The role of emergency contraception

Trends in Utilization of Emergency Contraceptives in Tanzania: A Retrospective Longitudinal Study From 2018 to 2023

Introduction Emergency contraceptives (ECs) are a critical method for preventing unwanted pregnancies following unprotected sexual intercourse. However, Tanzania is experiencing an alarming surge in the misuse of ECs among reproductive-aged females, particularly younger girls and women. Reports of their use as regular contraceptives are a rising concern. Deviations from their intended use in emergencies may not only increase the risk of contraceptive failure but also increase the risk of adverse health events. This study aims to delineate and evaluate the utilization patterns of ECs over six consecutive years using importation data obtained from the Tanzania Medicines and Medical Devices Authority (TMDA). Materials and methods We analyzed the EC data collected by TMDA over six consecutive years using a retrospective longitudinal design. Microsoft Power BI (Microsoft® Corp., Redmond, WA) was used to clean, organize, and aggregate the data. IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States) was used to analyze annual trend utilization using linear regression. Results We analyzed 114 importation consignments for ECs, identifying 95.6% (109 records) as oral ECs and 4.4% (five records) as intrauterine devices (IUDs) between 2018 and 2023. This data revealed a significant increase in the volume of EC imports, with its contribution increasing from 1.9% in 2018 to 60.1% in 2023. This highlights the marked increase in EC consumption in Tanzania. In 2023, the defined daily dose per 1000 inhabitants per year (DID) peaked at 3.917826, indicating an unprecedented increase of 4,983.06% compared to the lowest DID observed in 2019 at 0.0873552. The year 2023 alone accounted for 41.63% of the total DID (9.43) over the entire study period. In 2019 and 2020, there was a decrease in EC consumption, followed by a rapid increase from 2021 to 2023. The reduction in EC consumption from 2019 to 2020 was 36.9% compared to that between 2021 and 2022. Conclusions The significant rise in EC importation and utilization in Tanzania between 2018 and 2023, marked by fluctuating consumption trends and a notable surge, highlights the urgent need for targeted educational and policy intervention. This will guide the rational and informed use of ECs, ensuring access aligns with best practices for reproductive health.

Pericoital contraception

PURPOSE OF REVIEW

To evaluate the literature on repeat use of emergency contraception and pericoital approaches to contraception.

RECENT FINDINGS

Women are very interested in an oral, on-demand contraceptive option, were one available. Ulipristal acetate and a combination of levonorgestrel (LNG) and meloxicam (a cyclo-oxygenase-2 inhibitor) both appear to be more effective at disrupting ovulation than LNG alone. Recent advisories from the United Kingdom regarding daily dosing of ulipristal for fibroids emphasize the need for more safety data.

SUMMARY

Repeat pericoital dosing of 1.5-mg LNG is approximately as effective as other on-demand contraceptive methods and is overall very safe. The most common side effect is irregular bleeding. Repeat on-demand ulipristal acetate or meloxicam/other cyclo-oxygenase-2 inhibitors have potential as an on-demand option either alone or in combination but have not been evaluated for contraceptive efficacy in a large-scale study. Given the high unmet need for contraception, even among women with access to available options, there is a distinct need for options that address needs of women who are interested in an on-demand option. On-demand oral contraception has the potential to expand the convenience of contraceptive options and overall contraceptive use.

What happens the morning after? The costs and benefits of expanding access to emergency contraception

Emergency contraception (EC) can prevent pregnancy after sex, but only if taken within 72 hours of intercourse. Over the past 15 years, access to EC has been expanded at both the state and federal level. This paper studies the impact of those policies. We find that expanded access to EC has had no statistically significant effect on birth or abortion rates. Expansions of access, however, have changed the venue in which the drug is obtained, shifting its provision from hospital emergency departments to pharmacies. We find evidence that this shift may have led to a decrease in reports of sexual assault.

