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Bury F, Iguyovwe V, Trivett M, Baraitser P. Patterns of use of emergency and oral contraceptives from an online service in the United Kingdom during the COVID-19 pandemic: A quantitative study of routinely collected data. Contraception 2023; 122:109992. [PMID: 36849031 PMCID: PMC9968475 DOI: 10.1016/j.contraception.2023.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES Our study aimed to describe users of a free online contraception service, compare online emergency contraceptive pill (ECP) users with online oral contraceptive (OC) users, and describe patterns of use of online ECP and OC over time, including transition from ECP to more effective forms of contraception. STUDY DESIGN Analysis of routinely collected, anonymized data from a large, publicly funded, online contraceptive service in the United Kingdom from April 1, 2019 to October 31, 2021. RESULTS The online service provided 77,447 prescriptions during the study period. About 84% for OC and 16% for ECP, of which 89% were ulipristal acetate. ECP users were younger, lived in more deprived areas, and were less likely to be of white ethnicity than OC users. About 53% ordered OC only, but 37% ordered both ECP and OC. Among those prescribed both OC and ECP (n = 1306), 40% had one method as dominant, 25% appeared to move from one method to the other (11% ECP to OC, 14% OC to ECP), and 35% continued to use both methods. CONCLUSIONS Online services are accessible to diverse young populations. While the majority of users order OC only, our study suggests that where there is free, online access to both OC and ECP, and those ordering ECP are always offered free OC, transition to more effective ongoing forms of contraception is uncommon. Further research is needed to understand whether online access to ECP increases its attractiveness and reduces likelihood of transition to OC. IMPLICATIONS This study demonstrates that free, online contraceptive services are accessible to ethnically and socioeconomically diverse users. It identifies a subgroup of contraceptive users who combine use of OC and ECPs over time, and suggests that improved access to ECP may alter contraceptive choices.
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Surveying the persistence of age and gender-based restrictions on over-the-counter emergency contraception across pharmacies in Los Angeles County, California, USA. J Am Pharm Assoc (2003) 2022; 62:1654-1658. [DOI: 10.1016/j.japh.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
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Chan MC, Munro S, Schummers L, Albert A, Mackenzie F, Soon JA, Ragsdale P, Fitzsimmons B, Renner R. Dispensing and practice use patterns, facilitators and barriers for uptake of ulipristal acetate emergency contraception in British Columbia: a mixed-methods study. CMAJ Open 2021; 9:E1097-E1104. [PMID: 34848550 PMCID: PMC8648349 DOI: 10.9778/cmajo.20200193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ulipristal acetate 30 mg became available as prescription-only emergency contraception in British Columbia, Canada, in September 2015, as an addition to over-the-counter levonorgestrel emergency contraception. In this study, we determined dispensing and practice use patterns for ulipristal acetate, as well as facilitators of and barriers to emergency contraception for physicians, pharmacists and patients in BC. METHODS In the quantitative component of this mixed-methods study, we examined ulipristal acetate use from September 2015 to December 2018 using a database that captures all outpatient prescription dispensations in BC (PharmaNet) and another capturing market sales numbers for all oral emergency contraception in BC (IQVIA). We analyzed the quantitative data descriptively. We conducted semistructured interviews from August to November 2019, exploring barriers and facilitators affecting the use of ulipristal acetate. We performed iterative qualitative data collection and thematic analysis guided by Michie's Theoretical Domains Framework. RESULTS Over the 3-year study period, 318 patients filled 368 prescriptions for ulipristal acetate. Use of this agent increased between 2015 and 2018. However, levonorgestrel use by sales (range 118 897-129 478 units/yr) was substantially higher than use of ulipristal acetate (range 128-389 units/yr). In the 39 interviews we conducted, from the perspectives of 12 patients, 12 community pharmacists, and 15 prescribers, we identified the following themes and respective theoretical domains as barriers to access: low awareness of ulipristal acetate (knowledge), beliefs and experiences related to shame and stigma (beliefs about consequences), and multiple health system barriers (reinforcement). INTERPRETATION Use of ulipristal acetate in BC was low compared with use of levonorgestrel emergency contraception; lack of knowledge, beliefs about consequences and health system barriers may be important impediments to expanding use of ulipristal acetate. These findings illuminate potential factors to explain low use of this agent and point to the need for additional strategies to support implementation.
