Offering Emergency Contraception Research Articles

Forensic Nurses' Understanding of Emergency Contraception Mechanisms: Implications for Access to Emergency Contraception.

An estimated 25,000 pregnancies result from sexual assault in the United States annually. Numerous professional healthcare organizations endorse offering emergency contraception (EC) as an integrated aspect of post-sexual-assault care. Lack of knowledge surrounding EC's mechanism of action, including misinterpreting ECs as abortifacients, might restrict patient access to this important healthcare option. We evaluated sexual assault nurse examiners' understanding of the mechanism of action of oral ECs levonorgestrel (LNG) and ulipristal acetate (UPA). A cross-sectional survey of practicing sexual assault nurse examiners was conducted through the International Association of Forensic Nurses. Among 173 respondents, 96.53% reported they prescribed/dispensed EC at the time of medical forensic examinations. LNG was prescribed more frequently than UPA (57.80% vs. 38.2%, respectively). When asked if they agreed or disagreed if LNG and UPA can disrupt an established pregnancy, 83.2% selected disagree/strongly disagree for LNG versus 78.6% for UPA, which were not significantly different. When asked whether the Supreme Court ruling overturning Roe v. Wade would change their EC prescribing, 79.77% reported it will have no change, 6.94% said it would increase, and 12.72% reported they were unsure. Several commented they were concerned whether state laws would prohibit EC and at least one program stopped prescribing EC because of their state laws. Addressing misinformation regarding EC's mechanism of action and increasing access to oral EC options after sexual assault have the potential to reduce the incidence of rape-related pregnancy.

Sexual Assault Nurse Examiner and Emergency Contraception Access in Emergency Departments in the United States: A National Survey

Background: Despite the rise in sexual assault presentations in emergency departments (ED) in the United States, real-world access to sexual assault nurse examiners (SANE) and emergency contraception medication is unknown. We aimed to determine the real-world access of emergency sexual assault care by surveying EDs in the United States. Methods: EDs listed in the Centers for Medicare & Medicaid Services database were contacted telephonically by anonymous callers trained to collect responses from ED personnel. The study employed a cross-sectional survey to ascertain the availability of SANE and emergency contraception in EDs nationwide. Additional variables collected included regional demographics, urban status, hospital size, faith affiliation, academic affiliation, and existence of legislative requirements to offer emergency contraception to sexual assault patients. Findings: Of the 4360 eligible hospitals, 960 (22.0%) were contacted. SANE availability and emergency contraception access were reported to be available in 48.9% (95%CI: 45.5, 52.0) and 42.5% (95%CI: 39.4, 45.7) of hospitals, respectively. Emergency contraception access was a strong predictor of SANE availability. Hospitals reporting SANE availability were more likely to be large, rural, and academic affiliation. Hospitals reporting patient access to emergency contraception in the ED were more likely to be located in the Northeast, large, rural, academic affiliation, and in states with legislative requirements. Interpretation: Our results suggest that access to sexual assault services including emergent SANE and contraceptive medication in EDs remains poor with disparities. Geographic region, hospital size, and legislative status of the state are important predictors. Funding: None to declare. Declaration of Interest: None to declare.

Assessment of contraceptive curricula in US pharmacy programs

IntroductionPharmacists prescribe contraception in some states following expansions in scope of practice. Adequate education on contraception in pharmacy curricula is crucial to effectively deliver these services. MethodsA 26-item survey assessing contraception curricula regarding was administered by email to instructors and administrators at 139 pharmacy schools in the United States. The survey assessed teaching methods, hours taught, topic content, and opinion of adequacy of contraceptive education provided by the program. ResultsThe survey achieved a response rate of 40% (n = 56). All programs that responded offer emergency contraception and hormonal contraception content, 96% offer non-hormonal over-the-counter contraception content, and 91% offer long-acting reversible hormonal contraception content. Average number of hours taught were as follows: non-hormonal over-the-counter contraception 2.0 hours, emergency contraception 0.9 hours, hormonal contraception 3.0 hours, long-acting reversible hormonal contraception 0.8 hours, and non-reversible hormonal contraception 0.5 hours. Patient cases were most used to supplement didactic content in all topics. Standardized patient interviews were used less frequently for both hormonal contraception (25%) and emergency contraception (7%). About 68% of programs agreed or strongly agreed that the contraceptive education provided by the program was adequate. A majority (70%) indicated interest in a standardized contraceptive curriculum. ConclusionsContraceptive education is broadly covered in didactic curricula within pharmacy education. Further assessment and development of curricula standards may be warranted to assess quality and adequacy of contraceptive education in pharmacy.

