Use Of Emergency Contraceptive Pills Research Articles

To Have or to Hold: Use Patterns and Pregnancy Rates in Adolescent Mothers Given Advance Ecps or Ecp Prescriptions

Background: Randomized controlled trials have demonstrated that the advanced provision of emergency contraceptive pills (ECPs) increases their use without deterring the use of condoms or highly effective contraceptives or incurring risky sexual behavior or the acquisition of sexually transmitted diseases. The purpose of this study was to examine the effect of two advance provision intervention strategies (ECP packets vs. prescription) on unprotected sexual intercourse, ECP use, and pregnancy rates in an adolescent maternity program.

Effect of an emergency contraceptive pill intervention on pregnancy risk behavior

Objective Previous trials of emergency contraceptive pills (ECPs) found that in menstrual cycles ending in pregnancy, ECP use was more common among women exposed to interventions that enhanced access to the medication than among women with standard access. We examined data from one such trial to explore whether this finding has implications regarding the effect of the intervention on pregnancy risk behavior. Methods In our recent randomized trial, the intervention group received unlimited free ECPs in advance of need, whereas control participants obtained the medication when needed at usual cost. Participants were followed up for 1 year. In this secondary analysis, we examined ECP and contraceptive use in the cycles ending in pregnancy in that trial. Results Pregnancies in the intervention group appeared to have been more likely than those in the control group to be classified as “probably” or “possibly” ECP failures (12/74 in the intervention group vs. 1/74 in the control group; p=.012) and more likely to have occurred in the context of use of less efficacious contraceptives. Conclusion Unrestricted access to ECPs in this trial may have increased the frequency of coital acts with the potential to lead to pregnancy.

Advance provision of emergency contraceptive pills reduces treatment delay: a randomised controlled trial among Swedish teenage girls

To evaluate an intervention involving advance provision of emergency contraceptive pills (ECP) to Swedish teenage girls. Some 420 girls aged 15-19, requesting ECP at a local youth clinic were randomly assigned to intervention group (IG) (n=214) or control group (CG) (n=206). Both groups received ECP on request. The IG received one extra dose of ECP, condoms and an information leaflet regarding ECP and condom use. Main outcome measures were differences between IG and CG regarding ECP use, time span between unprotected intercourse and ECP intake, contraceptive use, and sexual risk taking. Questionnaires were completed at the initial visit, and the girls were followed up by structured telephone interviews 3 and 6 months later. At the 3-month follow-up, girls in the IG were almost twice as likely to have used ECP compared to girls in the CG (IG: 24.0%, CG: 13%, p=0.02), and they used it sooner after unprotected intercourse (mean time IG: 13.61 h, CG: 25.47 h, p=0.007). Significant differences persisted 6 months after the intervention (ECP use IG: 31%, CG: 19%, p=0.01; and mean time IG: 15.59 h, CG: 26.38 h, p=0.006). No significant differences were found in the use of regular hormonal contraceptives or condoms at either follow-up. About 40% of the girls in both groups had risked pregnancy during the follow-up period, but only half of these had used ECP. This intervention shortened the time interval from unprotected intercourse to pill intake without jeopardising contraceptive use and without increasing sexual risk taking.

Women Seeking Emergency Contraceptive Pills by Using the Internet: Wu J, Gipson T, Chin N, et al. Obstet Gynecol 2007;110:44–52

This study was a quantitative survey of 200 women seeking emergency contraceptive pills (ECPs) from The Emergency Contraceptive Website (http://ec.princeton.edu). The objective of the study was to determine the barriers and attitudes related to emergency contraceptive access among women who use the Internet. Telephone surveys of a convenience sample of 200 women requesting ECPs were obtained. These women were predominantly white, college-educated, urban residents of high socioeconomic status. A 27-item survey collected the following information: 1) reason(s) for needing ECPs, 2) recent contraceptive and ECP use, 3) barriers to getting ECPs, 4) attitudes about advanced prescription of ECPs and non-prescription ECPs, and 5) demographics. The women most commonly reported condom breakage, slippage, or incorrect use as the reason for needing ECPs. Structural barriers, such as inconvenient office hours, were cited as the largest barrier to obtaining emergency contraception for those women who attempted to obtain ECPs from local providers. The majority of women in the study, however, employed unconventional resources such as the Internet for emergency contraception. Most women supported advanced prescription of ECPs for future use, but less than half were in support of non-prescription ECPs. The main concern about non-prescription emergency contraception was that it may promote risky sexual behavior and poor contraceptive practice. The authors conclude that this study gives new insight into the issue of emergency contraception through an integrated analysis of both qualitative and quantitative data.