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Affiliation(s)
- Michelle C Chan
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Sarah Munro
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Laura Schummers
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Arianne Albert
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Frannie Mackenzie
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Judith A Soon
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Parkash Ragsdale
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Brian Fitzsimmons
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
| | - Regina Renner
- Department of Obstetrics and Gynaecology (Chan, Munro, Fitzsimmons, Renner), Centre for Health Evaluation and Outcome Sciences (Munro), Department of Family Practice (Schummers, Soon) and Faculty of Pharmaceutical Sciences (Soon, Ragsdale), University of British Columbia; Women's Health Research Institute (Albert, Mackenzie), British Columbia Women's Hospital, Vancouver, BC
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Michie L, Cameron ST. Emergency contraception and impact on abortion rates. Best Pract Res Clin Obstet Gynaecol 2019; 63:111-119. [PMID: 31362908 DOI: 10.1016/j.bpobgyn.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022]
Abstract
Emergency contraception (EC) is a drug or a device that is taken after sexual intercourse to prevent unintended pregnancy. The most effective EC is the copper-bearing intrauterine device (Cu-IUD), but oral EC methods are more commonly used and include a single dose of either levonorgestrel (1.5 mg) or ulipristal acetate (30 mg). Although all EC methods are extremely safe, access to EC is often limited due to prevailing misconceptions over how EC works. Although EC can prevent unintended pregnancy for an individual woman, it has failed to make an impact on abortion rates at a population level. This may be because it is not used after every episode of unprotected sex and because existing oral EC methods are only effective if used before ovulation. Future strategies around EC should focus on maximising uptake of Cu-IUD, facilitating initiation of effective regular contraception after EC and developing a more effective oral EC.
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Affiliation(s)
- L Michie
- The Gatehouse, NHS Ayrshire and Arran, Ayrshire Central Hospital, United Kingdom.
| | - S T Cameron
- Chalmers Sexual and Reproductive Health Centre, NHS Lothian, 2 A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom; Obstetrics and Gynaecology, University of Edinburgh, United Kingdom.
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Joaquim J, Reis M, Matos C, Lopes J, Pires T. Knowledge and consumption of emergency contraception pills in a tertiary education student population. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mooney-Somers J, Lau A, Bateson D, Richters J, Stewart M, Black K, Nothnagle M. Enhancing use of emergency contraceptive pills: A systematic review of women’s attitudes, beliefs, knowledge, and experiences in Australia. Health Care Women Int 2018; 40:174-195. [DOI: 10.1080/07399332.2018.1526286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Julie Mooney-Somers
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Amber Lau
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
| | - Deborah Bateson
- Family Planning New South Wales, Sydney, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - Juliet Richters
- Kirby Institute for Infection and Immunity in Society, University of New South Wales, New South Wales, Australia
| | - Mary Stewart
- Family Planning New South Wales, Sydney, Australia
| | - Kirsten Black
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - Melissa Nothnagle
- Natividad Family Medicine Residency, University of California San Francisco, Salinas, California, USA
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7
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Emergency contraception supply in Australian pharmacies after the introduction of ulipristal acetate: a mystery shopping mixed-methods study. Contraception 2018; 98:243-246. [DOI: 10.1016/j.contraception.2018.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 12/30/2022]
