Providing Emergency Contraception Research Articles

Emergency contraceptive provision in the emergency department and risk analysis for delayed utilization in South Korea.

In certain nations, the emergency department (ED) has been designated as the primary center to provide emergency contraception (EC). However, analyses of ED visits for EC are limited. Moreover, ED-based research that focuses on time is limited to only a few surveys. The aims of this study were to examine the characteristics of ED visitors for EC and the interval between the coitus and arrival at the ED, and to analyze the factors associated with delays in visiting the ED. This retrospective cohort study involved patients at 2 urban tertiary academic hospitals in South Korea. All patients who presented to the ED for EC between January 2019 and December 2021 were analyzed. The median age of the participants was 26 years. The most common variables were age of 20 to 29 years (42.0%), evening visits (34.9%), weekends or public holidays (62.6%), single status (89.2%), and visits after contraceptive failure (79.1%). The mean time interval was 7.49 hours, and 77.4% of all patients visited the ED within 12 hours. Patients who received public sex education presented earlier (P < .001). ED visits after nonconsensual sexual incidents represented significantly delayed presentations (P < .001). Regression analysis revealed that both the lack of public education and the occurrence of nonconsensual coitus were associated with incident-to-ED visit intervals of >12 hours. Most patients received emergency contraceptive pill (ECP) within the recommended timeframe. In particular, nationwide school-based public sex education positively affected early ECP access. In contrast, ECP provision was delayed for patients who experienced nonconsensual coitus. Strategies for timely ECP access should account for possible concerns about stigmatization and privacy.

Response to "Catholic Hospitals Should Permit Physicians to Provide Emergency Contraception to Rape Victims as an Act of Conscience".

Response to "Catholic Hospitals Should Permit Physicians to Provide Emergency Contraception to Rape Victims as an Act of Conscience".

Conscientious Objection to Emergency Contraception

Conscientious Objection to Emergency Contraception

Emergency contraception from historical myth to modern reality: a historical timeline and updated interpretation

Introduction: Emergency contraception is the use of a birth control method after coitus has taken place and there is a fear that it may lead to a pregnancy. Historical attempts were more likely to be harmful rather than effective. Oral estrogens, progestins, anti-progesterone, and partial agonist/antagonists of progesterone have all been used with varying degrees of efficacy. Currently ethinyl estradiol/levonorgestrel combinations, levonorgestrel alone, ulipristal acetate, and mifepristone are the usual oral methods depending on availability. Copper carrying and more recently levonorgestrel releasing intrauterine devices have also been used successfully. The intrauterine devices appear to be more effective than the oral methods and are also regular contraceptive methods and in addition have therapeutic properties. Background: The evolution from longer duration oral treatments with side effects to the current single tablet of levonorgestrel, ulipristal acetate, or mifepristone with low side effects and reasonable efficacy is described. The role of the highly effective copper intrauterine device and now also the levonorgestrel intrauterine device for emergency contraception is examined. Conclusion: Oral emergency contraception is a short term solution. Expanding emergency contraception to include the levonorgestrel releasing intrauterine device may provide long term contraception and health benefits as well as providing emergency contraception.

Effectiveness and Harms of Contraceptive Counseling and Provision Interventions for Women : A Systematic Review and Meta-analysis.

The effectiveness and harms of contraceptive counseling and provision interventions are unclear. To evaluate evidence of the effectiveness of contraceptive counseling and provision interventions for women to increase use of contraceptives and reduce unintended pregnancy, as well as evidence of their potential harms. English-language searches of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE (1 January 2000 to 3 February 2022) and reference lists of key studies and systematic reviews. Randomized controlled trials of interventions providing enhanced contraceptive counseling, contraceptives, or both versus usual care or an active control. Dual extraction and quality assessment of studies; results combined using a profile likelihood random-effects model. A total of 38 trials (43 articles [25472 participants]) met inclusion criteria. Contraceptive use was higher with various counseling interventions (risk ratio [RR], 1.39 [95% CI, 1.16 to 1.72]; I 2= 85.3%; 10 trials), provision of emergency contraception in advance of use (RR, 2.12 [CI, 1.79 to 2.36]; I 2= 0.0%; 8 trials), and counseling or provision postpartum (RR, 1.15 [CI, 1.01 to 1.52]; I 2= 6.6%; 5 trials) or at the time of abortion (RR, 1.19 [CI, 1.09 to 1.32]; I 2= 0.0%; 5 trials) than with usual care or active controls in multiple clinical settings. Pregnancy rates were generally lower with interventions, although most trials were underpowered and did not distinguish pregnancy intention. Interventions did not increase risk for sexually transmitted infections (STIs) (RR, 1.05 [CI, 0.87 to 1.25]; I 2= 0.0%; 5 trials) or reduce condom use (RR, 1.03 [CI, 0.94 to 1.13]; I 2= 0.0%; 6 trials). Interventions varied; few trials were adequately designed to determine unintended pregnancy outcomes. Contraceptive counseling and provision interventions that provide services beyond usual care increase contraceptive use without increasing STIs or reducing condom use. Contraceptive care in clinical practice could be improved by implementing enhanced contraceptive counseling, provision, and follow-up; providing emergency contraception in advance; and delivering contraceptive services immediately postpartum or at the time of abortion. Resources Legacy Fund. (PROSPERO: CRD42020192981).

