Making Emergency Contraception Research Articles

Assessment of Knowledge, Attitude and Utilization of Emergency Contraception among Unmarried Women of Reproductive Age in Adama, Ethiopia

Background: Knowledge about methods of emergency contraception could reduce the level of unwanted pregnancy and unsafe abortion. Particularly, utilization of emergency contraception among unmarried women have beneficiary health outcome as it adds choice for helping sexually active unmarried women to avoid unintended pregnancy and its consequences. Objectives: To assess knowledge, attitude and utilization of emergency contraception among unmarried women of reproductive age. Methods: A cross-sectional community based survey was conducted among 491 unmarried women of reproductive age chosen by systematic random sampling method at Adama Town. Collected data using pre-tested structured questionnaire were analyzed by chi-square test and binary logistic regression. Result: From the total unmarried women participated in the study (n=470), one hundred eighty two (38.7%) had knowledge of emergency contraception. Of these 182, one hundred seventy three (95%) of them know oral pills only and the rest know oral pills and intra uterine devices as a method of emergency contraception. About 61.3% of those ever heard of emergency contraception had positive attitude towards making emergency contraception available to all women who need it but only 4.2% of respondents reported that they had used emergency contraception previously. Age, educational status, occupation, knowledge of time in menstrual cycle when pregnancy is more likely to occur, having experience of sexual intercourse and having discussion on reproductive health are significantly associated with awareness of emergency contraceptive (p < 0.001). Conclusion: Emergency contraception knowledge, attitude and utilization among sampled urban unmarried women is low. Therefore, there is a need to emphasize on increasing knowledge and accessibility of emergency contraception to all unmarried women in the study area.

Behind-the-Counter, but Over-the-Border? The Assessment of the Geographical Spillover Effects of Emergency Contraception on Abortions.

Washington was the first state to ease the prescription requirements making emergency contraception (EC) available behind-the-counter at pharmacies to women of any age in 1998. Using county-level vital statistics data in conjunction with the pharmacy specific location data from the Not-2-Late Hotline database, I study whether the increased access to EC affects fertility rates within the state and beyond the borders of the state that allows it. Unlike other studies that rely on geographic variations in access, I show that increased availability of EC in Washington, measured by the distance to the closest 'no-prescription EC pharmacy', is associated with a statistically significant albeit economically moderate decrease in abortion rates in Washington counties where women had access to 'no-prescription EC'. These effects are localized (i.e., decrease with travel distance) and robust in a number of specifications. Finally, I find some evidence in support of geographical spillover effects in Idaho, but not in Oregon. However, after accounting for the availability of abortion services, the decrease in 'treated' Idaho counties is rather small. Copyright © 2016 John Wiley & Sons, Ltd.

Factors associated with utilization of emergency contraception among female students in Mizan-Tepi University, South West Ethiopia.

BackgroundUnintended pregnancy poses a major health problem on female students in higher educations. One of the key interventions to reduce unintended pregnancy and unsafe abortion as outlined in the national youth strategy is making emergency contraception (EC) available for these risky population. However, despite its availability in many countries, EC has failed to have the desired impact on unintended pregnancy rates and its utilization is limited in colleges and universities. The objective of this study was to assess factors associated with utilization of emergency contraception among female students in Mizan-Tepi University (MTU), south west Ethiopia.MethodsA cross-sectional, institution based study was conducted from March 10–30, 2014. Multistage sampling technique was used to select the participants for the quantitative method whereas; purposive and volunteer sampling techniques were used for the qualitative study. Quantitative data were cleaned, coded and entered into Epi-data 3.1 and analyzed using SPSS version 20:00. Binary and multiple logistic regression analysis were done to determine the association between the use of EC and the predicator variables. Data from focus group discussion were transcribed and translated to English then coded, and categorized into similar themes.ResultA total of 489 female students were participated in the quantitative study making a response rate of 90.6 %. The finding shows that 46.3 % of them have used EC following unprotected sex. Female students’ knowledge about EC [AOR: 3.24; 95 % CI 1.32, 7.98], age at first sexual intercourse (i.e. ≥20 years) [AOR: 4.04; 95 % CI 1.72, 9.52], history of pregnancy [AOR: 3.12; 95 % CI 1.34, 7.24] and previous use of regular contraceptives [AOR: 5.01; 95 % CI 2.23, 11.27] were found to be significant predictors of EC utilization. In the focused group discussion, a total of 32 female students were participated and the result shows that lack of knowledge about EC and fear of being seen by others (information disclosure) were reported as main factors for not using EC.ConclusionThe study shows that the level of EC use was low. Female students’ level of knowledge about EC, age at first sexual intercourse, previous use of regular contraceptives and history of pregnancy were major predictors of EC utilization. Therefore, designing strategies to enhance EC utilization by increasing female students’ level of awareness on EC is recommended.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1812-6) contains supplementary material, which is available to authorized users.

