Educational Intervention Among Adolescents and Young Adults on Emergency Contraception Options.

PURPOSE: Emergency contraception (EC), the 'last chance' contraceptive method, has gained significance post-Roe, but most young people do not know their options. METHODS: We conducted an educational intervention on EC among 1,053 students aged 18-25 years. We assessed changes in knowledge of key aspects of EC using generalized estimating equations. RESULTS: At baseline, virtually no one was aware of the intrauterine device for EC (4%), but postintervention, 89% correctly identified intrauterine devices as the most effective EC (adjusted odds ratio [aOR] = 116.6; 95% confidence interval [CI] 62.4, 217.8). Knowledge that levonorgestrel pills could be accessed without a prescription grew (60%-90%; aOR = 9.7, 95% CI 6.7-14.0), as did knowledge that pills work best when taken as soon as possible (75%-95%; aOR = 9.6, 95% CI 6.1-14.9). Multivariate results showed adolescent and young adult participants absorbed these key concepts across age, gender, and sexual orientation. DISCUSSION: Timely interventions are needed to empower youth with knowledge of EC options.

Society of Family Planning Clinical Recommendation: Emergency contraception.

Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG (such as Plan B One-Step, My Way, Take Action), and oral ulipristal acetate (UPA) (ella). These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPA at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPA use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.

Choosing Plan B Over Plan A: Risk Compensation Theory and Contraceptive Choice in India.

Can women's contraceptive method choice be better understood through risk compensation theory? This theory implies that people act with greater care when the perceived risk of an activity is higher and with less care when it is lower. We examine how increased over-the-counter access to emergency contraceptive pills (ECPs) accompanied by marketing campaigns in India affected women's contraceptive method choices and incidence of sexually transmitted infections (STIs). Although ECPs substantially reduce the risk of pregnancy, they are less effective than other contraceptive methods and do not reduce the risk of STIs. We test whether an exogenous policy change that increased access to ECPs leads people to substitute away from other methods of contraception, such as condoms, thereby increasing the risk of both unintended pregnancy and STIs. We find evidence for risk compensation in terms of reduced use of condoms but not for increases in rates of STIs.

Knowledge, attitude and practice of emergency contraceptive pills among community pharmacy practitioners working in Kathmandu Valley: a cross-sectional study.

BACKGROUND: Unintended pregnancy occurs due to incorrect or inconsistent use of a contraception method. Such pregnancies can create an economic burden on the family, society and nation as a whole. Unintended pregnancy is the underlying cause of abortion which can also result in infertility and maternal death. Adequate knowledge of emergency contraceptive pills (ECPs) and positive attitudes among the community pharmacy practitioners (CPPs) is a prerequisite for timely access of ECP, thus ultimately lessening the incidence of unintended pregnancies. This study intended to explore the knowledge, attitude and practice of CPPs toward ECPs in Kathmandu valley. METHODS: Cross-sectional study conducted in community pharmacies located in three districts of Kathmandu valley. A convenience sampling method was employed to interview CPPs in 227 community pharmacies using a validated questionnaire. Questionnaire assessed the demographic characteristics; knowledge, attitude and dispensing practice of the CPPs. Data were subjected to descriptive and inferential analysis using SPSS 18 (SPSS Inc., Chicago, IL, USA). RESULTS: Approximately 75% of respondents had a good practice on dispensing ECPs, and 70% of them counselled all the users. A significant association (p-value< 0.05) was obtained between the dispensing practice of respondents and their knowledge level. ECP related knowledge was higher among the age group 40-49 years, BPharm degree holders with experience above 10 years and community pharmacies located inside the city and in the Kathmandu district. After adjusting the possible confounder variables, age, degree and district of pharmacy were significantly associated with knowledge. Similarly, respondents' practice towards ECP was higher among the age group 40-49 years with experience above 10 years and community pharmacies located inside the city and in the Kathmandu district. Adjusted for other variables, only community pharmacies located at Kathmandu district was significantly associated with the practice. CONCLUSION: CPPs lacked specific important information on ECP and opined against its' availability as an over-the-counter drug, despite good overall knowledge and positive attitude. Many thought that ECP without prescription would increase promiscuity towards sexual behaviour and result in unsafe sex along with its' repeated use. Hence, training and proper counselling strategies should be afoot to refine the delivery of service by CPPs.

Knowledge and Parity: Perspectives of Usage of Emergency Contraceptive Pills among Women of a Rural Area of Delhi.