Catholic Hospitals Should Permit Physicians to Provide Emergency Contraception to Rape Victims as an Act of Conscientious Provision.

While many Catholic hospitals permit the prescription of the emergency contraception drug levonorgestrel for rape victims, some continue to prohibit this practice as a matter of institutional conscience. While the standard approach to this issue has been to offer an argument that levonorgestrel either is or is not morally permissible, we have taken a different tack. We begin by briefly describing and acknowledging that reasonable disagreement exists on this question (part one), and then arguing that the reasonable disagreement itself can serve as a compelling basis for Catholic leadership at hospitals that prohibit emergency contraception for rape victims to accommodate physicians who wish to provide levonorgestrel as a matter of conscience (part two). We end by anticipating and responding to some objections.

The consequences of armed conflict on the health of women and newborn and sexual reproductive health – A position statement by the European Board and College of Obstetrics and Gynaecology (EBCOG)

Armed conflict brings about significant health-related consequences to the non-combatant population especially the elderly, women, and children. The consequences for women extend further than battle-related deaths. One important consequence of conflict is the population displacement resulting from individuals and families seeking safety in non-conflict zones. This forced migration places women at risk of gender-based violence during their journey and for this reason the host countries should ensure that the migrants are given access to reproductive health services, including providing emergency contraception and abortion. In the conflict zone, the collapse of all social support, including healthcare services, contribute towards a marked deterioration in the level of care provided to ensure reproductive health and safe motherhood. In addition, the community living the conflict zone is at an increased risk of community infectious disease and poor management of chronic illness. Women and children are almost always innocent victims of war. The international community must act effectively to primarily avoid conflict by sound diplomatic intervention and, when diplomacy fails, reduce the consequences of conflict.

Delivering integrated care after sexual violence in the Democratic Republic of the Congo

In the eastern Democratic Republic of the Congo, ongoing armed conflict increases the incidence of gender-based violence (GBV) and presents a distinct and major barrier to care delivery for all...

P114 Implementation of the rcog guideline on emergency contraception advice in two centres within london: Abstract P114 Table 1

<h3>Background/introduction</h3> Since 2011 guidelines by the Royal College of Obstetrics and Gynaecology (RCOG) have stated that those who provide emergency contraception are required to give certain guidance. This includes counselling on the contraception provided as well as protection against unwanted pregnancy in the future in the form of LARC (long-acting reversible contraception). This, however, is neither ubiquitously achieved or documented across the centres offering this service. <h3>Aim(s)/objectives</h3> To ascertain the level of concordance with the RCOG guidelines at two centres within London, and highlight the importance of following and documenting them. <h3>Methods</h3> A comprehensive search was performed using the emisweb tool in The Essex Lodge surgery in Plaistow on 11/12/14 and in the Highland Road Practice in Bromley on 15/01/15. <h3>Results</h3> This audit collected data on 57 patients from both the practices, 20 of whom (27%) had been given no documented advice on either LARC or the medication itself, 12 (16%) contraception advice only, 25 (33%) LARC only, and only 18 (24%) advice on both. <h3>Discussion/conclusion</h3> The varying results between practices indicate that greater care needs to be taken to provide patients with information concerning both the treatment that they are requesting and preventative measures. It is also important to document that these objectives have been achieved with each consultation- something which we have found was not done ubiquitously as is recommended. We have produced an informative poster and hope that this will facilitate changes in the future.