Levonorgestrel for emergency contraception

Unintended pregnancy is a persistent public health and social concern worldwide. The initial hope was that the widespread use of emergency contraceptive pills (ECPs) – methods that prevent pregnancy after unprotected sex – would reduce the incidence of unintended pregnancy. However, ECPs have not been demonstrated to lead to a population-level reduction in unintended pregnancy, because women do not use this moderately efficacious contraceptive often enough when they are at risk. ECPs containing 1.5 mg of the progestin levonorgestrel are available throughout the world. They are efficacious, safe and well tolerated. The only dedicated ECP available in the USA is a two-dose formulation of levonorgestrel (0.75 mg each); it is sold over the counter to clients 18 years of age and by prescription only for females under the age of over 18 years, although there is no medical rationale for requiring a prescription for any woman.

Preventing Rapid Repeat Teen Pregnancies: Why Aren't Emergency Contraceptive Pills the Answer?

Background: Emergency contraceptive pills (ECPs) have not had the anticipated impact on teen pregnancy. This is because even young women who have ECPs on hand often fail to use them following unprotected intercourse. Few studies pair ECP use with episodes of unprotected sexual intercourse. We hypothesized that the problem of ECP under-utilization is far bigger and more pervasive than the literature suggests.

Use of emergency contraceptive pills and condoms by college students: A survey

Objectives This study examined the intentions, knowledge, and attitudes of college students regarding the use of emergency contraceptive pills (ECPs) and condoms. Design and setting A cross-sectional descriptive study was conducted at 16 Korean colleges. Methods Data were collected from March 15 to June 10, 2006 from a convenience sample of 1046 college students using a survey questionnaire. The survey included measures of demographic variables, intention to use ECPs (one item) and condoms (one item), knowledge about ECPs (12 items), and attitudes toward using ECPs (12 items) and condoms (16 items). All items except knowledge were rated on a 5-point Likert-type response format, with higher scores indicating greater intentions, more positive attitudes, and greater knowledge. Results Of the 1046 participants, 76.3% had heard of ECPs and 13.2% of the sexually active participants ( n=190) had used them. Participants showed a general lack of knowledge about ECPs and misconceptions about their safety. The intentions of using ECPs and condoms were positively correlated with each other and with attitude such that the more positive the attitude, the greater their intention to use both ECPs and condoms. There were significant gender differences on many of the variables, in that female students had higher knowledge about ECPs, intention of using ECPs and condoms, and more positive attitude toward condoms than male students who had more positive attitudes toward ECPs. Females had more concerns about the safety of ECPs than males. Conclusions The findings suggest that college students must be better informed about ECPs, and reassured about their safety. Additionally, promoting ECPs would not negatively affect condom use. Efforts are needed to disseminate up-to-date information to the general public and to develop educational and awareness programs to empower young people to make informed decisions about the use of ECPs and condoms.

Availability of services for emergency contraceptive pills at high school-based health centers.

School-based health centers have the potential to increase adolescents' awareness of, access to and use of emergency contraceptive pills, which can prevent unintended pregnancy following unprotected sex. In 2001, 250 high school-based health centers responded to a nationwide mail survey that assessed the provision of education, referral and prescription services for emergency contraceptive pills, as well as the perceived benefits and barriers related to offering these services. Frequencies, cross-tabulations and logistic regression models were used to analyze the data. Fifty-nine percent of the centers provided education and referrals for emergency contraceptive pills, while 30% provided prescriptions. Staff generally identified the same benefits of and barriers to services, although centers that provided services were more likely than nonproviders to report benefits and less likely to report barriers. Predictors of offering education were providing reproductive health services (odds ratio, 4.6) and citing the increased likelihood that students would use the method (3.5) and have the opportunity to discuss contraception (2.6). Reporting the benefit of pregnancy prevention was a predictor of offering referrals (2.9), while providing reproductive health services (30.4) and citing pregnancy prevention (6.3) were predictors of offering prescriptions. Predictors of the decreased likelihood of offering services were also identified. School centers that provide all three services have the greatest potential to ensure the successful use of emergency contraceptive pills by adolescents. While the number of centers offering services appears to be increasing, greater efforts are needed to improve students' awareness of and access to the method so they can make informed decisions regarding their reproductive health.