CONTEXT: Correct use of emergency contraceptive pills (ECPs) may prevent up to 95% of unwanted pregnancies which may significantly decrease unsafe abortions and maternal mortality. AIMS: Assessment of knowledge and use of ECPs among women and to explore factors associated with them. MATERIALS AND METHODS: This was a facility-based cross-sectional study. Data were collected using a prestructured, pretested questionnaire from 381 reproductive age women (15-49 years) selected by systematic random sampling. Statistical Package for the Social Sciences version 16 and Epi info (version 7.0.) were used for all statistical analyses. Descriptive analysis was performed, and results were expressed in terms of frequencies and percentages. The Chi-square and Fisher's exact test were used as tests of significance in univariate analysis. Determinants of use of ECPs were identified using logistic regression. RESULTS: Of 381 women interviewed, awareness level of ECPs (ever heard about ECPs) was found to be 34% (n = 128). Ever use of emergency contraception was reported by 38 (9.7%). Age (odds ratio [OR] = 3.02, 95% confidence interval [CI] [1.88-4.87]), education (OR = 0.086, 95% CI [0.047-0.158]), husband's education (OR = 0.11, 95% CI [0.067-0.187]), socioeconomic status (OR = 6.14, 95% CI [3.28-11.51]), and family status (OR = 2.6, 95% CI [1.59-4.24]) were found to be significantly associated with the use of emergency contraceptives. CONCLUSIONS: The study identified that most respondents lack adequate knowledge about ECPs, and ever use of ECPs was very low. Factors that were associated with the use of ECPs were age, literacy, socioeconomic status, and knowledge about the method. Creating a sustainable awareness on ECPs and their use may serve them with power to control their parity.

Pre-service knowledge, perception, and use of emergency contraception among future healthcare providers in northern Ghana.

BACKGROUND: Emergency contraception, if used properly, can prevent up to over 95 % of unwanted and mistimed pregnancies. However, a number of obstacle including healthcare providers knowledge, perception, and attitude towards emergency contraception (EC) prevent women and adolescents from having access to EC. METHODS: This was a cross-sectional study among 191 female final year nursing and midwifery students of Tamale Nurses and Midwives Training College in the Northern Region of Ghana. Purposive sampling method was used to sample 100 students from the nursing programme and 91 from the midwifery programme. Chi-square and Fisher's exact tests were performed to determine factors associated with awareness about EC and use of EC. RESULTS: Over four-fifths, 166(86.91%), of the participants indicated they had heard about EC prior to the study. Majority (80.10%) of the participants correctly indicated the time within which to take emergency contraceptive pills (ECPs). More than half, 105(54.97%), of the participants did not know the appropriate time within which to use IUD as EC. Almost four-fifths, 74(38.74%), of the participants indicated it is morally wrong to use EC and more than half, (n = 104, 54.45%), of them said EC use promotes promiscuity. Only 49(25.65%) participants said they had ever used ECP. Of the number that indicated ever-using ECP, 36(73.47%) cited condom breakage or slippage as the reason for using the method. CONCLUSION: Though there was a relatively high level of EC awareness and knowledge among the students, some students lacked detailed knowledge about the method, especially the use of IUD as EC. We found that it was easy to access EC in the study area but the use of EC was low among the students. Most of the students demonstrated a positive attitude towards EC, but many of them believed EC encourages promiscuous sexual behaviour and that it is morally wrong to use EC. The curriculum for nursing and midwifery education should provide opportunity for detailed information and practical knowledge on EC to demystify negative perceptions and attitudes of nursing and midwifery students towards EC and other forms of contraception and to improve their knowledge on EC.

Emergency Contraceptive Pills (ECP) Knowledge, Attitudes, and Practices Among Women Working in the Entertainment Industry and Men in the Trucking Industry, Bhutan.

Emergency contraceptive pills (ECP) were recently made available over the counter in Bhutan. We evaluated knowledge, attitudes, and practices concerning ECP in 2 populations at risk for HIV and STI (sexually transmitted infections): entertainment women (drayang) and male truck drivers and helpers (truckers). Of 179 drayang and 437 truckers intercepted at venues, 73.7 and 21.1%, respectively, had heard of ECP; 47.0% of drayang had used them. Their concerns about ECP use included harm to the body, impact on future pregnancy, side effects, and HIV/STI risk. Education programs are needed in Bhutan to increase awareness of ECP for unplanned pregnancy and condoms to prevent HIV and STI.

