers (45% and 34%, respectively). There was no significant difference between caller types on the five barriers assessed. ConclusionLack of availability may contribute to teen and unintended pregnancies.

Knowledge and counseling preferences of the public and pharmacy staff on emergency contraception: Results of a cross-sectional study in Belgium

ObjectiveTo assess the knowledge and counseling preferences of the public (‘individuals’) and pharmacy staff (‘professionals’) in Belgium on emergency contraceptive pills (ECPs). Study designCross-sectional study using 2 different anonymous, online surveys (one addressing the public and one professionals). ResultsOverall, 1518 individuals and 1118 professionals participated, obtaining a mean knowledge score of 6.3(±1.8)/10 and 5.0(±1.6)/10, respectively. For the public, a lower level of knowledge was found among men, nonhealthcare workers, and low educated individuals with no prior ECP use/purchase. For professionals, a lower level of knowledge was observed among pharmacy-technicians, French-speaking persons, and professionals with ≥5 years of experience and poorly involved in continuous education. ConclusionsLimited knowledge on ECPs was observed among the public and pharmacy staff in Belgium, underscoring educational and counseling opportunities on ECPs.

Knowledge and attitude on sexually transmitted infections and contraceptive use among university students in Bhutan.

ObjectivesThe unmet needs of contraception can lead to unintended pregnancy and transmission of sexually transmitted infections (STI). Therefore, this study aimed to evaluate the contraception use, knowledge, and attitude on STI among students under Royan University of Bhutan (RUB).MethodsThis was a cross-sectional study using an online questionnaire. The questionnaire was developed in Google forms and the link was shared through the college WeChat groups. The questionnaire consisted of four parts on socio-demographic, sexual behaviour and contraceptive use, knowledge, and attitude on STIs. All the students under RUB were invited to participate voluntarily in this study. The socio-demography was presented in frequency and proportion.ResultA total of 1,283 students participated in this survey and 55.0% (701) were females. Of this, 29.4% (377) were sexually active and 94.4% reported using modern contraception. Commonly used contraceptives were: condoms (83.8%, 316) and emergency contraceptives (20.6%, 78), respectively. The mean knowledge and attitude scores on STI were 9.94 (range 2–20) and 12 (range 2–14), respectively. Good knowledge and attitude on STI were reported in 53.2% (683) and 70.1% (899) of participants.ConclusionStudents reported average knowledge and a good attitude towards STI. Contraceptive use among university students was low. There is a need to strengthen health education on STIs in schools and universities. All forms of contraceptives especially condoms should be made easily available to sexually active people.

Emergency contraception in the iPLEDGE program: A cross-sectional survey of pediatric dermatology provider understanding and practice.

For patients with acne treated with the teratogen isotretinoin, emergency contraception (EC) is the only recourse when abstinence fails or effective contraception is not properly used. The purpose of this study was to evaluate the current understanding and provision of EC among pediatric dermatology providers. The survey found that 37% (21/57) of providers indicated they were at least somewhat confident in their understanding of EC. 7% (4/57) of providers agreed/strongly agreed that they provided EC counseling to all patients of reproductive potential at their initial visit and 3.5% (2/57) agreed/strongly agreed that they provide EC counseling at follow-up visits. Our survey results suggest the need for improved EC education for pediatric dermatology providers and subsequent counseling for patients of reproductive potential on isotretinoin therapy.

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.

Objection or Obstacle: Applying Amartya Sen's Capability Approach to the Conscientious Refusal of Emergency Contraception.

The conscientious refusal to dispense emergency contraception (EC) is legally protected in fourteen states. While the ethical dimensions of these objections have been explored within moral and feminist philosophy, conscientious refusal to the over-the-counter sale of EC has not been significantly studied through an egalitarian lens, especially with attention to the existing reproductive healthcare landscape in which these refusals occur. This article argues, through Amartya Sen's capability approach, that conscientious refusal to EC creates a burdensome inequality for people wishing to prevent pregnancy that manifests within a background of historical injustices, elevating its importance in our weighing of capabilities.

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.

Abortion Is Only the Beginning

Abortion Is Only the Beginning

Effect of Educational Instructional Module on Childbearing Women's Awareness Regarding Emergency Contraception.

Effect of Educational Instructional Module on Childbearing Women's Awareness Regarding Emergency Contraception.