Awareness of emergency contraception among female college students in Chandigarh, India

Adolescents and young women are at the greatest risk of unintended pregnancy because they are unlikely to see a family planning provider before or immediately after the sexual activity. Therefore, preventing unintended pregnancy among them is the important concern. Sexually active young women are clients with special needs for contraception. They are eligible to use a variety of the available contraceptives. Introduction of emergency contraception (EC) in the recent past can help them avoid such unintended pregnancies. To investigate the awareness of emergency contraception in female college students. Cross-sectional, questionnaire-based study. This study was conducted among college-going undergraduate and graduate female students of Punjab University, Chandigarh. Systematic random sampling was used to select the respondents. Of the 1,017 college students included in the study, 507 (49.9%) knew about different contraceptive methods. Maximum awareness was regarding oral contraceptive pills (239, 47.1%). Only 74 (7.3%) had knowledge about emergency contraceptive pills (ECP). Of them, 10 (14.7%) students knew the correct time for use of ECP and the side effects of ECP were known to 48 (88.9%) respondents. Awareness about ECP was very low among female college students of Chandigarh, especially regarding correct timing of its use and its side effects. Appropriate awareness programs on EC are needed for them.

The determinants and circumstances of use of emergency contraceptive pills in France in the context of direct pharmacy access

Background In France, the 1999 introduction of a dedicated emergency contraceptive pill (ECP) available without a prescription has resulted in a 72% increase in its use over the past 5 years, especially among younger women. Methods We used a population-based health survey conducted in 1999 and in 2004 to examine the changes in the determinants of lifetime ECP use among women aged between 15 and 24 years. We also explored the determinants and circumstances of recent use of ECPs in 2004 among women aged between 15 and 44 years who are at risk for unplanned pregnancy. Results In 1999, 14.6% of women aged between 15 and 24 years had ever used ECPs; this proportion rose to 31.7% in 2004. Results show consistent patterns of lifetime ECP use in 1999 and in 2004, with greater use among higher-educated women and women living in large cities. In 2004, 22% of women were using no contraceptive at the time they used ECPs and 84% resumed use of a regular contraceptive after ECP use. However, 5.5% had unprotected intercourse after taking ECPs in the same menstrual cycle and in the next. Conclusion Despite direct pharmacy access, differences in ECP use remain by social and residential status. Emergency contraceptive pills were used as a backup method in case of contraceptive failure and did not impede the use of subsequent regular contraception.

Increased sexual risk taking behavior among Swedish female university students: repeated cross‐sectional surveys

The aim of this study was to perform a repeated cross-sectional study of female university students' sexual and contraceptive behavior, as well as experiences of pornography and sexual harassment and compare the findings with those from earlier studies. Waiting-room questionnaires to female university students (n = 315) visiting a Student Health Centre in Sweden. Similar investigations had been performed earlier, which enabled comparisons. Almost all women (98%) had experienced intercourse and giving oral sex (94%). Condoms were most often used at first intercourse (72%) and combined oral contraceptives at latest intercourse (67%). The ever use of emergency contraceptive pills had increased from 22% to 52% over five years and there was a tendency towards more risk-taking behavior with more sexual partners (mean 5.4 in 1999 and mean 7.4 in 2004), more experience of first-date intercourse without a condom (37-45%), and more self-reported sexually transmitted infections (14-21%). The proportion of women who had undergone an abortion remained stable (6%) and fewer women reported ever being sexually harassed in 2004 compared to 1999. In conclusion, contraceptive use remained stable over time, but there was a trend towards more risky sexual behavior with more sexual partners, more unprotected first-date intercourse, and more self-reported sexually transmitted infections. Induced abortions, however, had not increased, but the use of emergency contraceptive pills had more than doubled in the five years between 1999 and 2004.

The determinants and circumstances of the use of emergency contraceptive pills in France in the context of direct pharmacy access

In France, the 1999 introduction of a dedicated emergency contraceptive pill (ECP) that is available without a prescription has resulted in a 72% increase in its use over the past 5 years, especially in younger women (aged 15���24 years old).