Awareness and Attitudes Toward Emergency Contraceptives Among College Students in South India.

BACKGROUND: In India every year, a large number of pregnancies are unplanned resulting in unsafe abortion. This has tremendous implications both on health and survival of women. Usage of emergency contraceptive pills (ECPs) could be a solution provided the usage is as per guidelines and social issues do not cause objections. AIM: This study was done to assess the awareness and attitudes regarding ECPs. METHODS: Data were collected using self-administered questionnaire from the university students. RESULTS: Out of 449 students, 384(85.5 %) had heard about ECPs. The commonest source of information was television 299(77.9 %). Only 128(33.3 %) students knew that ECPs do not help in prevention of STDs. 209(54.4 %) participants knew the correct time frame for taking ECPs. 109(28.4 %) were unaware of its side effects. Only 149(33.2 %) had received reproductive health education (RHE) in the past. The awareness level of students about ECPs was moderate among 231(60.2 %) participants. Awareness was significantly more among males (p = 0.013), students with science background (p = 0.001) and those who had RHE previously (p = 0.043). 219(57 %) had average level of perception toward ECPs. 254(66.2 %) participants favored prescription before procuring ECPs from drug stores. 261(68 %) participants favored information about ECPs to be given in educational institutions, and a majority, 186(48.4 %), said they would recommend ECPs to their friends. Average-to-good perception about ECPs was seen in significantly greater proportion of females (p = 0.034). CONCLUSION: RHE is must at educational institutions so as to promote awareness and to remove misconceptions about ECPs among youth. This would help users in preventing unintended pregnancies and unsafe abortions.

Adolescents' Knowledge, Attitude and Utilization of Emergency Contraceptive Pills in Nigeria's Niger Delta Region.

BACKGROUND AND OBJECTIVE: Risky sexual activity among adolescents is on the increase and contraceptive prevalence rate is low which is evidenced by high rate of teenage pregnancy in Bayelsa state, Nigeria. This study assesses the adolescents' knowledge, attitude and utilization of emergency contraceptive pills (ECP) in Amassoma Community, Bayelsa State, in the Niger Delta region of Nigeria. METHODS: The study was a descriptive cross-sectional research design. A purposive sampling technique was used to select a sample of 220 respondents from the target population. Data were collected using a self-structured questionnaire. Descriptive and inferential statistics were used to analyze the data generated. RESULTS: Majority of the respondents had high level of knowledge and positive attitude towards emergency contraceptive pills but had low level of utilization. Concerns about what others may say, parental attitude, contraceptive availability, contraceptive accessibility, and peer influences were the major factors that influenced the utilization of contraceptive pills. There was no significant relationship between knowledge and utilization of emergency contraceptive pills, as well as level of knowledge and their utilization of emergency contraceptive pills. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Adolescents in the study were more likely to use emergency contraceptive pills, if parents and others reaction to adolescents' contraceptive use were positive about those. Health care professionals, especially nurses, should organize enlightenment programs to educate adolescents, parents and the public on the benefits of adolescents' contraceptives use, especially ECP.

Safety data for levonorgestrel, ulipristal acetate and Yuzpe regimens for emergency contraception.

UNLABELLED: The World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) provide recommendations for use of emergency contraceptive pills (ECPs), including levonorgestrel (LNG) and combined oral contraceptives (COCs). A new ECP formulation, ulipristal acetate (UPA), is now available worldwide. To determine whether LNG, UPA or COC (Yuzpe) ECPs are safe for women with certain characteristics or medical conditions, we searched the PubMed and Cochrane databases for articles published from date of inception until May 2015 pertaining to the safety of LNG, UPA or Yuzpe ECP use. For direct evidence, we considered studies that looked at safety outcomes among women with certain medical conditions or characteristics taking ECPs compared with women not taking ECPs. For indirect evidence, we considered studies that reported pharmacokinetic (PK) data for ECP use among women with certain medical conditions or characteristics and studies that reported safety outcomes among healthy women taking ECPs. Five studies provided direct evidence; of these five studies, four examined LNG or Yuzpe use among pregnant or breastfeeding women, and one reported risk of ectopic pregnancy among women repeatedly using LNG ECPs. Poor pregnancy outcomes were rare among pregnant women who used LNG or Yuzpe ECPs during the conception cycle or early pregnancy. Breastfeeding outcomes did not differ between women exposed to LNG ECP and those unexposed, and there was no increased risk of ectopic pregnancy versus intrauterine pregnancy after repeated use of LNG ECPs compared with nonuse. Forty-five studies provided indirect evidence. One PK study demonstrated that LNG passes into breastmilk but in minimal quantities. In addition, nine studies examined pregnancy outcomes following ECP failure among healthy women, and 35 articles reported adverse events. Studies suggest that serious adverse events are rare among women taking any of these ECP formulations. IMPLICATIONS: Evidence on safety of ECPs among women with characteristics or medical conditions listed within WHO and CDC family planning guidance is limited. However, both direct and indirect evidence for our study question did not suggest any special safety concerns for the use of ECPs among women with particular medical conditions or personal characteristics, such as pregnancy, lactation or frequent ECP use.