Misconceptions about missed conceptions: the meanings of emergency contraceptive pills use among young adult couples

Emergency contraceptive pills (ECP) are a safe and efficacious backup method of birth control. Despite widespread availability, ECP is underutilized by young women. While partner level of involvement has been shown to influence contraceptive behavior, there is a dearth of knowledge regarding any possible association between partner influence and ECP use. To better understand the reasons for the seemingly underuse of ECP, a grounded theory study was conducted to elucidate the relationship of couple dynamics and knowledge of, attitudes toward, and decision making regarding the use of ECP in coupled young adults. Consistent with contemporary constructivist grounded theory methods, several categories were identified including the meanings associated with ECP use. This article presents an elaboration of this particular finding. The meanings that participants ascribed to ECP use represented a continuum of value attributes regarding ethics, safety, efficacy, and responsibility.

Timing of the medical examination

The medical examination of the sexually abused child may have evidentiary, medical, and therapeutic purposes, and the timing of the examination requires consideration of each of these objectives. In cases of acute sexual assault, emergent examinations may be needed to identify injury, collect forensic evidence, and provide infection and pregnancy prophylaxis. Alternately, most sexually abused children are not identified immediately after assault, and the timing of the examination needs to balance physical and emotional issues with the availability of qualified examiners. In all cases, the best interests of the child should be paramount.

Impact of emergency contraception status on unintended pregnancy: observational data from a women's health practice

Objective:

This study aimed to determine if nonprescription emergency contraception (EC) availability impacted self-reported unintended pregnancy rates and to assess women’s knowledge and awareness of EC prior to and after nonprescription availability.

Methods:

A survey regarding contraception use and knowledge was verbally administered to a cross-sectional, convenience sample of 272 pregnant women receiving prenatal care at a large urban community women’s clinic between August 2003 and October 2008. Statistical analyses determined the differences between two groups (before [BA] and after, [AA] non-prescription EC availability in the U.S. drug market) in terms of self-reported unintended pregnancy rates, knowledge and awareness of EC.

Results:

The AA group reported higher incidence of unintended pregnancy when compared to the BA group (90.7% vs. 72.7%, P = 0.0172). The majority of both groups reported that they were not using any contraception at the time of conception (BA-84.4%; AA-83.3%). There was no significant difference in the participants’ awareness of EC between the two groups (BA-46.8% vs. AA-43.0%) nor was there a significant difference between the two groups in the self-reported willingness to use EC in the future (BA-53.1% vs. AA-63.4%). However, among participants who were unaware of EC, 61% reported they would consider using it in the future after receiving brief EC counseling from a pharmacist or student pharmacist. Neither age nor pregnancy intention was associated with self-reported EC awareness but there was an association with income (P = 0.0410) and education (P = 0.0021).

Conclusion:

The change from prescription-only to non-prescription status of EC in the U.S. drug market did not impact the unintended pregnancy rate in this patient population. Lack of knowledge and awareness is still a major barrier to widespread EC use.

Impact of individual values on adherence to emergency contraception practice guidelines among pediatric residents: implications for training

OBJECTIVE

To evaluate the impact of individual, system, and interpersonal factors on emergency contraception practices. We hypothesized that abortion attitudes and attitudes toward teen sex would be significant individual factors influencing emergency contraception practices.

DESIGN

This was a cross-sectional, anonymous Internet survey.

SETTING

Four pediatric residency programs in the Baltimore, Maryland-Washington, DC, metropolitan area during April to June 2007.

PARTICIPANTS

One hundred forty-one pediatric residents completed the survey.

MAIN EXPOSURE

Abortion attitudes were assessed by participants' level of agreement with abortion in 7 scenarios. Attitudes toward teen sex were assessed by participants' level of agreement with 5 statements about the acceptability of teens having sex.

MAIN OUTCOME MEASURES

Emergency contraceptive counseling behavior was assessed by reported frequency of including emergency contraception in routine contraceptive counseling. Intention to prescribe emergency contraception was assessed by reported likelihood of prescribing in 5 scenarios.