Behind-the-Counter, But Over-the-Border? The Assessment of the Spillover Effect of Increased Availability of Emergency Contraception in Washington on Neighboring States

Washington was the first state to ease the prescription requirements making emergency contraception (EC) available behind-the-counter at pharmacies to women of any age in 1998. I hypothesize that the increased availability of EC affects fertility rates beyond the borders of the state that allows it. In contrast to the literature, I show that increased access to EC is associated with a statistically significant albeit economically small decrease in abortion rates in Washington counties where women had access to no-prescription EC pharmacies. Yet, there is no effect on pregnancy rates. These results are robust in a number of specifications. Finally, I find some evidence in support of the spillover effects in Idaho, but not Oregon. However, after accounting for changes in the availability of abortion services, the decrease in fertility rates in treated Idaho counties is rather small and models lack sufficient power to detect it.

The effect on use of making emergency contraception available free of charge

BackgroundCost is a barrier to use of emergency contraception (EC). Since 2008, EC has been available free of charge without restriction in pharmacies throughout Scotland. A survey of EC use among women requesting abortion in 2010 allows comparison of use reported in earlier surveys, when EC was only available on prescription and when EC was available from the pharmacy but at a cost. Study DesignA questionnaire survey about knowledge of the availability of free EC from pharmacies, and its use to prevent the index pregnancy, was performed among 204 women requesting abortion in Edinburgh, Scotland. ResultsSeventy percent of 204 respondents (n=143) knew that EC was available free from pharmacies; 22 (11%) had used it in the cycle in which conception occurred. EC use was not influenced by knowledge of its availability free of charge. Women from affluent areas were significantly more likely to have used EC to try to prevent the pregnancy than counterparts from less affluent areas (p=.041). ConclusionsNeither availability from the pharmacy nor removal of a charge for EC has increased its use among women having an abortion in Scotland.

Emergency Contraception: Perceptions and Use Patterns

Despite efforts to make emergency contraception (EC) readily available, many women do not take advantage of this option. Investigators assessed use

Emergency Contraception in Peru: Shifting Government and Donor Policies and Influences

Inclusion of emergency contraception in national family planning programmes is consistent with international agreements that countries should strive to ensure access to a wide range of contraceptive methods and promote voluntary, informed choice. Yet in 2005, USAID/Peru requested that its NGO grantees in Peru take a “neutral” position on emergency contraception in activities or materials that involve its funds. For many decades, donor countries have viewed conservative religious forces in low-income countries as an obstacle to expanding family planning programmes. Today, however, far-right organisations in the United States are having an unprecedented influence on US public policy, including in countries such as Peru. This article analyses shifts in USAID/Peru's policy on emergency contraception in Peru since 1992. In Peru today, there is widespread official and public support for making emergency contraception available. Given USAID's long support for family planning internationally and in Peru, the current policy appears to be the result of attacks by US far-right organisations carried out in synergy with sympathetic US public officials and anti-choice Peruvian allies.RésuméInclure la contraception d'urgence dans les programmes nationaux de planification familiale est conforme aux accords internationaux qui obligent les pays à assurer l'accès à un vaste éventail de méthodes contraceptives et à promouvoir un choix consenti et bien informé. Pourtant, en 2005, l'USAID/Pérou a demandé que les ONG bénéficiant de ses subventions au Pérou adoptent une position « neutre » sur la contraception d'urgence dans les activités ou les matériels utilisant ses fonds. Longtemps, les pays donateurs ont considéré les forces religieuses conservatrices dans les pays à faible revenu comme un obstacle à l'élargissement des programmes de planification familiale. Aujourd'hui, les organisations d'extrême droite aux États-Unis ont une influence sans précédent sur la politique publique américaine, par exemple au Pérou. Cet article analyse les changements dans la politique d'USAID/Pérou sur la contraception d'urgence au Pérou depuis 1992. Aujourd'hui au Pérou, un vaste mouvement officiel et public souhaite que la contraception d'urgence devienne disponible. Compte tenu du soutien apporté de longue date par l'USAID à la planification familiale au niveau international et au Pérou, la politique actuelle semble le résultat des attaques d'organisations d'extrême droite menées en synergie avec des fonctionnaires américains sympathisants et des alliés péruviens opposés à l'avortement.ResumenLa inclusión de la anticoncepción de emergencia en los programas nacionales de planificación familiar concuerda con los acuerdos internacionales en que los países deben esforzarse por garantizar acceso a una amplia gama de métodos anticonceptivos y promover decisiones informadas y voluntarias. No obstante, en 2005, USAID/Perú solicitó que sus ONG beneficiarias en Perú asumieran una posición “neutral” respecto a la anticoncepción de emergencia en actividades o materiales financiados con sus fondos. Por muchas décadas, en los países donantes las fuerzas religiosas conservadoras en países de bajos ingresos han sido consideradas como un obstáculo a la ampliación de los programas de planificación familiar. Hoy día, sin embargo, las organizaciones ultraderechistas en Estados Unidos ejercen una influencia sin precedentes en las políticas públicas de EE.UU., incluso en países como Perú. En este artículo se analizan los cambios en las polticas de USAID/Perú respecto a la anticoncepción de emergencia en Perú desde 1992. Actualmente, en Perú existe un gran apoyo extendido, tanto oficial como público, para ampliar el acceso a la anticoncepción de emergencia. En vista de que USAID lleva muchos años apoyando la planificación familiar a nivel internacional y en Perú, las políticas actuales parecen ser el resultado de ataques de organizaciones ultraderechistas de EE.UU., realizados en sinergía con funcionarios públicos simpatizantes y aliados peruanos contra el derecho a decidir.

