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Chan YYS, Wan SFR, Li HWR, Lo SST. A revisit of knowledge, attitude and practice of emergency contraception in Hong Kong. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024:bmjsrh-2024-202331. [PMID: 39271236 DOI: 10.1136/bmjsrh-2024-202331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVES To revisit women's knowledge, attitudes and practices (KAP) regarding emergency contraception (EC) in Hong Kong. The research sought to provide insights for improving the accessibility and quality of EC services. STUDY DESIGN A cross-sectional study, where self-administered questionnaires were distributed at a major community sexual and reproductive health service in Hong Kong over a 3-month period between July 2023 and October 2023. Descriptive and regression analyses were used. RESULTS Of 1127 respondents, the majority (n=1057, 93.8%) reported using contraception and 513 (45.6%) had used EC. The main contraceptive methods used were male condoms and oral contraceptive pills. The majority (n=1035, 91.8%) of respondents demonstrated awareness about EC and 938 (83.2%) participants correctly reported the timeframe for oral EC. Around two-thirds reported the internet as being their leading source of EC knowledge. Over 93% of respondents advocated for enhancing public awareness. Acceptance of non-traditional means of obtaining EC, such as over-the-counter provision (51.3%), pharmacy provision (49.8%) and telemedicine consultation (43.1%), were higher than face-to-face EC consultations (32.9%). CONCLUSIONS Family planning service users' characteristics and KAP regarding EC have significantly changed over the last 20 years. Women now demonstrate greater awareness, knowledge and openness regarding EC, indicating improved readiness for more liberal delivery of EC nowadays. This study highlights the need for restructuring EC service provision in Hong Kong to address women's changing preferences and contraceptive needs, and to minimise barriers to EC access. We recommend reclassifying emergency contraceptive pills as non-prescription drugs in Hong Kong to align with international practice.
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Affiliation(s)
- Yat Yee Shizuka Chan
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Siu Fan Rebecca Wan
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, Hong Kong
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Leelakanok N, Kangwanrattanakul K, Petchsomrit A, Sapapsap B, Siritientong T, Methaneethorn J. After morning, phew! A knowledge, attitudes, and practices survey related to emergency oral contraception in Thai pharmacists. J Pharm Policy Pract 2023; 16:97. [PMID: 37528496 PMCID: PMC10391845 DOI: 10.1186/s40545-023-00601-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Pharmacists' knowledge and attitude toward Emergency Oral Contraception (EOC) can affect users' access to EOCs, especially where EOCs are provided by pharmacists without the need for prescriptions. We conducted a Knowledge, Attitudes, and Practice (KAP) survey on Thai pharmacists to better understand KAP related to EOCs and the correlation among KAP components. METHODS An in-depth interview, GoogleTrend search, and Pantip.com search were conducted. The findings, together with data from a previously published systematic review and meta-analysis, were used to develop KAP survey questions which were distributed online. Spearman's rank correlation coefficient and linear mixed model were used to investigate the correlation and association among KAP components. RESULTS The in-depth interview with pharmacists showed that sex and unwanted pregnancy are very sensitive topics in Thailand. Sex and EOC education should be provided by parents and healthcare professionals at a young age. This agreed with opinions from Thai internet users that sex literacy was generally low and sex education was not provided adequately. From the total of 421 survey responses, Thai pharmacists had average knowledge, poor attitude, and average practice related to EOCs (median score = 51.02%, 21.81%, and 60.0%, respectively). The correlations between KAP in pharmacists were weak (ρ = 0.107-0.525, p < 0.02). Pharmacists who rated themselves as having higher scores in knowledge and attitude also rated themselves higher in the practice score. However, the total scores describing the knowledge of or attitude toward EOCs were not associated with EOC practice scores. CONCLUSIONS In Thai pharmacists, self-rating KAP scores overestimated total KAP scores. The correlation among KAP components was weak. EOC knowledge and attitudes should be promoted, although this may not improve EOC practice in Thai pharmacists.