Assessment of knowledge, attitude, and practice in health care delivery

Dear Editor, I went through an article entitled “Knowledge and attitude of medical undergraduate, interns and postgraduate students in India towards emergency contraception”, published recently in the North American Journal of Medical Sciences.[1] The article derives its strength from the fact that ultimately, it is this study population which has a role to play in emergency contraception. KAP comprises of three components-knowledge, attitude, and practice. These types of studies are a good way to assess health care delivery. KAP studies are easy to conduct, measurable, and easily interpretable. This makes these studies a useful survey methodology. Most of the KAP studies lack in measuring attitude properly (the second part of a standard KAP survey questionnaire).[2] It is here that this study suffers too. Attitudes are acquired characteristics of an individual. Attitude includes three components: (a) A cognitive or knowledge element (b) an affective or feeling element, and (c) a tendency to action.[3] Attitude has been defined as a relatively enduring organization of beliefs around an object, subject, or concept which predisposes one to respond in some preferential manner. The authors have done a nice work while dealing with the feeling element of the attitude, but have handled “tendency to action” inadequately. The focus in attitude evaluation has to be the study participant and not someone else. In question number one of the attitude component [Table 1], the focus is on paramedical staff. The other three questions really focus on knowledge, and not on attitude.[1] The attitude part could have been constructed as follows: Table 1 Participant's attitude about emergency contraception A patient seeks consultation after unprotected sex. The target attitude for health care professionals in this situation should be providing emergency contraception. The scale should read as:

The Morning After: A History of Emergency Contraception in the United States (review)

Reviewed by: The Morning After: A History of Emergency Contraception in the United States Joyce A. Berkman Heather Munro Prescott . The Morning After: A History of Emergency Contraception in the United States. Critical Issues in Health and Medicine. New Brunswick, N.J.: Rutgers University Press, 2011. xi + 163 pp. $69.00 (cloth, 978-0-8135-5162-3), $22.95 (paperbound, 978-0-8135-5163-0). Heather Munro Prescott provides an engrossing and many-angled account of the origins and development of emergency contraception in the United States through to 2010. This study, chronologically organized and eschewing simplistic categories of friends and foes of emergency contraception, contextualizes the growth of popular and legal approval for emergency contraception within the fluid political history of the nonemergency birth control pill, changing feminist perspectives on hormonally based contraceptives, the anti-abortion backlash to Roe v. Wade, and the complex evolution of U.S. drugs' oversight and regulation. Charting shifts and continuities in public attitudes regarding unwanted pregnancy, Prescott observes how oral contraceptives were promoted to cure the unwanted pregnancy "disease," then reframed as attention expanded to societal causes of unwanted pregnancy; for example, taking into account sexual violence and social inequality, and in the later 1960s counting reproductive self-control as essential to a woman's power to over her own body. Relying on diverse documentation such as congressional hearings, Federal Drug Administration transcripts, National Institute of Health minutes, Planned Parenthood papers, television broadcasts, unpublished individual papers in numerous archives, professional, political and popular journals as well as relevant print and internet scholarship, Prescott builds the case that the consensus that emerged in support of emergency contraception—radical feminist groups antagonistic to decades of male medical and pharmaceutical callousness over women's interests; women of color rightfully suspicious of population control agendas; population and family planners; pharmaceutical and medical professionals—did not come easily. It entailed diligent and creative collaborative outreach and organization even among groups internally divided. It reflected constant medical, feminist, and non feminist reassessment of the risks of emergency contraception relative to the risks of alternative postcoital methods of preventing birth. Crucial to consensus building were conservative successes: Women of diverse races rose up against the stalling of FDA approval for RU 486, against pharmaceutical companies concealing the fact that the regular birth control pill could also be used as a postcoital contraceptive, and against judicial restrictions of access to abortion. Throughout her account Prescott stresses the key role of countless women from the 1960s to the present day who demanded ready access to emergency contraception, ultimately through over-the-counter purchase. She argues that "recent activism on emergency contraception demonstrates how women have continued to use personal histories of their bodies to transform reproductive health research and healthcare policy" (p. 127). Prescott is fully aware that emergency contraception is not a panacea for a woman's well-being. Written from a feminist pro-contraceptive persuasion, her study joins others critical of shallow advocacy of emergency contraception and calls for reproductive justice. She concludes her study by stating that the feminist [End Page 296] health movement and consumer economic initiatives "have thus far been unable to resolve the economic inequalities in the United States that continue to pose an insurmountable barrier to those unable to afford the products of this self-care revolution" (p. 128). Prescott might add that even if this barrier were surmounted, eased availability of emergency contraceptives may well compound female vulnerability to unwanted male sexual overtures if concurrent female sexual autonomy and self-confidence did not also ensue. Prescott's excellent account is not without its limitations, as when she cursorily turns to global developments. Why, for example, did thirty-eight countries provide emergency contraception ahead of the United States? We need fuller understanding of national variables in health care provision and feminist activism as well as greater knowledge of international exchanges and collaborations, since for decades the United States imported much of its contraceptive technology from Europe. Disappointing, too, is Prescott's weak discussion of Supreme Court rulings on privacy rights, especially the three pivotal decisions during the 1970s that involved Bill Baird, no mere "contraceptive salesman" (p. 16). Since Prescott places substantial emphasis on female...