Pharmacist prescription of hormonal contraception in Oregon: Baseline knowledge and interest in provision

ObjectivesOregon has implemented legislation expanding the scope of pharmacists to directly prescribe short-acting hormonal contraception (pill and patch) without a medical prescription. Pharmacists are crucial to the success of the new law, but relatively little is known about their intentions to prescribe contraception, or the motivators or barriers in providing this service. MethodsWith the use of a cross-sectional survey of pharmacists practicing in Oregon before the legislative implementation, we analyzed responses to assess contraceptive knowledge, motivation to participate in direct provision, and perception of barriers to pharmacist prescription of contraception. A logistic regression model was used to examine the association between years in pharmacy practice and intention to provide direct access to contraception. ResultsA total of 509 pharmacists responded (17%). If training and reimbursement were offered, more than one-half of pharmacists would potentially be interested in prescribing contraception, managing side-effects, or moving women to a different hormonal method (57%, 61%, and 54%, respectively). However, only 39.1% of pharmacists surveyed planned to actually prescribe hormonal contraception when the legislation took effect. Shortage of pharmacy staff to provide services, concerns about liability, and a need for additional training were the three largest barriers to participation. Pharmacists practicing in urban locations (odds ratio 1.73, 95% CI 1.11-2.70) or currently offering emergency contraception (odds ratio 2.23, 95% CI 1.47-3.40) were significantly more likely to be planning to participate. ConclusionPreliminary data indicate a need to support pharmacists with education on contraceptive provision and development of interventions to facilitate counseling in the pharmacy setting.

Emergency Contraception Provision Barriers Among Emergency Medicine Residents

INTRODUCTION: Emergency medicine physicians can decrease the risk of unintended pregnancy in at-risk women presenting to the emergency department through consistent emergency contraception provision. We assessed emergency medicine residents' practice patterns and emergency contraception provision barriers to better understand emergency medicine resident training on emergency contraception. METHODS: An online survey was e-mailed to U.S.-based emergency medicine residency program directors for resident distribution. Current residents caring for reproductive-aged women were eligible. Survey questions assessed demographics, prescription and counseling patterns, and provision barriers. RESULTS: Three hundred forty-five participants met inclusion criteria and represented all training years and U.S. regions. Mean age was 29.9 years, and 50.3% were female. Most participants reported an academic (74.8%) and nonreligious (88.6%) hospital affiliation. A total of 24.7% of respondents prescribed emergency contraception over the last 6 months. Although 71.2% reported always offering emergency contraception after sexual assault, only 19.5% always offered emergency contraception after unprotected consensual sex. The most common emergency contraception provision barriers were lack of knowledge (37.5%) and lack of follow-up (39.1%). Respondents were more likely to prescribe emergency contraception if it was on formulary (odds ratio [OR] 18.8, 95% confidence interval [CI] 8.3-42.4) or a protocol for sexual assault victims included emergency contraception (OR 5.9, 95% CI 2.3-11.0). Participants were less likely to prescribe emergency contraception if they were first-year residents (OR 3.0, 95% CI 1.6-4.7) or if they reported lack of sufficient knowledge (OR 2.3, 95% CI 1.3-4.2). CONCLUSIONS: Emergency medicine residents often care for women at risk of unintended pregnancy yet have low emergency contraception prescription rates. Emergency department changes and improved education may increase emergency contraception provision to eligible women. Language: en

Emergency Contraception in Iowa Pharmacies Before and After Over‐the‐Counter Approval