RESULTS

When controlling for demographics and other predictors, residents with less favorable abortion attitudes were more likely to have the lowest intention to prescribe emergency contraception. Residents with more positive attitudes toward teen sex and who had a preceptor encourage emergency contraception prescription were more likely to include emergency contraception in routine contraceptive counseling most/all the time and to have the highest intention to prescribe.

CONCLUSION

Efforts to challenge and affect attitudes toward teen sex and to prompt residents to prescribe emergency contraception in clinical settings may be needed to encourage more proactive emergency contraceptive practice in accordance with national practice guidelines.

Characteristics of women who sought emergency contraception at a university-based women's health clinic

OBJECTIVE

The purpose of this study was to identify unique characteristics for seeking emergency contraception (EC) among sexually active unmarried women who attended a university-based women's health clinic (WHC).

STUDY DESIGN

Three hundred nine consecutive women who attended the women's health clinic for 3 months of the 2006 spring semester completed an anonymous self-administered questionnaire. Fisher exact and Student t tests were used to assess bivariate associations, and step-wise regression was used to determine independent associations.

RESULTS

Women who requested EC were more likely to have previously used EC (P < .001), to have had unprotected sex in the past 6 months (P < .001), to have experienced an unintended pregnancy in the past year (P = .009), and to perceive the need for EC use in the next 3 months (P < .001) but were less likely to use hormonal contraception or an intrauterine device (P < .001).

CONCLUSION

Our findings support the need for increased education that would include the use of and access to effective primary contraceptive methods in conjunction with EC awareness.

Analysis of content about sexuality and human reproduction in school textbooks in Spain

OBJECTIVES

The spread of sexually transmitted infections (STIs) inadolescents and teenage pregnancy rates are increasing. A decrease in the average age of youth's first sexual experience has also been noted. Sexual education programmes in schools have an important role to play in addressing these issues. The objective of this study was to analyse the content of textbooks in the areas of sexuality and human reproduction in order to evaluate the extent to which these textbooks promote healthy reproductive lifestyles, as well as avoidance of risk behaviour among adolescent students.

STUDY DESIGN

Descriptive study of the content of school textbooks.

METHODS

The study sample consisted of 12 textbooks (approximately 80% of all the textbooks used in Spanish secondary schools) which were edited in 2002. Content analysis evaluated the extent to which these books demonstrated reliable scientific information about: (a) condom effectiveness; (b) consequences, prevention and treatment of STIs; (c) family planning methods; (d) assisted reproductive technologies; and (e) the promotion of healthy reproductive lifestyles.

RESULTS

All textbooks presented inaccurate information in the areas studied. One hundred and fifty one quotes were identified that facilitated incomplete perception of sexuality or risky behaviour. On average, 12.6 incorrect messages were identified in each textbook.

CONCLUSIONS

The textbooks examined are neither appropriate nor sufficiently comprehensive for adolescent education on issues of sexuality. Results suggest a need for alternative textbooks based on better scientific evidence. It is essential that textbooks empower adolescents to make healthy decisions through the promotion of useful life skills that provide a more integrated concept of sexuality. There is a need for approaches to sexual education to integrate values commonly held by parents of the youth that use such texts.

College students' perceptions of emergency contraception provision

BACKGROUND AND OBJECTIVE

The authors examined college students' perceptions regarding emergency contraception (EC) provision in light of the then pending U.S. Food and Drug Administration (FDA) decision about the over-the-counter (OTC) status of EC.

METHODS

We randomly sampled 7000 male and female students who were enrolled full-time at the University of Michigan during the winter 2006 semester. A total of 1585 (22.6%) students responded to our web-based survey and were included in these descriptive analyses.