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Grzeskowiak LE, Roberts CT, Calabretto HE. Emergency contraception - an evidence-based practice guide. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Luke E. Grzeskowiak
- Adelaide Medical School; Robinson Research Institute; University of Adelaide; Adelaide Australia
- SA Pharmacy; Flinders Medical Centre; SA Health; Adelaide Australia
| | - Claire T. Roberts
- Adelaide Medical School; Robinson Research Institute; University of Adelaide; Adelaide Australia
| | - Helen E. Calabretto
- Adelaide Medical School; Robinson Research Institute; University of Adelaide; Adelaide Australia
- SHINE SA; Adelaide Australia
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Lindh I, Skjeldestad FE, Gemzell-Danielsson K, Heikinheimo O, Hognert H, Milsom I, Lidegaard Ø. Contraceptive use in the Nordic countries. Acta Obstet Gynecol Scand 2016; 96:19-28. [DOI: 10.1111/aogs.13055] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Ingela Lindh
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Finn E. Skjeldestad
- Research Group Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska Insitute and Karolinska University Hospital; Stockholm Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Helena Hognert
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Ian Milsom
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Øjvind Lidegaard
- Department of Obstetrics and Gynecology; Faculty of Health Sciences; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
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10
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Black KI, Geary R, French R, Leefe N, Mercer CH, Glasier A, Macdowall W, Gibson L, Datta J, Palmer M, Wellings K. Trends in the use of emergency contraception in Britain: evidence from the second and third National Surveys of Sexual Attitudes and Lifestyles. BJOG 2016; 123:1600-7. [PMID: 27245637 PMCID: PMC4995725 DOI: 10.1111/1471-0528.14131] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the changes in the prevalence of, and the factors associated with, the use of emergency contraception (EC) in Britain between 2000 and 2010, spanning the period of deregulation and increase in pharmacy supply. DESIGN Cross-sectional probability sample surveys. SETTING AND POPULATION British general population. METHODS Data were analysed from the second and third British National Surveys of Sexual Attitudes and Lifestyles (Natsal), undertaken in 1999-2001 and 2010-12. Univariate and logistic regression analyses were used to measure change in EC use amongst sexually active women aged 16-44 years not intending pregnancy. MAIN OUTCOME MEASURES Prevalence of EC use and factors associated with use. RESULTS Of the 5430 women surveyed in 1999-2001 and the 4825 women surveyed in 2010-12, 2.3 and 3.6%, respectively, reported using EC in the year prior to interview (P = 0.0019 for change over time). The prevalence of EC use increased amongst single women and those with higher educational attainment (adjusted odds ratio, aOR 1.51; 95% confidence interval, 95% CI 1.04-2.20; P = 0.0308). Increases in EC use were generally greater among women without behavioural risk factors, such as those with no history of abortion within 5 years (aOR 1.57; 95% CI 1.17-2.12; P = 0.0029), or those whose first heterosexual intercourse occurred after the age of 16 years (aOR 1.68; 95% CI 1.21-2.35; P = 0.0021). The increase in EC use was also more marked among women usually accessing contraception from retail sources than among those doing so from healthcare sources, which may reflect a use of condoms amongst EC users. CONCLUSION The increase in EC use among women in Britain in the first decade of the 21st century was associated with some, but not all, risk factors for unplanned pregnancy. Advice and provision may need to be targeted at those at highest risk of unplanned pregnancy. TWEETABLE ABSTRACT Despite pharmacy access, only a small rise in emergency contraception use has been seen in Britain over 10 years.