A Sad Day for Science at the FDA

The FDA has again postponed a decision about making emergency contraception available to women without a prescription. Drs. Alastair Wood, Jeffrey Drazen, and Michael Greene write that this deserves serious scrutiny, since it appears to reflect political meddling in the drug-approval process.

Effects of making emergency contraception available without a physician's prescription: a population-based study.

Timely access to emergency contraception has the potential to reduce the number of unwanted pregnancies and subsequent abortions. A public health policy initiative in British Columbia beginning in December 2000 allowed pharmacists to provide emergency contraceptives (ECs) without a prescription. We sought to determine changes in EC use after the policy was introduced and to analyze EC use with data generated by the policy. All Ovral, Preven and Plan B EC prescriptions from Jan. 1, 1996, to Dec. 31, 2003, were identified through the BC PharmaNet and Medical Services Plan administrative databases and the data analyzed to determine changes between 1996 and 2002. Changes over time were determined in the frequency of EC provision, choice of EC agent, frequency of EC use by age group, repeat use and geographic distribution of EC prescription for the pre- and post-policy periods. Anonymized patient-specific data from treatment consent forms were used to describe the reason for EC use, interval between unprotected intercourse and EC prescription, proportion prescribed for immediate or future use, referrals for regular birth control and STD screening and concomitant antiemetic use. Consent data also provided the time in the menstrual cycle that the EC was requested. The number of EC prescriptions increased from a pre-policy mean of 8805 (99% confidence interval 7823-9787) in the years 1996 to 2000 to a post-policy total in 2002 of 17 794. Physicians prescribed the levonorgestrel regimen (Plan B) less frequently than did pharmacists. The frequency of EC use was highest among women aged 20-24 years across all study years, and all age groups demonstrated a post-policy increase in use. On average, 2.1% of the women received an EC 3 or more times a year over the period of the study. More women in urban regions received ECs than women in more rural areas of the province. Analysis of pharmacist treatment consent forms used in 2001 and 2002 showed that 56.2% of women receiving an EC reported using a method of birth control that had failed, 55.7% of pharmacist-provided ECs were obtained within 24 hours after unprotected intercourse, 1.1% of ECs were obtained for future use, antiemetics were provided to 57.7% of women receiving the Yuzpe regimen (Ovral, Preven) and to 20.5% of women receiving levonorgestrel, and women tended to seek ECs when unprotected intercourse occurred at the time of highest risk of pregnancy in their menstrual cycle. Women in greatest financial need obtained ECs more frequently from physicians than from pharmacists. The policy change that granted pharmacists authority to provide ECs to women without a physician's prescription did not simply expand EC availability but was associated with an overall increase in EC use in the province.