RESULTS

Nearly all (94%) respondents knew of EC. When asked whether EC should be made available OTC, 60% of respondents agreed, 23% disagreed, and 17% were unsure. If EC were to be made available OTC, 34% of respondents indicated that they (or their partner) would purchase EC in advance of need, and 44% stated that they would purchase it only after unprotected sexual intercourse or contraceptive failure. Advance discussion and provision of EC is underused. Only 10% of all female respondents indicated that their current healthcare provider had spoken to them about EC in a routine health visit, and just 5% of female respondents were offered a supply of EC in advance of need.

CONCLUSIONS

Continued efforts are needed to ensure timely access to EC in this population.

Determinants of demand: method selection and provider preference among US women seeking abortion services

BACKGROUND

Medication abortion has the potential to increase abortion availability, primarily through new provider networks; however, without a better understanding of how and why women make decisions regarding both their abortion method and their provider, expansion efforts may be misguided and valuable resources may be wasted.

STUDY DESIGN

We undertook an exploratory study to investigate method and provider preferences. Semistructured one-on-one interviews were conducted with 205 abortion clients at three family planning clinics.

RESULTS

Study participants greatly preferred the clinic setting for their abortion; the majority of women in the study would not have gone to their regular physician if they had been given the option. In addition, method choice trumps provider choice for the majority of women who would have preferred their regular provider. Participants who chose the aspiration procedure were more likely to have previous knowledge about the medication method. Travel time was not a predictor of preferring one's regular physician over the clinic.

CONCLUSIONS

Expanding provider networks via the private sector is unlikely to be a panacea. In addition to these efforts, more attention may need to be paid to addressing logistic barriers to access. Physicians offering abortion services need to let their patients know they offer such services prior to their patients' need for them. Questions remain regarding the information being circulated about medication abortion.

Emergency contraception provision: a survey of Michigan physicians from five medical specialties

OBJECTIVE

Despite the controversy over expanding delivery options for emergency contraceptive pills (ECP), little is known about physicians' attitudes toward over-the-counter (OTC) provision of ECP, and prior research on physicians' practices often has focused on a single specialty. This study examined the attitudes and practices regarding advance provision and OTC status of ECP among physicians in five medical specialties likely to encounter patients in need of ECP.

METHODS

A mail survey of a random sample of 850 Michigan physicians in family/general medicine, internal medicine, obstetrics/gynecology, pediatrics, and emergency medicine was conducted. Respondents' ECP-related attitudes and practices were assessed, and differences by physician characteristics were examined using chi-square tests and multivariable logistic regression analyses.

RESULTS

Two hundred seventy-one physicians responded to the survey (response rate = 32%), with 42% of them favoring OTC provision of ECP and 40% opposing it. Half of respondents never routinely initiated discussions about ECP with their sexually active, female patients, and 77% of respondents did not routinely offer advance prescriptions. After adjusting for other factors, including medical specialty, older physicians ( > or =50 years) were significantly more likely than their younger counterparts to support OTC provision of ECP (OR = 2.9, 95% CI 1.7-4.9) or offer advance prescriptions (OR = 2.5, 95% CI 1.1-5.8). Physicians with a specialty in obstetrics/gynecology were 3.5 times (95% CI 1.3-9.8) as likely as physicians in family/general medicine to offer advance prescriptions for ECP, and female physicians were 2.5 (95% CI 1.05-6.0) times as likely as male physicians to offer advance prescriptions. Graduation from a medical school within the United States and practicing in a private practice were marginally associated with a lower likelihood of supporting OTC status of ECP (OR = 0.5, 95% CI: 0.2-1.0; and OR equals; 0.6, 95% CI 0.3-1.1, respectively).

CONCLUSIONS

Certain physician characteristics were significantly associated with their ECP-related attitudes and practices. The majority of physicians surveyed in this study did not offer advance prescriptions for ECP, and few had initiated discussions on ECP with patients, which may pose critical barriers to patients' timely access.