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Affiliation(s)
- KI Black
- University of SydneySydneyNSWAustralia
| | - R Geary
- London School of Hygiene and Tropical MedicineLondonUK
| | - R French
- London School of Hygiene and Tropical MedicineLondonUK
| | - N Leefe
- University College LondonLondonUK
| | | | - A Glasier
- London School of Hygiene and Tropical MedicineLondonUK
| | - W Macdowall
- London School of Hygiene and Tropical MedicineLondonUK
| | - L Gibson
- London School of Hygiene and Tropical MedicineLondonUK
| | - J Datta
- London School of Hygiene and Tropical MedicineLondonUK
- University of EdinburghEdinburghUK
| | - M Palmer
- London School of Hygiene and Tropical MedicineLondonUK
| | - K Wellings
- London School of Hygiene and Tropical MedicineLondonUK
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11
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Italia S, Brand H. Status of Emergency Contraceptives in Europe One Year after the European Medicines Agency's Recommendation to Switch Ulipristal Acetate to Non-Prescription Status. Public Health Genomics 2016; 19:203-10. [PMID: 27022731 DOI: 10.1159/000444686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 02/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In November 2014, the European Medicines Agency (EMA) recommended switching the emergency contraceptive (EMC) ulipristal acetate to non-prescription status. This study's objective is to assess the current legal status of the two EMCs ulipristal acetate and levonorgestrel in Europe and to report on the development of sales figures for EMCs since they were made freely available. METHODS Health authorities were contacted in autumn 2015 and asked about the current status of EMCs and whether the sales figures had changed after a switch to non-prescription status. Additionally, data on consumption were collected in 18 German community pharmacies. RESULTS As of November 2015, most countries in the European Union (EU) have followed the EMA recommendation. Hungary kept the prescription-only status. In Malta, EMC drugs are not authorized. Germany and Croatia switched levonorgestrel to non-prescription status as well. Of the EU candidate and European Free Trade Association countries, ulipristal acetate is available without prescription in Norway and Bosnia and Herzegovina only. Several countries reported an increase in EMC sales since the switch. CONCLUSIONS An EMA recommendation can strongly contribute to the harmonization of a drug's legal status in the EU. In most European countries, ulipristal acetate and/or levonorgestrel are now freely available.
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Affiliation(s)
- Salvatore Italia
- Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Chofakian CBDN, Borges ALV, Sato APS, Alencar GP, Santos OAD, Fujimori E. Does the knowledge of emergency contraception affect its use among high school adolescents? CAD SAUDE PUBLICA 2016; 32:S0102-311X2016000100703. [DOI: 10.1590/0102-311x00188214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/23/2015] [Indexed: 11/22/2022] Open
Abstract
Abstract This study aimed to test how knowledge on emergency contraception (according to age at sexual initiation, type of school, and knowing someone that has already used emergency contraception) influences the method’s use. This was a cross-sectional study in a probabilistic sample of students 15-19 years of age enrolled in public and private middle schools in a medium-sized city in Southeast Brazil (n = 307). Data were collected in 2011 using a self-administered questionnaire. A structural equations model was used for the data analysis. Considering age at sexual initiation and type of school, knowledge of emergency contraception was not associated with its use, but knowing someone that had used the method showed a significant mean effect on use of emergency contraception. Peer group conversations on emergency contraception appear to have greater influence on use of the method than knowledge itself, economic status, or sexual experience.
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13
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Emergency contraception. Widely available and effective but disappointing as a public health intervention: a review. Hum Reprod 2015; 30:751-60. [PMID: 25678571 PMCID: PMC4447791 DOI: 10.1093/humrep/dev019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/12/2015] [Accepted: 01/19/2015] [Indexed: 12/30/2022] Open
Abstract
Emergency contraception (EC) prevents pregnancy after unprotected sex or contraceptive failure. Use of EC has increased markedly in countries where a product is available over the counter, yet barriers to availability and use remain. Although effective in clinical trials, it has not yet been possible to show a public health benefit of EC in terms of reduction of unintended pregnancy rates. Selective progesterone receptor modulators developed as emergency contraceptives offer better effectiveness than levonorgestrel, but still EC is less effective than use of ongoing regular contraception. Methods which inhibit ovulation whenever they are taken or which act after ovulation to prevent implantation and strategies to increase the uptake of effective ongoing contraception after EC use would prevent more pregnancies.