To compare availability of emergency contraception in Iowa pharmacies, before and after the U.S. Food and Drug Administration (FDA) approved over-the-counter sales and identify reasons why over-the-counter, emergency contraception might still not be available in some Iowa pharmacies. Secondary analysis of data collected for an existing, descriptive study. A total of 906 pharmacies were identified; 405 (56.8%) pharmacies participated before, and 308 (43.2%) after the FDA policy change. Data collected via a scripted telephone survey. After the FDA changed its policy and allowed over-the-counter sales of emergency contraception, the percentage of Iowa pharmacies offering emergency contraception increased from 57.8% to 70%. In the before sampling, 67.5% reported a perceived lack of demand as the primary reason for not carrying emergency contraception 66.7% reported this rationale in the after group. Other reasons included store policy, and moral, religious, or personal reasons. Pharmacists were surprisingly uninformed about the action of emergency contraception; before the FDA approved over-the-counter sales 53% believed the drugs primarily worked by blocking implantation of a fertilized egg. Indeed, even after FDA approved over-the-counter sales, 38% of pharmacists still believed that emergency contraception was comparable to an abortifacient. In addition, before the policy changed, 43.8% of pharmacists accepted emergency contraception as safe for teenagers; this percentage fell to 27.9% after the policy change. Significant increases in the carrying of emergency contraception suggest the policy did succeed in increasing access. Despite this, barriers to access exist. Further research should explore why pharmacies might not carry emergency contraception.

Compliance with Mandated Emergency Contraception in New Mexico Emergency Departments

New Mexico enacted a law in 2003 requiring that emergency departments (EDs) offer emergency contraception (EC) to survivors of sexual assault and that both doses be administered in the ED. This investigation sought to examine practices and knowledge of ED providers about EC in the setting of sexual assault. We visited hospitals in New Mexico from July 2005 to December 2005 and administered an 18-item questionnaire to three providers-a physician, a nurse, and a clerk-in the ED. The questionnaire included items related to characteristics of the hospital, knowledge of providers about EC and the law, and ED practices relevant to EC for sexual assault survivors as well as for women who had consensual unprotected intercourse. Surveys were completed at 33 of 38 hospitals (87%). Overall, 52% of respondents reported that EC was routinely offered to sexual assault survivors, and 33% reported that both doses were administered in the ED. Forty-one percent of RNs, MDs, and clerks reported that EC was offered to sexual assault survivors who were minors regardless of age. Overall, 64% of respondents knew that EC may prevent pregnancy up to 72 hours after unprotected intercourse, and only 12% of respondents reported awareness of any requirements to offer EC to sexual assault survivors. Respondents reported that physicians in the ED more often routinely offered EC to sexual assault survivors (52%) than to women who requested it after consensual sex (20%). Thirty-three percent of respondents indicated parental consent was necessary for minors in the setting of sexual assault, although there is no requirement for parental notification in New Mexico. EDs in New Mexico are not universally complying with the law. Better dissemination of the law and education about EC could improve care of sexual assault survivors in New Mexico.

Characteristics Associated with Emergency Contraception Use by Family Planning Patients: A Prospective Cohort Study

Little is known about how written family planning clinic policy regarding emergency contraception, as well as personal characteristics, behaviors and attitudes, may influence a woman to use emergency contraception. Between June 2001 and July 2002, women attending publicly funded family planning clinics in Pennsylvania were enrolled in an 18-month longitudinal study. Half attended clinics with a policy of offering emergency contraception in advance; the remainder had only emergent access to the drug. After providing baseline data, women completed monthly automated phone surveys about recent sexual activity, contraceptive use and attitudes toward pregnancy. Characteristics associated with recent use of emergency contraception were examined using multivariate logistic regression. Responses to 3,700 phone surveys from 729 women showed that 25% of those who attended clinics offering advance access used emergency contraception at least once during the study, compared with 8% who attended emergent access clinics. Women attending advance access clinics had significantly elevated odds of having used emergency contraception in the past month (odds ratio, 2.6). Other characteristics positively associated with the likelihood of recent emergency contraception use were familiarity with the drug, having a new sex partner and having unprotected sex at least once (2.0 each); negative feelings toward pregnancy (1.4); and using condoms as one's main contraceptive method (1.8). In addition to discussing and offering advance emergency contraception, providers should further explore specific behaviors and attitudes associated with emergency contraception use.

Expanding access to emergency contraception through state systems: the Washington State experience.