Women's attitudes towards mechanisms of action of family planning methods: survey in primary health centres in Pamplona, Spain

Background

Informed consent in family planning includes knowledge of mechanism of action. Some methods of family planning occasionally work after fertilization. Knowing about postfertilization effects may be important to some women before choosing a certain family planning method. The objective of this survey is to explore women's attitudes towards postfertilization effects of family planning methods, and beliefs and characteristics possibly associated with those attitudes.

Methods

Cross-sectional survey in a sample of 755 potentially fertile women, aged 18–49, from Primary Care Health Centres in Pamplona, Spain. Participants were given a 30-item, self-administered, anonymous questionnaire about family planning methods and medical and surgical abortion. Logistic regression was used to identify variables associated with women's attitudes towards postfertilization effects.

Results

The response rate was 80%. The majority of women were married, held an academic degree and had no children. Forty percent of women would not consider using a method that may work after fertilization but before implantation and 57% would not consider using one that may work after implantation. While 35.3% of the sample would stop using a method if they learned that it sometimes works after fertilization, this percentage increased to 56.3% when referring to a method that sometimes works after implantation. Women who believe that human life begins at fertilization and those who consider it is important to distinguish between natural and induced embryo loss were less likely to consider the use of a method with postfertilization effects.

Conclusion

Information about potential postfertilization effects of family planning methods may influence women's acceptance and choice of a particular family planning method. Additional studies in other populations are necessary to evaluate whether these beliefs are important to those populations.

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.

Identifying barriers to emergency contraception use among young women from various sociocultural groups in British Columbia, Canada

CONTEXT

Despite advances related to the provision of emergency contraception in Canada, particularly the granting of independent prescriptive authority to pharmacists in 2000, little is known about the ways in which women perceive potential barriers to using it.

METHODS

In 2004, an ethnically diverse sample of 52 women living in Greater Vancouver participated in interviews that were analyzed for an assessment of women's knowledge, attitudes and experiences related to emergency contraception, with particular attention to the ways in which ethnicity affected their stories.

RESULTS

Participants generally misperceived emergency contraception as an abortifacient, and often mistakenly thought that it has long-term effects on health and fertility. Knowledge gaps regarding reproductive physiology impeded clear understanding of when it is most effective. Participants also reported receiving subtle and sometimes overtly stigmatizing messages from providers when they sought emergency contraception. Asian and South Asian women were particularly concerned about negative interactions with providers; for example, they feared that female providers from their sociocultural community might recognize, chastise or gossip about them. Institutional policies (e.g., a Catholic hospital's refusal to provide the method), coupled with low awareness of pharmacists' prescriptive authority, also created barriers to use.

CONCLUSIONS

Women's ability to benefit from emergency contraception is hampered by lack of knowledge and conservative cultural or social mores. Serious contextual and structural shifts are required before woman-centered approaches to provision of the method become the norm.

Women's experiences with emergency contraception in an internal medicine practice

BACKGROUND

Emergency contraceptive pills (ECPs) are effective for preventing unintended pregnancy. Whether patients in primary care settings receive physician counseling regarding ECPs has not been evaluated.

METHODS

We conducted a cross-sectional telephone survey of reproductive-age women who sought care at a university-based general internal medicine clinic regarding receipt of physician counseling about ECPs, knowledge and experiences with ECPs, and attitudes toward using ECPs.

RESULTS

One hundred forty-nine women aged 18-45 completed the survey. Eighty percent of respondents (n = 119) were at risk for unintended pregnancy. Although all women in the sample had seen an internist in the previous 12 months, only 10% had received physician counseling about ECPs. There was little difference in the proportion of women who received counseling about ECPs comparing those who received care from an obstetrician/gynecologist and an internist with women who received care from an internist alone (13% vs. 8%, p = 0.529). Receipt of ECP counseling was not associated with the consistency of current contraceptive use. No women who were married or over the age of 40 were counseled about ECPs. The majority of participants (92%) had heard of ECPs, although most (54%) had learned about them through the media. Fifty-four percent of women would be likely to use ECPs to prevent unintended pregnancy.