Challenges in Introducing New Contraceptive Methods: A Case Study of India.

Increasing choice and introducing new contraceptive methods in the National Family Welfare Program in India could play a significant role in increasing adoption of contraception and meeting the unmet need of a large proportion of couples. However, inclusion of any new contraceptive method in India has to face many challenges at different steps: from clinical trials, administrative processes, acceptance in the national program, and reaching the intended beneficiaries. Having a good product is necessary but not sufficient for widespread accessibility, acceptance, and use. This article reviews the challenges based on the available policy documents, literature review, and discussions with senior program managers of the Ministry of Health and Family Welfare and development organizations. It concludes that comprehensive strategic planning is needed to address all possible barriers to ensure new contraceptive access at an affordable price by the beneficiaries it is intended for.

"In rape cases we can use this pill": a multimethods assessment of emergency contraception knowledge, access, and needs on the Thailand-Burma border.

OBJECTIVES: To evaluate availability, service delivery, and barriers to access to emergency contraceptive pills (ECPs) along the Thailand-Burma border. METHODS: From June 2010 to May 2011 we undertook a multimethods qualitative assessment among cross-border populations, migrants, and refugees. We conducted 46 key informant interviews with representatives from 25 organizations, 18 focus group discussions with migrant adults, migrant adolescents, and healthcare workers, and a service mapping exercise with 22 stakeholders. RESULTS: We found low use of ECPs among the target populations. Structural barriers and lack of evidence-based reproductive health protocols, education, and information restrict access to the limited family planning resources available in this region. Misinformation about ECPs was widespread among health workers and organizational policies were often non-evidence based. CONCLUSION: Potential policy and program interventions to improve access to ECPs along the Thailand-Burma border include integrating evidence-based practices into community efforts, expanding training opportunities for health workers, and improving communication and coordination among organizations serving populations on both sides of the border.

'Stratified Contraception': Emergency Contraceptive Pills and Women's Differential Experiences in Contemporary India.

Available without prescriptions in India since 2005, emergency contraceptive pills (ECPs) and their advertisements have provided women with increased contraceptive options and a vocabulary to talk about their reproductive lives. I draw on long-term fieldwork with women in urban India about ECPs, demonstrating a new form of 'stratified contraception' enabled by these pills and their advertisements. I posit that there are within India spaces that replicate the luxuries and privileges of the global North. These material conditions, I suggest, are replicated when it comes to contraception as there are hubs of women consumers of contraception and contraceptive advertising that participate in an 'imagined cosmopolitanism' within the global South in close proximity to 'contraceptive ghettos.' Moving beyond simplistic binaries, I outline three major stratifications along which women experience this medical technology and outline the implications for women and their contraceptive choices when notions of northern privilege exist in the 'South.'

Píldora anticonceptiva de emergencia: características de la demanda en una organización no gubernamental en Chile / Emergency contraceptive pill: demand characteristics in a non-governmental organization in Chile

Antecedentes: En Chile, existe escasa información sobre las características de las usuarias de la píldora de emergencia y aún hay barreras para obtenerla, pese a existir una ley que garantiza su acceso. Objetivos: Indagar sobre el perfil de las mujeres que demandan la píldora de emergencia y las barreras para acceder al método en centros públicos de salud. Método: Estudio descriptivo y transversal. Se revisaron las fichas clínicas de usuarias de la píldora de emergencia atendidas en Prosalud Chile de enero de 2012 a marzo de 2013, para analizar edad, razón de uso, uso previo y antecedentes de no acceso. Resultados: Se analizaron 520 fichas clínicas. Edad promedio de las usuarias 21,8 +/- 6,8 años. 50 por ciento usó el anticonceptivo porque tuvo un coito sin protección anticonceptiva y la otra mitad porque su método falló. El 71,7 por ciento no había usado la píldora previamente y 0,8 por ciento (3 mujeres) la habían usado 3 y 4 veces; 8,8 por ciento no obtuvo el anticonceptivo en centros públicos de salud. Conclusiones: La mayoría de las usuarias de la píldora de emergencia son jóvenes y la solicitan porque no usaron un anticonceptivo o éste les falló. El uso previo y frecuente es muy bajo. Aún existen barreras en el acceso en centros públicos de salud.