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Affiliation(s)
- Nattawut Leelakanok
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, 169 Long-Hard Bangsaen Rd, Mueang, Chonburi, 20131, Thailand
| | - Krittaphas Kangwanrattanakul
- Division of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, 169 Long-Hard Bangsaen Rd., Mueang, Chonburi, 20131, Thailand.
| | - Arpa Petchsomrit
- Division of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Burapha University, 169 Long-Hard Bangsaen Rd, Mueang, Chonburi, 20131, Thailand
| | - Bannawich Sapapsap
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, 169 Long-Hard Bangsaen Rd, Mueang, Chonburi, 20131, Thailand
| | - Tippawan Siritientong
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Burn and Wound Care, Chulalongkorn University, Bangkok, Thailand
| | - Janthima Methaneethorn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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Emergency Contraception: Access and Challenges at Times of Uncertainty. Am J Ther 2022; 29:e553-e567. [PMID: 35998109 DOI: 10.1097/mjt.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The UN Commission on Life-Saving Commodities for Women's and Children's Health identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation. AREAS OF UNCERTAINTY Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access. DATA SOURCES PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetrician and Gynecologists, the World Health Organization, The United Nations. THERAPEUTIC ADVANCES A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device. CONCLUSIONS EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts, threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.
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Jin XX, Sun L, Lai XL, Li J, Liang ML, Ma X. Effect of Mirena placement on reproductive hormone levels at different time intervals after artificial abortion. World J Clin Cases 2022; 10:511-517. [PMID: 35097076 PMCID: PMC8771403 DOI: 10.12998/wjcc.v10.i2.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/24/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Improper methods of contraception greatly increase the risk of abortion, cervical or endometrial lesions, and the number of recurrent artificial abortions. These complications result in the deterioration of a patient’s outcome. Further, the proportion of artificial abortions is highest among unmarried females. Placement of an intrauterine device, such as the Mirena, after an artificial abortion may decrease the likelihood of an endometrial injury caused by recurrent abortions while significantly improving its contraceptive effects.
AIM To discuss the effect of Mirena placement on reproductive hormone levels at different time points after an artificial abortion.
METHODS Women (n = 119) undergoing an artificial abortion operation were divided into the study (n = 56) and control (n = 63) groups. In the study group, the Mirena was inserted immediately after the artificial abortion, whereas in the control group, it was inserted 4–7 d after the onset of the first menstrual cycle after abortion. All participants were followed-up for 6 mo to observe the continuation and expulsion rates and adverse reactions and to measure the levels of serum estradiol (E2), follicle stimulating hormone (FSH), and luteinizing hormone (LH).
RESULTS The continuation rates were 94.64% and 93.65% in the study group and the control group, respectively. The expulsion rates were 1.79% and 3.17% in the study group and the control group, respectively. There was no statistically significant difference between the two groups (P > 0.05). There were also no statistically significant differences in the proportion of patients with bacterial vaginitis, trichomonas vaginitis, or cervicitis between the groups (P > 0.05). Six months after Mirena placement, E2 Levels were 45.50 ± 7.13 pg/mL and 42.91 ± 8.10 pg/mL, FSH 13.60 ± 3.24 mIU/mL and 14.54 ± 3.11 mIU/mL, and LH 15.11 ± 2.08 mIU/mL and 14.60 ± 3.55 mIU/mL in the study and control groups, respectively. There were no significant differences in hormone levels between the two groups (P > 0.05). There were also no statistically significant differences in the proportions of abnormal menstruation, prolonged menstruation, or pain during intercourse between the study and control groups after Mirena placement (P > 0.05). There were no statistically significant differences in uterine volume, sexual desire, sexual activity, or the sexual satisfaction score between the study and control groups before and after Mirena placement (P > 0.05).
CONCLUSION Placement of a Mirena intrauterine device immediately after an artificial abortion does not increase the risk of adverse reactions and can help prevent endometrial injury caused by recurrent abortions.