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Affiliation(s)
- ESHRE CapriWorkshop Group
- Correspondence address. P.G. Crosignani, Scientific Direction, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Via M. Fanti, 6, 20122 Milano, Italy, E-mail:
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Chofakian CBDN, Borges ALV, Fujimori E, Hoga LAK. Conhecimento sobre anticoncepção de emergência entre adolescentes do Ensino Médio de escolas públicas e privadas. CAD SAUDE PUBLICA 2014; 30:1525-36. [DOI: 10.1590/0102-311x00149413] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 01/30/2014] [Indexed: 11/22/2022] Open
Abstract
O objetivo do estudo foi analisar o nível de conhecimento sobre anticoncepção de emergência entre adolescentes do Ensino Médio de escolas públicas e privadas. Estudo transversal com a participação de 705 estudantes de 15 a 19 anos, matriculados no Ensino Médio de escolas públicas e privadas de um município do Estado de São Paulo, Brasil. Utilizou-se amostragem probabilística estratificada por tipo de escola e sistemática por turma. Cerca de 24,9% dos adolescentes das escolas privadas e 32% das escolas públicas haviam iniciado a vida sexual e usado a anticoncepção de emergência. A média de escore de conhecimento foi de 3,87 (DP = 2,12) nas escolas públicas e 5,14 (DP = 2,00) nas escolas privadas. Análise de regressão linear múltipla mostrou que adolescentes de escolas privadas, do sexo feminino, com mais idade, que já tinham iniciado a vida sexual, usado a anticoncepção de emergência e conheciam alguém que já usou o método, foram as que alcançaram o maior escore de conhecimento. Conclui-se que poucos adolescentes estão corretamente informados sobre o método e muitos têm ideias equivocadas.
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Trilla C, Senosiain R, Calaf J, Espinós JJ. Effect of changes to cost and availability of emergency contraception on users' profiles in an emergency department in Catalunya. EUR J CONTRACEP REPR 2014; 19:259-65. [PMID: 24865942 DOI: 10.3109/13625187.2014.913787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Emergency contraception (EC) accessibility has evolved differently in Catalunya as compared with other autonomous communities in Spain. Free-of-charge access within the Public Health System was authorised in 2004, and over-the-counter (OTC) access was implemented in 2009. The aim of the study is to assess the impact of these measures on demand and users' profiles at our institution. METHODS A retrospective study, in our Emergency Department, was conducted to evaluate EC requests in relationship to accessibility modifications. The age of women and which days of the week they attended were analysed. RESULTS The number of EC requests, the distribution by age and the demand over the week remained stable after access to EC became free of charge. However, requests sharply decreased following OTC access implementation. Distribution by age also changed, with a significant increase in requests from women under 25 years (72% vs 56%, p < 0.001). Demand was greatest on Sunday and Monday, and this distribution persisted over the study period. CONCLUSION EC requests remained unchanged following free-of-charge access to EC, but decreased after OTC implementation. Women currently seeking EC at no cost at our institution are more likely to be younger and to request it on a Monday.
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Affiliation(s)
- Cristina Trilla
- Department of Obstetrics and Gynaecology, Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
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16
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Baird AS, Trussell J, Webb A. Use of ulipristal acetate and levonorgestrel for emergency contraception: a follow-up study. ACTA ACUST UNITED AC 2014; 41:116-21. [PMID: 24869461 DOI: 10.1136/jfprhc-2013-100733] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Previously we showed that increasing the choice of emergency contraception (EC) guided by medical eligibility did not result in wholesale large-scale usage of ulipristal acetate (UPA). This further 12-month study aimed to answer three questions. (1) Does offering choice of EC lead to change in methods used? (2) Are women who choose UPA more likely than those who choose levonorgestrel (LNG) to continue using condoms for subsequent contraception or to decline any ongoing contraception? (3) Do more women choosing LNG 'quick start' hormonal contraception? METHODS A retrospective study of EC episodes (1 April 2012 to 31 March 2013) by quarters. Among women offered all three methods of EC (49.1%) we noted the method chosen, and decisions on ongoing contraception among those choosing either LNG or UPA. Differences were tested for statistical significance. RESULTS In 6110 episodes of EC, LNG was issued in 69.2%, UPA in 26.0%, and a copper intrauterine device (Cu-IUD) was fitted in 4.8%. Quarter by quarter, the data show a small decline in LNG use, suggesting plateauing by the last quarter, and a significant increase in UPA use between the first and the other three quarters (p<0.001). Use of the Cu-IUD remained static. The percentage of women offered three methods rose to 54.2%. In women offered full choice (3000; 49.1%) we saw a significant increase in choice of UPA, from 39.3% to 48.6% (p<0.001). Women who chose LNG were more likely to quick start (p=0.02) or be continuing contraception already used (p<0.001). Overall, those choosing UPA were more likely to use condoms (p<0.001) but were no more likely to decline ongoing contraception (p=0.13). CONCLUSIONS There was a significant increase in women using UPA for EC compared with our previous study, particularly among those wishing to use condoms for continuing contraception. Women choosing LNG were more likely to quick start pills or to continue current hormonal contraception. Detailed attention to continuing contraception following EC may be an important factor in the prevention of unwanted pregnancy.
