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Jum'Ah D, Abu-Farha R, Alzoubi KH, Binsaleh AY, Shilbayeh SAR. Evaluating community pharmacists awareness, perception and roles in providing emergency contraceptives in Jordan. Contraception 2024:110515. [PMID: 38879072 DOI: 10.1016/j.contraception.2024.110515] [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: 03/30/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE This cross-sectional study aimed to assess Jordanian community pharmacists' awareness, perception, and roles concerning emergency contraceptives provision. STUDY DESIGN We administered a structured questionnaire to community pharmacists in Jordan using convenience sampling. The questionnaire included sections on demographic information, knowledge about emergency contraceptives, perception towards emergency contraceptive, and prior experience in emergency contraceptives provision. RESULTS A total of 299 community pharmacists responded to the study. Most pharmacists had a Pharm D/BPharm degree (94.6%) and worked in independent community pharmacies (75.6%). While pharmacists demonstrated relatively high knowledge scores regarding emergency contraception, with a median score of 10 out of 14, misconceptions persisted, particularly regarding the mechanism of action and side effects of emergency contraception. Pharmacists expressed mixed perceptions regarding emergency contraception, with a significant proportion advocating for prescription-only access (76.6%) and expressing ethical reservations (48.2%). Only 38.1% reported prior experience in emergency contraceptives provision. Regression analyses revealed that attendance at emergency contraceptives-focused workshops significantly increased the likelihood of pharmacists providing emergency contraceptives (Adjusted Odds Ratio=2.569, p = 0.001). CONCLUSIONS Jordanian community pharmacists exhibit readiness to provide emergency contraceptives, but persistent misconceptions and regulatory barriers hinder optimal provision. Targeted educational interventions, particularly through workshops, are crucial in enhancing pharmacists' knowledge and promoting emergency contraceptives provision. IMPLICATIONS Responding pharmacists often reported the misconception that emergency contraceptives can cause abortion. Also, some pharmacists expressed religious or moral objections to prescribing oral emergency contraceptives. Thus, this study underscores the importance of receiving comprehensive training on ethical and religious considerations in healthcare practice.
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Affiliation(s)
- Dima Jum'Ah
- Clinical Pharmacy and Therapeutics Department, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Rana Abu-Farha
- Clinical Pharmacy and Therapeutics Department, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, UAE; Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Ammena Y Binsaleh
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sireen Abdul Rahim Shilbayeh
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Grant A, Smarr B. Feasibility of continuous distal body temperature for passive, early pregnancy detection. PLOS DIGITAL HEALTH 2022; 1:e0000034. [PMID: 36812529 PMCID: PMC9931282 DOI: 10.1371/journal.pdig.0000034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/01/2022] [Indexed: 01/02/2023]
Abstract
Most American women become aware of pregnancy ~3-7 weeks after conceptive sex, and all must seek testing to confirm their pregnant status. The delay between conceptive sex and pregnancy awareness is often a time in which contraindicated behaviors take place. However, there is long standing evidence that passive, early pregnancy detection may be possible using body temperature. To address this possibility, we analyzed 30 individuals' continuous distal body temperature (DBT) in the 180 days surrounding self-reported conceptive sex in comparison to self-reported pregnancy confirmation. Features of DBT nightly maxima changed rapidly following conceptive sex, reaching uniquely elevated values after a median of 5.5 ± 3.5 days, whereas individuals reported a positive pregnancy test result at a median of 14.5 ± 4.2 days. Together, we were able to generate a retrospective, hypothetical alert a median of 9 ± 3.9 days prior to the date at which individuals received a positive pregnancy test. Continuous temperature-derived features can provide early, passive indication of pregnancy onset. We propose these features for testing and refinement in clinical settings, and for exploration in large, diverse cohorts. The development of pregnancy detection using DBT may reduce the delay from conception to awareness and increase the agency of pregnant individuals.
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Affiliation(s)
- Azure Grant
- The Helen Wills Neuroscience Institute, University of California, Berkeley, California, United States of America
| | - Benjamin Smarr
- Department of Bioengineering, University of California, San Diego, California, United States of America,Halicioğlu Institute for Data Science, University of California, San Diego, California, United States of America,* E-mail:
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Dinis-Oliveira RJ, Vieira DN. Acute liver failure requiring transplantation: A possible link to ulipristal acetate treatment? Basic Clin Pharmacol Toxicol 2021; 129:278-282. [PMID: 34187080 DOI: 10.1111/bcpt.13631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022]
Abstract
The present case describes in detail a 55-year-old woman diagnosed with acute liver injury 3 days after completion of the first treatment course with ulipristal acetate (UPA), 5 mg/day orally for uterine fibroids causing persistent bleeding (treatment duration of 109 days). Liver transplantation was performed approximately 6 weeks after UPA suspension, and a photograph of the explanted liver is presented. Of note, other common causes of acute liver injury, such as history of alcohol or other psychoactive substances abuse, viral hepatitis and autoimmune hepatitis or preexisting liver disease were all excluded. This case was reported to the European Medicines Agency (EMA) and contributed to the final recommendations of the Pharmacovigilance Risk Assessment Committee (PRAC) disclosed in January 2021. The causality assessment considered a probable case of drug-induced liver injury as a consequence of UPA treatment, and the Roussel Uclaf Causality Assessment Method (RUCAM) was scored as unlikely. Although further studies are needed aiming to avoid confounding factors, this case suggests that liver function tests should be monitored during treatment with UPA.