Barriers and Biases: Ethical Considerations for Providing Emergency Contraception to Adolescents in the Emergency Department

When adolescents seek emergency contraception in the emergency room, social judgment on the part of clinicians can hamper treatment.

Conscientious Refusals by Hospitals and Emergency Contraception

Hospitals sometimes refuse to provide goods and services or honor patients’ decisions to forgo life-sustaining treatment for reasons that appear to resemble appeals to conscience. For example, based on the Ethical and Religious Directives for Catholic Health Care Services (ERD), Catholic hospitals have refused to forgo medically provided nutrition and hydration (MPNH), and Catholic hospitals have refused to provide emergency contraception (EC) and perform abortions or sterilization procedures. I consider whether it is justified to refuse to offer EC to victims of sexual assault who present at the emergency department (ED). A preliminary question, however, is whether a hospital’s refusal to provide services can be conceptualized as conscience based.

Cynicism, with Consequences

On a recent evening, while working in a children's hospital emergency department as a pediatric emergency medicine physician, picked up the chart of yet another patient without a true emergency: a sixteen-year-old with vaginal discharge. After reviewing her chart, her nurse and spoke with her in her room. Her story was all too familiar. She was sexually active. She did not use contraception. She had also been treated for pelvic inflammatory disease three times before, but luckily, she had not yet been pregnant. like many adolescents, she did not have a primary care physician, so the emergency department was her primary care clinic. informed her that she would need a pelvic exam and a pregnancy test. also asked if she had had unprotected intercourse in the last five days. She said yes. gave her my standard sex talk for adolescents, which covers condoms, safe sex, and emergency contraception, also known as Plan B. Before could finish, the nurse huffed out of the room. Back at the nursing station, asked the nurse to gather the supplies would need to do a pelvic exam and pregnancy test. also told her that the patient wanted Plan B. The nurse rolled her eyes. I can't stand it when girls like this are having sex but can't accept the consequences, she said. And this girl is obviously having sex with multiple partners. She shook her head. I refuse to give her Plan B. You can get it yourself. Trying to figure out her reasoning, asked her why, exactly, she was refusing to get the Plan B. She told me, This patient is not being responsible, and don't believe in abortion. tried to explain that emergency contraception doesn't cause abortions. In fact, scientific evidence shows that the main mechanism is to prevent ovulation, not implantation, and that it won't affect an already fertilized or implanted embryo. She didn't seem to care. was torn. Part of me wanted to tell her that, if she was going to work in my ED, she was going to have to give patients the medications that ordered, while part of me wanted to respect her beliefs. But had a nagging suspicion that her response had nothing to do with her beliefs--that she just thought this irresponsible adolescent did not deserve our help. Every day on the front lines of health care, treatment decisions like this one are made. What factors influence them and ultimately determine what care a particular patient receives? In the real world, it is clear that treatments do not solely depend on what is medically indicated for the disease at hand. Should the decision to provide emergency contraception depend on the situation? For example, suppose this sixteen-year-old was in a monogamous relationship and using a condom, but it broke. Would we have felt the same? Does (or should) her socioeconomic status play a role in how we treat her? How about her race? What if she were a rape victim? While a particular treatment may be legal or medically indicated, that doesn't mean it will always be discussed with or provided to patients; much depends on the attitudes of the health care providers, and those attitudes are often based on the context they perceive to be relevant. Studies have shown the majority of emergency contraception prescriptions in the ED are given in situations involving nonconsensual intercourse or sexual assault. Consensual unprotected intercourse, though, can be a different story. Over the years, have known both physicians and nurses who, like the nurse above, refuse to prescribe emergency contraception in this situation. In order to assess the attitudes, beliefs, and experiences that influence health care providers' decisions about emergency contraception in pediatric emergency departments, Melissa Miller and I, along with several colleagues, recently conducted a multicenter study to examine this issue. We interviewed focus groups of nurses and physicians to elicit their thoughts and experiences regarding emergency contraception in the pediatric emergency department. …