Access to family planning and reduction of unintended pregnancy are long-standing priorities for Washington States Department of Health (DOH) and Department of Social and Health Services (DSHS). Working together to ensure that all pregnancies are intended (consciously and clearly desired at the time of conception) the two agencies provide family planning counseling and a broad choice of contraceptive methods through a range of health and social service programs. When a dedicated product for emergency contraception became available in 1998 widespread integration of relevant information and services became one more strategy the agencies used to realize the goal of reducing unintended pregnancy in the state. Since 1997 the Program for Appropriate Technology in Health (PATH) has collaborated with state colleagues to increase access to emergency contraception. In a series of interviews conducted in December 2003 PATH asked administrators managers and others who were involved in the initial process to describe the experience. The story that emerged described here is one of strong high-level support for family planning services that created an ideal platform for expanding emergency contraception services establishing collaborations between relevant agencies and increasing the number of state programs and the range of service providers offering emergency contraception services. The result was an innovative approach to service delivery that made it possible to reach underserved and low-income populations including those not served by Title X--funded clinics. Our objective in sharing Washington States experience is to stimulate further state-level innovation for expanding access to emergency contraception. (excerpt)

Expanding Access to Emergency Contraception Through State Systems: The Washington State Experience

Access to family planning and reduction of unintended pregnancy are long-standing priorities for Washington States Department of Health (DOH) and Department of Social and Health Services (DSHS). Working together to ensure that all pregnancies are intended (consciously and clearly desired at the time of conception) the two agencies provide family planning counseling and a broad choice of contraceptive methods through a range of health and social service programs. When a dedicated product for emergency contraception became available in 1998 widespread integration of relevant information and services became one more strategy the agencies used to realize the goal of reducing unintended pregnancy in the state. Since 1997 the Program for Appropriate Technology in Health (PATH) has collaborated with state colleagues to increase access to emergency contraception. In a series of interviews conducted in December 2003 PATH asked administrators managers and others who were involved in the initial process to describe the experience. The story that emerged described here is one of strong high-level support for family planning services that created an ideal platform for expanding emergency contraception services establishing collaborations between relevant agencies and increasing the number of state programs and the range of service providers offering emergency contraception services. The result was an innovative approach to service delivery that made it possible to reach underserved and low-income populations including those not served by Title X--funded clinics. Our objective in sharing Washington States experience is to stimulate further state-level innovation for expanding access to emergency contraception. (excerpt)

Accessibility of Family Planning Services: Impact of Structural and Organizational Factors

This study sought to determine whether selected structural and organizational characteristics of publicly available family planning facilities are associated with greater availability. A survey was sent to 726 publicly available family planning facilities in four states. These included local health departments, federally qualified health centers (FQHC), Planned Parenthood sites, hospital outpatient departments, and freestanding women's health centers. Usable responses were obtained from 526 sites for a response rate of 72.5%. Availability variables included the provision of primary care services; the contraceptives offered; professional staffing; scheduling, waiting time, and transportation; and cultural congruence and competency. The structural and organizational variables were state, type of organization, and funding source. Some states were more likely to offer emergency contraception while others were more likely to have weekend hours. FQHCs were most likely to provide primary care and Planned Parenthood sites most likely to offer emergency contraception. Title X funding was associated with increased likelihood of providing emergency contraception and staffing by midlevel practitioners and registered nurses. This study found that availability varied by structural and organizational variables, many of which are determined by federal and state policies. Revising some of these policies might increase utilization of family planning facilities.

Provision of Contraceptive and Related Services By Publicly Funded Family Planning Clinics, 2003

In addition to contraceptive services, publicly funded family planning clinics provide low-income women with a range of reproductive diagnostic, treatment and educational services. Nationally representative information about the scope of services available from clinics is needed to formulate policy and programmatic recommendations.In 2003, more than 1,000 U.S. clinics responded to an eight-page survey on service availability and clinic policies. Differences in the proportions of clinics reporting each service or policy were examined by clinic type and receipt of Title X funding.Nearly all clinics offer pills, injectables and condoms; 75% offer the patch; and 80% offer emergency contraception. Most clinics (73%) typically use a conventional Pap smear for initial cervical cancer screenings; 27% use liquid-based Pap tests. For follow-up, 68% of clinics use liquid-based or other advanced testing. Virtually all clinics screen at least some clients for chlamydia; Planned Parenthood and Title X-funded clinics, more than others, tend to focus screening efforts on sexually active women aged 25 and younger. Single-dose treatments are provided by 58% of clinics. Nine in 10 clinics offer HIV testing on-site, most of them to any client who requests it. Services targeted to specific populations include counseling about abstinence for minors (91%); non-reproductive health services for men (36%); and availability of staff such as translators (81%) and bilingual administrative (59%) or clinical personnel (57%) for non-English-speaking clients.More public funding is imperative for clinics to keep up with the demands of new technologies and a diverse client base.