The impact of using emergency contraception on reproductive health outcomes: a retrospective review in an urban adolescent clinic

The effort to make emergency contraception (EC) more easily available has been challenged by concerns that prescribing EC may tempt adolescents to have unprotected intercourse, resulting in higher rates of pregnancy and sexually transmitted infections (STIs). This study examined differences in reproductive health history and outcomes among girls who were prescribed EC compared with those seeking other reproductive health care. In a retrospective chart review, the subjects (182 total: 92 EC, 90 control) were girls aged 13 to 21 years, 63% black and 31% white, in an urban, hospital-based adolescent outpatient clinic. Pregnancies, STIs, and visits for first pelvic examination and Pap smear were compared for the 12 months before the identifying visit (IDV) and for up to 2 years after the IDV (mean: 10.9 months±8.2 months). Twenty-six subjects became pregnant with no significant difference between groups. Control subjects were found to have a higher incidence of chlamydia. Before the IDV, EC users were more likely than controls to have never had a pelvic examination (23% vs. 6%, P<0.002) or a Pap smear (24% vs. 6%, P<0.002). However, 80% of EC subjects who had never had a pelvic examination received one as a result of the initial visit and follow-up related to receiving EC. Using EC is not associated with increased risk for future STIs and pregnancy among adolescent girls. Requesting EC may initiate routine gynecologic care.

Emergency contraception: lessons learned from the UK

ContextSince January 2001, women aged over 16 years in the UK have been able to purchase progestogen-only emergency hormonal contraception from pharmacists without prescription. This paper outlines the context in...

Connaissances sur la pilule du lendemain des étudiants et des femmes de 20 à 45 ans dans la région du Bas-Saint-Laurent, au Québec

Purpose: This study assessed levels of knowledge of the emergency contraceptive pill among adolescents and women from Bas-Saint-Laurent, Quebec.Methods: This prospective descriptive study surveyed 145 boys and 265 girls attending secondary school (levels 3, 4, and 5), college, university or professional school with a self-administered questionnaire on their knowledge of emergency contraception. Random sampling was carried out by clusters among the various groups. A telephone survey was carried out in an adult population of 430 women from the same region, using a similar sampling design.Results: Most of the participants knew about the existence of the emergency contraceptive pill: 98.5 percent in girls, 90.3 percent in boys, and 96.5 percent in adult women. Nevertheless, their level of knowledge was limited: only 37.5 percent of girls, 19.1 percent of boys, and 16.4 percent of adult women knew that it could be used up to three days after unprotected sexual intercourse.Conclusion: These findings suggest that health promotion programs should focus not only on awareness of the existence of emergency contraception, but also on the appropriate context and timeframe for its use, so as to make emergency contraception more accessible to women of reproductive age.

'Under 16s get pregnant too'.

Teenagers support moves to make emergency contraception available over the counter

A new model for collaboration — making emergency contraceptives available in developing countries

Private/public-sector collaboration in contraceptive research and development offers a fresh opportunity to consider a holistic approach to making emergency contraception (EC) available in developing countries. Emergency contraception has been available since the 1970s but has remained under-utilized. Emergency contraception may be used by women who want to prevent a pregnancy and therefore has a specific use, in a specific situation. This paper highlights the distinct and reciprocal advantages of a collaborative approach between the Consortium for Emergency Contraception (the public sector) and a pharmaceutical company (the private sector), to the introduction of EC in developing countries. The importance of cultivating a public/private-sector collaborative approach, which serves the interests of both parties concerned, in order to foster progress in this important initiative, is highlighted.

Breaking the Silence on Emergency Contraception

In the US about 10 million couples risk unplanned pregnancy every night and more than half of the 6.3 million annual pregnancies are unintended. While emergency postcoital contraception is available to reduce this risk most women do not know about it because pharmaceutical companies have failed to apply to the US Food and Drug Administration (FDA) for permission to advertise the oral contraceptive (OC) regimen that can be used in emergencies. If adolescents seek emergency contraception they can be given contraceptive and disease prevention counseling at the same time. Recently significant steps are being taken to inform women about the availability of emergency contraception. The Reproductive Health Technologies Project has launched a year-long nationwide media campaign to educate women about emergency contraception and has created an emergency contraceptive hotline (888-NOT-2-LATE) as well as a web site containing a list of local providers of emergency contraception (http://opt.princeton.edu/ed/). The campaign seeks to educate primary care providers as well as women. Also the FDA has declared several brands of OCs to be safe and effective for use as emergency contraception and has explicitly invited companies to file for the opportunity to market OCs for this purpose. Making emergency contraception widely available is the most important step in preventing unwanted pregnancies.

Making emergency contraception better known

Making emergency contraception better known