Health Care Providers' Knowledge of, Attitudes Toward and Provision of Emergency Contraceptives In Lagos, Nigeria

Emergency contraception can play an important role in reducing the rate of unintended pregnancies in Nigeria. Although it is included in the national family planning guidelines, there is limited awareness of this method among clients. In 2003-2004, a sample of 256 health care providers within Lagos State were surveyed about their knowledge of, attitudes toward and provision of emergency contraceptives, using a 25-item, self-administered questionnaire. Frequencies were calculated for the various measures, and chi-square tests were used to determine significant differences. Nine in 10 providers had heard of emergency contraception, but many lacked specific knowledge about the method. Only half of them knew the correct time frame for effective use of emergency contraceptive pills, and three-fourths knew that the pills prevent pregnancy; more than a third incorrectly believed that they may act as an abortifacient. Fewer than a third of respondents who had heard of the pills knew that they are legal in Nigeria. Of those who had heard about emergency contraception, 58% had provided clients with emergency contraceptive pills, yet only 10% of these providers could correctly identify the drug, dose and timing of the first pill in the regimen. Furthermore, fewer than one in 10 of those who knew of emergency contraception said they always provided information to clients, whereas a fourth said they never did so. Nigerian health care providers urgently need education about emergency contraception; training programs should target the types of providers who are less knowledgeable about the method.

Contraceptive failures and determinants of emergency contraception use

Objectives Two years after emergency contraceptive pills (ECPs) were made available without prescription in France, we investigated the determinants of ECP use in a representative sample of women at risk for unintended pregnancy. Study Design This study is based on data collected from a population-based cohort exploring contraceptive practices and abortion ( N=2863). Results Among the 706 women at risk for unintended pregnancy during the first year of follow-up (2001), only 11.1% used ECPs. Women in stable relationships or using the same contraceptive method during the year were less likely to use ECPs than other women. The study also demonstrates that detailed knowledge of ECPs increases the probability of its subsequent use. Conclusions Given the low frequency of ECP use in cases of unintended pregnancy risk, these results suggest that information campaigns should be targeted not only at women with irregular contraceptive practices but also at women who experience errors in the use of their regular contraceptive method.

The impact of pharmacy access to emergency contraceptive pills in France

Objective The objective of this study is to determine the impact of pharmacy access to emergency contraceptive pills (ECPs) on ECP use, risky sexual behavior and contraceptive use patterns in France. Methods We analyzed the responses of women to heath surveys conducted in 1999 and 2004. Results We found that increasing access to ECPs in France by introducing a dedicated product and by eliminating prescription requirement resulted in increased ECP use, with the vast majority of ECP users in 2004 having obtained ECPs directly from a pharmacy without a prescription. This increase in ECP access and use did not result in increased proportions of women who had ever had intercourse, or in a decrease in the age at first intercourse, or in an increase in the proportion of women at risk for unintended pregnancy. Among women at risk for unintended pregnancy, there was no decrease in the use of contraception and no decrease in the use of the most effective methods. Conclusion Introducing a dedicated product and allowing direct pharmacy access to ECPs in France have resulted in greater ECP use, with no negative impact on sexual behavior or use of contraception.

Comparison of knowledge, attitudes, experience, and opinions between teachers and guardians regarding the emergency contraceptive pill in Chiang Mai, Thailand

Teachers and guardians (parents or authorized persons) are expected to collaborate in educating female students about emergency contraceptive pills (ECPs) but it is unknown whether they have similar perspectives on ECPs. This study aimed to compare their knowledge, attitudes, experience, and opinions regarding ECPs. Questionnaires were distributed to 720 female teachers and guardians of eight randomly selected high schools and vocational schools in Chiang Mai, Thailand. There were significantly more teachers who knew about the existence of ECPs than guardians. More guardians reported some accurate information regarding ECPs than did teachers. More teachers than guardians believed that the use of ECPs was not morally wrong. Both teachers and guardians had similar experience with ECP use and similar agreement in teaching female adolescents about ECPs. The teachers and guardians had some different opinions on teaching barriers. It is suggested that both teachers and guardians are suited to teach female adolescents about ECPs, but they need preparation in different aspects.