From request to dispensation: how adolescent and young adult females experience access to emergency contraception in pharmacies

Purpose Emergency contraception (EC) access was liberalised in 2002 in Switzerland by making it accessible in pharmacies without medical prescription. However, its dispensation still requires a confidential interview with a pharmacist. This qualitative study aims to explore experiences of adolescent and young adult (AYA) females who have gone to a pharmacy in order to obtain EC. Materials and methods Thirty interviews were conducted from April to August 2019 with females aged between 15 and 25 years old at the interview. Inclusion criteria was to have requested at least one EC in a pharmacy between 2014 and 2019. A thematic content analysis was performed to extract themes brought up by the participants. Results Some participants reported that the most difficult moment in the process was the request at the counter. The majority of participants were escorted in a private back room but opinions were divided regarding this isolation. Experiences were sometimes negative due to lack of information and knowledge regarding the dispensation process. The interview also has also a preventive aim, but the information given during it often focussed solely on the risk of vomiting. Several participants reported having perceived or received moral judgements from pharmacists. Conclusions Pharmacists are key resources and EC dispensation an opportunity for sexual health. This exploratory study presents several elements requiring the adaptation of practices in order to prevent them from becoming barriers for AYA to access EC. Concerns are regularly expressed by young women about privacy, embarrassment and judgement in the pharmacy context regarding contraception.

Contraceptive care service provision via telehealth early in the COVID-19 pandemic at rural and urban federally qualified health centers in 2 southeastern states.

PurposeTo investigate telehealth use for contraceptive service provision among rural and urban federally qualified health centers (FQHCs) in Alabama (AL) and South Carolina (SC) during the initial months of the COVID‐19 pandemic.MethodsThis is a mixed‐methods study using data from the FQHC Contraceptive Care Survey and key informant interviews with FQHC staff in AL and SC conducted in 2020. Differences between rural and urban clinics in telehealth use for contraceptive service provision were assessed with a chi‐square test of independence. Interviews were audio recorded, transcribed, and coded to identify facilitators and barriers to telehealth.FindingsTelehealth for contraceptive care increased during the early months of the pandemic relative to prepandemic. Fewer rural clinics than urban clinics provided telehealth for contraceptive counseling (16.3% vs 50.6%) (P = .0002), emergency contraception (0.0% vs 16.1%) (P = .004), and sexually transmitted infection care (16.3% vs 34.6%) (P = .031). Key facilitators of telehealth were reimbursement policy, electronic infrastructure and technology, and funding for technology. Barriers included challenges with funding for telehealth, limited electronic infrastructure, and reduced staffing capacity.ConclusionsDifferences in telehealth service provision for contraceptive care between rural and urban FQHCs highlight the need for supportive strategies to increase access to care for low‐income rural populations, particularly in AL and SC. It is essential for public and private entities to support the implementation and continuation of telehealth among rural clinics, particularly, investing in widespread and clinic‐level electronic infrastructure and technology for telehealth, such as broadband and electronic health record systems compatible with telehealth technology.

Knowledge and Utilization of Family Planning Methods among people living with HIV in Kathmandu Valley

Background: HIV is a major global health issue, targeting the immune system and making the body prone to diseases. People living with HIV mostly face societal stigma and fear of disclosure resulting in discrimination of accessing health facilities leading to multiple sex partners, increased sexual activity and less use of condoms. HIV positive women are at risk of transmitting HIV to their infants and their partners. Thus, the family planning services if provided to PLHIV can help to improve their and families health. In addition to, it reduces the risk of mother-to-child transmission (PMTCT). Family planning is seemed to be a cost effective strategy for preventing mother to child transmission of HIV (PMTCT). In Nepal, people living with HIV/AIDS were found to experience stigma and discrimination, ultimately resulting in discrimination of accessing health facilities. The purpose of this study is to explore the knowledge of family planning methods and identify factors affecting the current utilization of such methods among HIV infected men and women attending ART sites of Kathmandu Valley. The study is expected to contribute in enhancing the present understanding of PLHIV towards family planning. Methods: The cross sectional descriptive method was used for the research. The study followed Population proportion to size method for the calculation of the respondents from four ART sites of Kathmandu Valley. Structured questionnaire used previously in similar research has been adopted with necessary question related to dual contraceptive use. Results: The mean age group of the respondents was (39.16 ± 6.969) years. More than two third respondents (69.5%) were Hindu. 34.8% respondents were married at the less than 20 years of age. Almost three- fourth of the PLHIV (74.4%) were literate where more than three fourth (79.3%) their spouses were literate and educated. About half of the respondents (43.9%) were found to be involved in professional/ technical/ managerial. More than half of the respondent’s spouses (63.4%) were HIV positive. All the respondents (100%) respondents had disclosed their status to their partners. Neither the respondents nor their partner had desire of further child. 28% of neither respondents nor their partners had used the family planning methods before HIV diagnosis. More than half (60.4%) of the respondents had sexual intercourse prior to last 6 months. 15.9% of the respondents positively responded to use of dual protection. Only 11% either respondents or their partners had used the emergency contraceptive pill. 17.7% respondents did not use any family planning. This study revealed that almost half of the respondents (48.8%) had the good knowledge on the use of contraception. Conclusion: The use of dual protection is much less than the half of the respondents. Therefore, counseling and health education towards motivating PLHIV on using dual FP methods to avoid the risk of HIV, STIs and unplanned pregnancy is encouraged.

Conscientious Objection to Emergency Contraception

Conscientious Objection to Emergency Contraception