Community pharmacists providing emergency contraception give little advice about future contraceptive use: a mystery shopper study

Background UK women increasingly prefer to attend a pharmacy for emergency contraception (EC) rather than a doctor. Most women who use EC do not conceive and remain at risk of pregnancy unless they start regular contraception. We undertook a study to evaluate the quality of service provision in community pharmacies in Lothian, Scotland, and to determine what advice is given about contraception after EC use. Study Design Mystery shopper study. Results EC was unobtainable from 5/40 pharmacies (12.5%), refused because of “contraindications” in 7 (17.5%) and offered in 28 (70%). Most pharmacists appeared nonjudgemental, over 75% asked appropriate questions about eligibility, and over 90% gave appropriate advice about use. EC was universally refused beyond 72 h after sex but universally provided when the date of the last menstrual period was uncertain. Ongoing contraception after EC use was discussed in only 32.5% of all pharmacies and only 43% of those issuing EC. Conclusions The quality of consultations for EC in pharmacies is generally good but only a minority discuss ongoing contraception after EC use. The implications for contraceptive use and unintended pregnancy rates are worrying.

Pharmacy Access to Emergency Contraception in Rural and Frontier Communities

Timely access to emergency contraception (EC) has emerged as a major public health effort in the prevention of unintended pregnancies. The recent FDA decision to allow over-the-counter availability of emergency contraception for adult women presents important rural health implications. American women, especially those living in rural and frontier areas, have one of the highest rates of unintended and teen pregnancy among developed countries. This study, conducted prior to the recent FDA ruling, evaluated the participation among California pharmacies in the pharmacy access program in December 2005, specifically comparing rural/frontier and urban pharmacies. The sample consisted of 862 California pharmacies, including 50 in rural/frontier areas, which were randomly selected and surveyed by telephone. The results indicated that similar proportions of rural/frontier pharmacies and urban pharmacies provided direct pharmacy access services (28% vs 22%, P = 0.32). However, of the 13 rural/frontier counties included in the survey, eight (62%) had no emergency contraception pharmacies. The rural/frontier pharmacies that provided emergency contraception services tended to be small, independent pharmacies in the most remote areas of the state. Among rural/frontier pharmacies that did not participate in the program, the primary reasons included lack of training or demand for emergency contraception. Only one rural/frontier pharmacist cited moral or religious opposition to providing emergency contraception. In light of the current limited over-the-counter status of emergency contraception, the role of rural and frontier pharmacies in ensuring access to emergency contraception will increase in the future.

Moral Disagreement and Providing Emergency Contraception: A Pluralistic Alternative

Moral Disagreement and Providing Emergency Contraception: A Pluralistic Alternative

Conscientious Objection and Emergency Contraception

This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons and concludes that they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested.

Using the theory of reasoned action to explain physician intention to prescribe emergency contraception.

Although research has examined providers' knowledge, attitudes and prescribing behaviors with regard to emergency contraception, none has used a theory-based approach to understanding the interplay of these factors. A cross-sectional survey of 96 faculty physicians from one Southern and three Midwestern universities was conducted in 2004 to assess factors associated with intention to prescribe emergency contraception. The theory of reasoned action guided the study hypotheses and survey design. Correlation and regression analyses were used to examine the data. Only 42% of respondents strongly intended to prescribe emergency contraception for teenagers, but 65-77% intended to do so for all other specified groups (women who ask for the method, who have had a method problem, who have experienced rape or incest, and who have had unprotected sex). Consistent with the theory of reasoned action, high intention to prescribe emergency contraception was associated with positive attitudes toward doing so and with the perception that specific colleagues or professional groups support prescribing it; however, the perception of support by colleagues or professional groups in general did not predict intention. Also consistent with the theory, physicians' knowledge about emergency contraception and their demographic characteristics were not significant. Interventions to encourage physicians to provide emergency contraception should take into account their attitudes toward the method and the components of those attitudes.

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.