Perceptions of Emergency Contraceptive Pills among Young Korean Women

Purpose: The purpose of this study was to examine the perceptions regarding the use of Emergency Contraceptive Pills (ECPs) among young Korean women. Method: The study included 14 unmarried women aged 19 to 34 years (mean, 25 years). Data was collected by focus group interviews and an in-depth interview from July to November, 2005. Content analysis was conducted. Result: The four major themes that emerged were control of accessibility, safety concern, lack of knowledge and information, and ambivalence. Control of accessibility: Most of the participants stated a prescription is necessary although they might feel ashamed if they had to ask for an ECP. Safety concerns: Participants thought that taking an ECP would be harmful to their body. Lack of knowledge and information: Most of the participants felt that they did not know enough about ECPs and were willing to learn more. Ambivalence: The participants stated that they would take an ECP when needed and would recommend it to a friend although they were concerned about the risks of ECPs. Conclusion: The results from this study suggest the need for an educational and awareness program to empower women to be able to make informed decisions on ECPs when needed.

Bleeding patterns after use of levonorgestrel emergency contraceptive pills

Objective The objective of this study was to describe bleeding after use of an emergency contraceptive pill (ECP) regimen consisting of 1.5 mg of levonorgestrel in a single dose. Methods We asked 120 women who had been treated with the regimen to keep daily bleeding diaries for 9 weeks. We compared bleeding patterns observed after treatment with usual patterns reported by the participants and with patterns observed in a prior study on women who had not taken ECPs. Results Treatment in the first 3 weeks of the menstrual cycle significantly shortened that cycle as compared both with the usual cycle length and with the cycle duration in a comparison group. The magnitude of this effect was greater the earlier the pills were taken. In contrast, the duration of the first menstrual period after treatment increased significantly with cycle week of treatment and was longer in women who used the treatment than in those who did not. Intermenstrual bleeding occurred in only 5% of women in the first cycle after treatment. Conclusions The effect of the single-dose levonorgestrel ECP regimen on the timing and duration of the next menstrual period depends on when during the cycle the pills are taken. Intermenstrual bleeding following treatment is uncommon.

Cost savings from use of emergency contraceptive pills in Australia

Emergency contraception, which prevents pregnancy after unprotected sexual intercourse, has the potential to reduce significantly the incidence of unintended pregnancy and the consequent need for abortion and to reduce medical care costs. To determine the savings generated by use of Postinor-2, the levonorgestrel regimen of emergency hormonal contraception, in Australia. We modelled the cost savings when women obtain Postinor-2 directly from a pharmacist where cost savings are measured as the cost of pregnancies averted by use of Postinor-2 per dollar spent on Postinor-2. Each dollar spent on a single treatment with Postinor-2 saves A$2.27-A$3.81 in direct medical care expenditures on unintended pregnancy depending on assumptions about savings from costs avoided by preventing mistimed births. Postinor-2 is cost-saving even under the least favourable assumption that mistimed births when prevented today occur 2 years later. Results are robust even to large changes in model input parameters. Emergency contraception is cost saving. More extensive use of emergency contraception could save considerable medical and social costs by reducing unintended pregnancies, which are expensive.

Availability of Services for Emergency Contraceptive Pills At High School?Based Health Centers

School-based health centers have the potential to increase adolescents' awareness of, access to and use of emergency contraceptive pills, which can prevent unintended pregnancy following unprotected sex.In 2001, 250 high school-based health centers responded to a nationwide mail survey that assessed the provision of education, referral and prescription services for emergency contraceptive pills, as well as the perceived benefits and barriers related to offering these services. Frequencies, cross-tabulations and logistic regression models were used to analyze the data.Fifty-nine percent of the centers provided education and referrals for emergency contraceptive pills, while 30% provided prescriptions. Staff generally identified the same benefits of and barriers to services, although centers that provided services were more likely than nonproviders to report benefits and less likely to report barriers. Predictors of offering education were providing reproductive health services (odds ratio, 4.6) and citing the increased likelihood that students would use the method (3.5) and have the opportunity to discuss contraception (2.6). Reporting the benefit of pregnancy prevention was a predictor of offering referrals (2.9), while providing reproductive health services (30.4) and citing pregnancy prevention (6.3) were predictors of offering prescriptions. Predictors of the decreased likelihood of offering services were also identified.School centers that provide all three services have the greatest potential to ensure the successful use of emergency contraceptive pills by adolescents. While the number of centers offering services appears to be increasing, greater efforts are needed to improve students' awareness of and access to the method so they can make informed decisions regarding their reproductive health.