Background: In Chile, the information about the characteristics of the users of emergency contraception pill is limited. In addition, some studies have revealed barriers to access to this method, despite the law guarantees its provision. Objectives: To enquire the profile of emergency contraceptive pills users and the barriers to its access in public health services. Methods: Descriptive and cross-sectional study. Clinical forms of users who requested the emergency contraceptive pill in Prosalud Chile from January 2012 to March 2013 were revised, in order to analyze age, reason to use, previous use and non-access history in public health services. Results: 520 clinical forms were analyzed. Users mean age was 21.8 +/- 6.8 years. 50 percent of women demanded the pill because they did not use any contraceptive and another half because the contraceptive failed. 71.7 percent had never used the pill previously and only 0.8 percent (3 women) used it three and four times before. 8,8 percent could not obtain the pill in public health services. Conclusions: The majority of the emergency contraceptive pills users are young and they use it because they did not use a contraceptive or the contraceptive failed. The previous and frequent use is low. There are still barriers to access to emergency contraceptive pills in public health services.

Intention to use emergency contraceptive pills and the role of knowledge in a Dutch national sample.

OBJECTIVES: Emergency contraceptive pills (ECPs) are underused for preventing unintended pregnancy. Not all women are willing to use them even when at risk of conceiving. This paper examines whether increased knowledge about ECPs may increase the intention to use these products. METHODS: Factors associated with intention to use emergency contraception (EC) were assessed among 1310 women who participated in the nationally representative Sexual Health in the Netherlands 2009 Survey. Logistic regression models included demographics, prior use of ECPs, and ECP knowledge. RESULTS: Seventeen percent of the women did not intend to use EC after unprotected sexual intercourse and a further 27% were unsure whether they would use it. Intention is most strongly related to prior use and not having children. Only two of six knowledge items were related to intention in the multivariate analyses. Being aware that ECPs can be obtained without prescription upgrades intention, whereas knowing that a woman can still get pregnant after having taken the ECP has a negative impact on intention. CONCLUSIONS: Improving knowledge may contribute to intention to use EC, but its role will be modest. To understand the reasons behind ECP use it is essential to study the contribution of other factors, like attitudes and social norms.

Prospects for coitally-dependent hormonal contraception: perspectives from women in urban Kenya and Nigeria.

INTRODUCTION: Emergency contraceptive pills (ECPs) were developed and marketed with the emergency aspect firmly in mind, but research and anecdotal evidence indicate that some women use them as a form of regular contraception, spurring efforts in the reproductive health community to explore the development of a coitally-dependent oral contraceptive pill. METHODS: We asked women of reproductive age in Nairobi, Kenya and Lagos, Nigeria how likely they would be to use a hypothetical pericoital pill and why. RESULTS: Bivariate logistic regressions indicated that women aged 18-35 years, with secondary education or higher, and who had ever used condoms or short-acting methods, were more likely to say that they would use this hypothetical pill. Women who had ever used a family planning method or ECPs were also more likely to say they would use this pill. The likely adopters reported that they would use the pericoital method if it prevented pregnancy with little or no health problems and was convenient and easy to use. CONCLUSION: The findings suggest that should a safe and effective pericoital hormonal pill become available then a significant number of women would adopt this method.

Emerging options for emergency contraception.

Emergency post-coital contraception (EC) is an effective method of preventing pregnancy when used appropriately. EC has been available since the 1970s, and its availability and use have become widespread. Options for EC are broad and include the copper intrauterine device (IUD) and emergency contraceptive pills such as levonorgestrel, ulipristal acetate, combined oral contraceptive pills (Yuzpe method), and less commonly, mifepristone. Some options are available over-the-counter, while others require provider prescription or placement. There are no absolute contraindications to the use of emergency contraceptive pills, with the exception of ulipristal acetate and mifepristone. This article reviews the mechanisms of action, efficacy, safety, side effects, clinical considerations, and patient preferences with respect to EC usage. The decision of which regimen to use is influenced by local availability, cost, and patient preference.