A national survey of emergency room provision of emergency contraception to sexual assault victims

One of six American women is a victim of sexual assault, which affects 17 million American women. In 2002���2003, a total of 198,000 sexual assaults were reported in the United States. The incidence of sexual-assault-related pregnancy is 1���5%, accounting for approximately 32,000 pregnancies per year in the United States. More than 50% of these pregnancies result in abortion. The acute-care sexual-assault visit is the optimal time to offer emergency contraception (EC) for the prevention of an unintended pregnancy.

An audit on the management of female victims of sexual assault attending a genitourinary medicine clinic.

The victims of sexual assault may attend GUM clinic without any referral from any other agency. The management of these cases need special care. We audited the management of females who were known to us as victims of sexual assault. In 15 months, 68 females attended our clinic. All were screened for sexually transmitted infections (STI). Emergency contraception was offered to only 38.4% at risk cases, and formal counselling support was offered to only 25% cases. Further care is necessary to improve counselling support and offering emergency contraception to the victims of sexual assault.

Management of acute adult sexual assault.

An estimated 13% of women and 3% of men worldwide report sexual assault in their lifetime. Although managing sexual assault may appear daunting, some victims want medical care only. After disclosure, discuss forensic assessment. If a complaint to the police is possible, give the first dose of emergency contraception if required, and refer for forensic assessment. If medical care only is desired, determine the timing and type of assault and current contraception, manage general and genital injuries and perform relevant tests. After unprotected vaginal rape, offer emergency contraception, chlamydia prophylaxis and vaccination against hepatitis B virus. Counselling is important for all victims of sexual assault, as psychosocial consequences are more common than physical injuries. Management by a sympathetic, non-judgmental health practitioner helps the victim to regain control.

Expanding Access to Emergency Contraception: The Case of Brazil and Colombia

Emergency contraception was proven effective nearly 30 years ago yet remains greatly under-utilised. In the Latin American and Caribbean region, it would serve the goals of reducing unwanted pregnancy, unsafe abortion and related morbidity, and as a back-up to condom use and a bridge to longer-term contraceptive methods if made more widely known and available. The International Planned Parenthood Federation Western Hemisphere Region has developed a model for the integration of emergency contraception into sexual and reproductive health care services. This model is being tested in a two-year project with national affiliates in Brazil, Chile, Colombia, the Dominican Republic and Venezuela, and will contribute to the work of the Latin American Consortium for Emergency Contraception. Case studies of Brazil and Colombia describe how health sector reforms, e.g. decentralisation and managed competition among health insurers and service providers, have influenced promotion strategies. The experience of Profamilia Colombia with registration of a dedicated product and providing emergency contraception within its national network of clinics, with a focus on staff training and work with young people, is described. In Brazil, BEMFAM's study of different modalities for offering emergency contraception, e.g. through contractual agreements with municipalities and its own clinics, is highlighted.

Emergency contraception provision: a survey of emergency department practitioners.

To determine emergency department (ED) practitioner willingness to offer emergency contraception (EC) following sexual assault and consensual sex, and to compare responses of practitioners from states whose laws permit the refusal, discussion, counseling, and referral of patients for abortions (often called "opt-out" or "abortion-related conscience clauses") with those of practitioners from states without these laws. Using a structured questionnaire, a convenience sample of ED practitioners attending a national emergency medicine meeting was surveyed. The 600 respondents were: 71% male, 29% female; 34% academic, 26% community, and 33% resident physicians; and 7% nurse practitioners and physician assistants. Many respondents (88%) were inclined to offer EC to those sexually assaulted by unknown assailants. More practitioners said they were willing to offer EC if the assailant was known to be HIV-infected rather than if the assailant had low HIV risk factors (90% vs. 79%, p < 0.01). More respondents would prescribe EC after sexual assault than consensual sex (88% vs. 73%, p < 0.01). The rates of willingness to offer EC were the same for practitioners in states with "abortion-related conscience clauses" and those from other states. Most ED practitioners said they were willing to offer EC. Although the risk of pregnancy exists after consensual sex, practitioners were less willing to prescribe EC after those exposures than for sexual assault. "Abortion-related conscience clauses" did not seem to influence willingness to offer EC.