CONCLUSIONS

Only a fraction of women seeing internists for their primary care are receiving counseling about ECPs, irrespective of receiving care from an obstetrician/gynecologist. As primary care physicians, internists should determine risk for unintended pregnancy, assess patients' knowledge and attitudes toward ECPs, and provide counseling about this effective therapy.

Levonorgestrel-Only Dosing Strategies for Emergency Contraception

The United States Food and Drug Administration-approved progestin-only dosing strategy for emergency contraception is levonorgestrel 0.75 mg taken as soon as possible within 72 hours of unprotected intercourse, with a second 0.75-mg dose taken 12 hours later. However, different dosing strategies have been studied and promoted by various organizations. The American College of Obstetricians and Gynecologists recommends a single dose of levonorgestrel 1.5 mg for emergency contraception as one option. As another option, they recommend two doses of levonorgestrel 0.75 mg may be effective when taken 12-24 hours apart. We performed a search of MEDLINE and International Pharmaceutical Abstracts from 1967-2006 to evaluate and describe the existing pharmacokinetic and patient outcome data regarding administration of levonorgestrel as a 1.5-mg single dose or two 0.75-mg doses taken 12 or 24 hours apart. Additional studies were identified from the bibliographies of the selected literature. Several pertinent articles were identified. All of the studies demonstrated that emergency contraception effectively prevented pregnancy. In addition, evidence supports the safety and efficacy of a single dose of levonorgestrel 1.5 mg for emergency contraception. Furthermore, when two doses of levonorgestrel 0.75 mg are administered, the second dose can confidently be taken 12-24 hours after the first without compromising efficacy. Understanding the evidence that supports the different emergency contraception dosing strategies is critical for clinicians, and especially pharmacists, who have interactive roles in dispensing emergency contraception.

Progesterone receptor modulator for emergency contraception: a randomized controlled trial

OBJECTIVE

Compare the efficacy and adverse effects of CDB-2914, a new progesterone receptor modulator, to levonorgestrel for emergency contraception.

METHODS

We performed a randomized, double-blinded noninferiority trial, enrolling healthy women seeking emergency contraception within 72 hours of unprotected intercourse. Participants were randomly assigned to receive a single dose of 50 mg of CDB-2914, plus a placebo 12 hours later or two doses of 0.75 mg of levonorgestrel taken 12 hours apart. Follow-up was scheduled 5 to 7 days after the expected onset of the next menstrual period. Posttreatment pregnancy was established by a positive urine test at follow-up and confirmed by quantitative serum beta-hCG. Daily diaries were used from the time of emergency contraception use until next menses to record adverse effects and sexual activity.

RESULTS

Product efficacy was evaluable in 775 of CDB-2914 users and 774 of levonorgestrel users. Pregnancies occurred in 7 (0.9%, 95% confidence interval 0.2-1.6%) and 13 (1.7%, 95% confidence interval 0.8-2.6%) women, respectively. Based on the estimated cycle day of unprotected intercourse, 85% and 69% of anticipated pregnancies, respectively, were averted. Nausea was reported by a somewhat greater percentage of CDB-2914 than levonorgestrel users (29% compared with 24%, P=.03), but the distribution of other adverse effects was similar in both groups. Women in both groups experienced considerable variation in menstrual cycle length as compared with their reported individual normal cycle lengths.

CONCLUSION

CDB-2914 is at least as effective as levonorgestrel in preventing pregnancies after unprotected intercourse and has a similar side effect profile.

LEVEL OF EVIDENCE

I.

Contraceptive options during perimenopause

During the transition years leading to menopause, the possibility of conception persists, although at a lower rate. Contraceptive choices available to perimenopausal women are as varied as those for their younger counterparts, albeit with some limitations related predominantly to coexisting medical conditions rather than the advancing age itself. In this review, different contraceptive choices pertaining to this age group will be discussed, with a focus on evidence-based data.