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Affiliation(s)
- Aisling Susan Baird
- Consultant in Sexual and Reproductive Health, Abacus Community Sexual Health Service, Liverpool Community Health, Liverpool, UK
| | - James Trussell
- Professor of Economics and Public Affairs, Office of Population Research, Princeton University, Princeton, NJ, USA and Visiting Professor, Hull York Medical School, University of Hull, Hull, UK
| | - Anne Webb
- Retired Consultant in Sexual and Reproductive Health, Abacus Community Sexual Health Service, Liverpool Community Health, Liverpool, UK
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Abstract
This review will focus on the available methods for emergency contraception (EC), efficacy, side effects and mechanisms of action. Copper intrauterine device (IUD) has been shown to be the most effective method for EC which can be continually used for regular contraception. However, this possibility is seldom used and may be little known. Among the hormonal EC methods 1.5 mg levonorgestrel is the most widely used EC pill while the more recently developed Ulipristal acetate (UPA) has been shown to be the most effective option. This is probably due to a more pronounced prevention of follicular rupture compared with other hormonal EC methods. Knowledge is needed to better advise lactating women and obese women on optimal EC method. Furthermore a possible interaction of UPA with regular hormonal contraception and possibilities for "bridging" from EC to regular contraception needs to be explored. To increase efficacy future studies should focus on EC methods that target the endometrium.
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Affiliation(s)
- P G L Lalitkumar
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/WHO-Collaborating Center, Karolinska University Hospital, Stockholm, Sweden
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Whelan AM, Langille DB, Hurst E. Nova Scotia pharmacists' knowledge of, experiences with and perception of factors interfering with their ability to provide emergency contraceptive pill consultations. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2013; 21:314-21. [DOI: 10.1111/ijpp.12017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 11/15/2012] [Indexed: 11/26/2022]
Abstract
Abstract
Objective
The objective of this research was to explore pharmacists' knowledge of, experiences with and perception of factors interfering with their ability to provide non-prescription emergency contraceptive pill consultations in the Canadian province of Nova Scotia.
Methods
A self-administered paper questionnaire was mailed, using Dillman's tailored design method, to all pharmacists (n = 1123) registered with the Nova Scotia College of Pharmacists.
Key findings
The response rate was 53.0% (595/1123), with 451 respondents working in community practice. Most respondents reported that they had provided consultations for the emergency contraceptive product Plan B since it became available without a prescription (93.6%), and that Plan B is kept behind the pharmacy counter (83.6%). Pharmacists most frequently (47.8%) reported spending 6–10 min providing Plan B consultations. Respondents were generally knowledgeable about Plan B; however, only 39.2% knew that it can be effective for up to 5 days and 69.3% knew that the incidence of vomiting is less than 50%. The factors interfering the most with providing Plan B consultations were lack of privacy (46.1%) and lack of staff to cover during the consultation (50.9%).
Conclusions
In general, Nova Scotia pharmacists are knowledgeable about emergency contraceptive pills; however, education regarding effective timing for use of such pills would be helpful. Private areas for counselling and consideration of pharmacy staffing schedules in community pharmacies may help address pharmacist concerns regarding their ability to provide Plan B consultations.
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Affiliation(s)
- Anne Marie Whelan
- College of Pharmacy, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donald B Langille
- Department of Community Health & Epidemiology, Centre for Clinical Research, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eileen Hurst
- Department of Community Health & Epidemiology, Centre for Clinical Research, Dalhousie University, Halifax, Nova Scotia, Canada
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