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Affiliation(s)
- Xiao-Xiao Jin
- Department of Obstetrics and Gynecology, Zhejiang Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Ling Sun
- Department of Obstetrics and Gynecology, Zhejiang Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Xiao-Li Lai
- Department of Obstetrics and Gynecology, Zhejiang Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Jie Li
- Department of Obstetrics and Gynecology, Zhejiang Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Mei-Li Liang
- Department of Obstetrics and Gynecology, Zhejiang Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Xia Ma
- Department of Obstetrics and Gynecology, Zhejiang Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
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Strong J. Exploring the roles of men and masculinities in abortion and emergency contraception pathways, Ghana: a mobile phone-based mixed-methods study protocol. BMJ Open 2021; 11:e042649. [PMID: 33550252 PMCID: PMC7925914 DOI: 10.1136/bmjopen-2020-042649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Global commitments have established goals of achieving universal sexual and reproductive health and rights (SRHR) access, but critical obstacles remain. Emergency contraception and induced abortion are overlooked in policy and research. Men's roles in the SRHR of others are significant, particularly as obstacles to universal SRHR. Evidence on gender, masculinities and SRHR is essential to understand and reduce the barriers faced by individuals seeking to avoid the conception or continuation of a pregnancy. METHODS AND ANALYSIS This study aims to understand men's masculinities and their relationships with emergency contraception and abortion. The protocol presents a multimethod study of men aged over 18 years in James Town, Accra, Ghana. In response to the COVID-19 pandemic, the research will use two mobile-based methods: a survey and in-depth interviews. Using respondent-driven sampling, an estimated 789 men will be recruited to participate in the survey, asking questions on their knowledge, attitude, behaviours and roles in emergency contraception and abortion. In-depth interviews focused on constructions of masculinity will be conducted with a purposive sample of men who participated in the survey. Data will be analysed concurrently using multiple regression analyses of quantitative data and abductive analysis of qualitative data. ETHICS AND DISSEMINATION Ethical approval has been granted by the London School of Economics and Political Science and the Ghana Health Service. The findings in this study will: engage with emerging research on masculinities and SRHR in Ghana and elsewhere; offer methodological insight for future research; and provide evidence to inform interventions to reduce obstacles for emergency contraception and abortion care seekers. Dissemination will occur at all levels-policy, academic, community-including multiple academic articles, policy briefs, workshops and presentations, conference papers, and theatre/radio-based performances of key messages.
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Affiliation(s)
- Joe Strong
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Zaami S, Signore F, Baffa A, Votino R, Marinelli E, Del Rio A. Emergency contraception: unresolved clinical, ethical and legal quandaries still linger. Panminerva Med 2020; 63:75-85. [PMID: 32329333 DOI: 10.23736/s0031-0808.20.03921-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Emergency contraception (EC) has been prescribed for decades, in order to lessen the risk of unplanned and unwanted pregnancy following unprotected intercourse, ordinary contraceptive failure, or rape. EC and the linked aspect of unintended pregnancy undoubtedly constitute highly relevant public health issues, in that they involve women's self-determination, reproductive freedom and family planning. Most European countries regulate EC access quite effectively, with solid information campaigns and supply mechanisms, based on various recommendations from international institutions herein examined. However, there is still disagreement on whether EC drugs should be available without a physician's prescription and on the reimbursement policies that should be implemented. In addition, the rights of health care professionals who object to EC on conscience grounds have been subject to considerable legal and ethical scrutiny, in light of their potential to damage patients who need EC drugs in a timely fashion. Ultimately, reproductive health, freedom and conscience-based refusal on the part of operators are elements that have proven extremely hard to reconcile; hence, it is essential to strike a reasonable balance for the sake of everyone's rights and well-being.
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Affiliation(s)
- Simona Zaami
- Section of Legal Medicine, Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Rome, Italy -
| | - Fabrizio Signore
- Department of Obstetrics and Gynecology, Misericordia Hospital, Grosseto, Italy
| | - Alberto Baffa
- Department of Obstetrics and Gynecology, Misericordia Hospital, Grosseto, Italy
| | - Raffaella Votino
- Department of Obstetrics and Gynecology, Misericordia Hospital, Grosseto, Italy
| | - Enrico Marinelli
- Section of Legal Medicine, Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Rome, Italy
| | - Alessandro Del Rio
- Section of Legal Medicine, Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Rome, Italy
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