Acceptance and use of emergency contraception with standardized counseling intervention: results of a randomized controlled trial

OBJECTIVE

The objective of this work was to evaluate the acceptance, use and recall of an optional advance prescription for emergency contraception (EC).

MATERIALS AND METHODS

This study used as randomized controlled trial evaluating contraceptive counseling intervention with women aged 16-44 years who were at risk for unintended pregnancy (N=737). Intervention participants (n=365) received contraceptive counseling with optional advance EC prescription. Control women (n=372) received no contraceptive or EC counseling. Among intervention participants, initial acceptance and use of EC in first 2 months were evaluated. Among all participants, differences were evaluated between recall of EC discussion and use of EC.

RESULTS

Among 365 intervention women, 336 received EC counseling and 51% of these 336 accepted advance EC prescription. At 2 months, among the women who had accepted EC, 6% had filled and used their prescription and 8% had filled but not used their prescription. At 12 months, intervention women were significantly more likely than controls to recall talking about EC (33% vs. 5%) and obtaining a prescription (38% vs. 6%), but there were no differences in the use of EC (6% vs. 6%).

CONCLUSION

When the option is available for EC counseling, approximately half of women accepted advance prescription for EC. However, few women who received information and/or an advance prescription remembered discussing EC, filled the prescription or used EC over 12 months.

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.

Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only

PURPOSE

This study measures the impact of the advance provision of emergency contraception (EC) among family planning clients at 31 clinics in California.

METHODS

We randomized over 9000 clients to receive a packet containing either two 0.75-mg levonorgestrel pills (Plan B) or an identical packet containing EC information only. We conducted follow-up interviews on a subset of 1130 clients selected to optimize the age and ethnicity distribution. The interviews collected information on EC use, contraception, risk-taking behaviors and EC attitudes.

RESULTS

Clients who received EC in advance were significantly more likely to have used EC (19%) than women who received information only (12%) (p=.0009). There were no significant differences between the contraceptive and risk-taking behavior of the two treatment groups. Study respondents of all ages and ethnicities expressed positive attitudes about EC. Nevertheless, even with EC on-hand, many respondents who reported unprotected intercourse decided not to take EC.

CONCLUSION

More research should be done on the reasons women decide not to use EC even when readily available.

Awareness and perceptions of emergency contraception among retail pharmacists in Kuwait

OBJECTIVE

To describe the awareness and perceptions of hormonal emergency contraception (EC) among retail pharmacists.

SETTING

Private retail pharmacies in Kuwait City.

METHOD

A self-administered questionnaire was developed to elicit pertinent demographic information as well as awareness of and concerns about EC and administered to the senior pharmacist in 51 randomly selected private retail pharmacies.

MAIN OUTCOME MEASURE

Proportion of pharmacists aware of EC and who had recommended EC.

RESULTS

The respondents had a mean (SD) age of 34.2 (7.7) years; 58.8% were male, and all but one were non-Kuwaiti. The median practice experience of the pharmacists was 6 years. Oral contraceptives and male condoms were universally available in the pharmacies, but none stocked emergency contraceptives, female condoms, or diaphragms. Twenty respondents (39.2%; 95% confidence intervals 25.5-53.9%) said they were aware of EC, and 4 (7.8%) that they had ever offered EC. Nine (17.6%) respondents saw EC as offering no advantages over other contraceptive measures and effectiveness was perceived to be low. Most cited concerns were of encouraging irresponsible behaviour and women relying on EC in place of regular contraceptive measures. Religious opposition (41.2%), lack of awareness by clients (51.0%) and lack of awareness by health providers (35.3%) were seen as the most significant obstacles to provision of EC.

CONCLUSION

Knowledge of EC is poor among community pharmacists in Kuwait. Action is needed to address this deficit and to make EC more accessible to women who wish to use it.

Nonprescription Availability of Emergency Contraception in the United States: Current Status, Controversies, and Impact on Emergency Medicine Practice

In October 2004, the American College of Emergency Physicians Council joined more than 60 other health professional organizations in supporting the nonprescription availability of emergency contraception. This article reviews the history, efficacy, and safety of emergency contraception; the efforts toward making emergency contraception available without a prescription in the United States; the arguments for and against nonprescription availability of emergency contraception; and the potential impact nonprescription availability could have on the practice of emergency medicine in the United States.

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

BACKGROUND

Timely access to emergency contraception has the potential to reduce the number of unwanted pregnancies and subsequent abortions. A public health policy initiative in British Columbia beginning in December 2000 allowed pharmacists to provide emergency contraceptives (ECs) without a prescription. We sought to determine changes in EC use after the policy was introduced and to analyze EC use with data generated by the policy.

METHODS

All Ovral, Preven and Plan B EC prescriptions from Jan. 1, 1996, to Dec. 31, 2003, were identified through the BC PharmaNet and Medical Services Plan administrative databases and the data analyzed to determine changes between 1996 and 2002. Changes over time were determined in the frequency of EC provision, choice of EC agent, frequency of EC use by age group, repeat use and geographic distribution of EC prescription for the pre- and post-policy periods. Anonymized patient-specific data from treatment consent forms were used to describe the reason for EC use, interval between unprotected intercourse and EC prescription, proportion prescribed for immediate or future use, referrals for regular birth control and STD screening and concomitant antiemetic use. Consent data also provided the time in the menstrual cycle that the EC was requested.

RESULTS

The number of EC prescriptions increased from a pre-policy mean of 8805 (99% confidence interval 7823-9787) in the years 1996 to 2000 to a post-policy total in 2002 of 17 794. Physicians prescribed the levonorgestrel regimen (Plan B) less frequently than did pharmacists. The frequency of EC use was highest among women aged 20-24 years across all study years, and all age groups demonstrated a post-policy increase in use. On average, 2.1% of the women received an EC 3 or more times a year over the period of the study. More women in urban regions received ECs than women in more rural areas of the province. Analysis of pharmacist treatment consent forms used in 2001 and 2002 showed that 56.2% of women receiving an EC reported using a method of birth control that had failed, 55.7% of pharmacist-provided ECs were obtained within 24 hours after unprotected intercourse, 1.1% of ECs were obtained for future use, antiemetics were provided to 57.7% of women receiving the Yuzpe regimen (Ovral, Preven) and to 20.5% of women receiving levonorgestrel, and women tended to seek ECs when unprotected intercourse occurred at the time of highest risk of pregnancy in their menstrual cycle. Women in greatest financial need obtained ECs more frequently from physicians than from pharmacists.

INTERPRETATION

The policy change that granted pharmacists authority to provide ECs to women without a physician's prescription did not simply expand EC availability but was associated with an overall increase in EC use in the province.

Contraception for college students

An important issue for human beings is the acquisition of normal sexual health, including the understanding and application of reproductive health when needed. Comprehensive sexuality education is not a topic provided to many children, adolescents, or college students in the United States, however. Students who were sexually active in high school may continue to be at risk for unwanted pregnancies and sexually transmitted diseases in their college life; those who chose abstinence in high school may abandon this concept in college, choosing coital behavior at all levels of university life-freshman through graduate levels. Most American college students are sexually active and many have multiple partners. This article reviews current contraceptive methods available to college students. College health providers and pediatricians are urged to be vigilant about the reproductive health needs of the college students they serve.

Over-the-counter availability of Plan B emergency contraception: further discussion and commentary

The controversy surrounding the potential switch of the Plan B emergency contraceptive therapy from prescription to over-the-counter status has been unprecedented. Regulatory, professional, and societal aspects of this issue have been discussed recently and will no doubt continue to be debated. In this editorial, members of the Medicine, Law, and Ethics panel of The Annals of Pharmacotherapy's Editorial Board offer a sampling of viewpoints touching on varying aspects of the controversy. Readers may wish to consider the ramifications of their professional decisions in this and similar situations in advance of having to make such decisions.