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Affiliation(s)
- Ricardo Jorge Dinis-Oliveira
- TOXRUN - Toxicology Research Unit, University Institute of Health Sciences, Advanced Polytechnic and University Cooperative (CESPU), CRL, Gandra, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.,UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Dinis-Oliveira RJ. Pharmacokinetics, toxicological and clinical aspects of ulipristal acetate: insights into the mechanisms implicated in the hepatic toxicity. Drug Metab Rev 2021; 53:375-383. [PMID: 33905271 DOI: 10.1080/03602532.2021.1917599] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ulipristal acetate is a drug used as emergency contraceptive (30 mg) and for the treatment of moderate to severe symptoms of uterine myomas (5 mg). After commercialization, and although the exact number is unknown, serious cases implying ulipristal acetate 5 mg as a contributing factor of liver injury, some leading to transplantation, were reported. These cases prompted to a restrict use of the drug in January 2021 by the European Medicines Agency. This work aimed to fully review pharmacokinetic aspects, namely focusing in the ulipristal acetate metabolism and other hypothetical toxicological underlying mechanisms that may predispose to drug-induced liver injury (DILI). The high lipophilicity, the extensive hepatic metabolism, the long half-life of the drug and of its major active metabolite, the long-term course of treatment, and possibility due to the formation of epoxide reactive may be contributing factors. Scientific results also points evidence to consider monitorization of liver function during ulipristal acetate treatment.
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Affiliation(s)
- Ricardo Jorge Dinis-Oliveira
- IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), Advanced Polytechnic and University Cooperative (CESPU), CRL, Gandra, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.,UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Sarver J, Cregan M, Cain D. Fractured copper intrauterine device (IUD) retained in the uterine wall leading to hysterectomy: A case report. Case Rep Womens Health 2021; 29:e00287. [PMID: 33552933 PMCID: PMC7851793 DOI: 10.1016/j.crwh.2021.e00287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 12/18/2022] Open
Abstract
Several types of contraception methods exist, and among these are hormonal and non-hormonal intrauterine devices (IUDs). Cases have been reported of fractured IUD pieces and retention of copper fragments upon attempted removal in office. These findings suggest the importance of careful removal of an IUD by providers. A 38-year-old Caucasian woman, gravida 2, para 2, presented for a colposcopy and endometrial biopsy (EMB). She had had a copper IUD (ParaGard) placed 10 years prior. She now requested to have it removed. After completion of the colposcopy and EMB, the provider located the IUD strings for removal. During careful removal of the IUD, a piece was broken off and remained in the uterine cavity. Upon visual inspection of the removed IUD, the right wing was missing and presumed to be still in the patient. Transabdominal and transvaginal ultrasound (TVUS) confirmed presence of a portion of the IUD in the uterine wall near the cervix. The patient was scheduled for surgical removal of the IUD by robot-assisted total laparoscopic hysterectomy with bilateral salpingectomy. This case highlights the importance of thorough evaluation of an IUD upon removal. Practitioners who work with IUD insertion and removal should remain informed about this rare complication. Risk of fracture during IUD removal should be better communicated between physicians and patients. This case study underlines the importance of careful IUD planning, from insertion to removal. Further research considering improved stepwise removal should be considered. Fracture of an intrauterine device (IUD) upon removal is a very rare complication, with a prevalence rate of 1–2%. Risk of fracture during IUD removal should be better communicated between physicians and patients. Our patient's IUD fracture prompted a hysterectomy to safely remove the device. Malposition of an IUD may interfere with effectiveness and complicate removal.
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Affiliation(s)
- Jordan Sarver
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701, United States of America
| | - Melissa Cregan
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701, United States of America
| | - Daniel Cain
- Twins Springs Gynecology, Massillon, OH 44646, United States of America
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Meunier L, Meszaros M, Pageaux GP, Delay JM, Herrero A, Pinzani V, Dominique HB. Acute liver failure requiring transplantation caused by ulipristal acetate. Clin Res Hepatol Gastroenterol 2020; 44:e45-e49. [PMID: 32146092 DOI: 10.1016/j.clinre.2020.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/14/2020] [Indexed: 02/04/2023]
Abstract
Ulipristal has recently been suspected to be hepatotoxic by the European Medicines Agency but the evidence base for hepatotoxicity is sparse. This is a brief formal report of a patient administered ulipristal for 6-8 weeks and who developed acute liver failure leading to liver transplantation. The explanted liver showed extensive hepatocyte necrosis and inflammation compatible with drug-induced liver injury and cirrhosis. The usual causes of acute hepatitis and cirrhosis were eliminated. There were no other potential causative drugs. This case suggests that ulipristal may cause acute hepatitis, with pre-existing cirrhosis probably contributing to the severity of liver injury observed in this case. Ulipristal prescribers must remain vigilant and monitor liver function in their patients.
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Affiliation(s)
- Lucy Meunier
- Liver and Transplantation Unit, University Hospital Montpellier, Montpellier, France.
| | - Magdalena Meszaros
- Liver and Transplantation Unit, University Hospital Montpellier, Montpellier, France
| | | | - Jean-Marc Delay
- Intensive Care Unit, DAR B, University Hospital Montpellier, Montpellier, France
| | - Astrid Herrero
- Department of General and Liver Transplant Surgery, University Hospital Montpellier, Montpellier, France
| | - Véronique Pinzani
- Department of Medical Pharmacology and Toxicology, CRPV, CHU Montpellier, University Montpellier, 34295 Montpellier, France
| | - Hillaire-Buys Dominique
- Department of Medical Pharmacology and Toxicology, CRPV, CHU Montpellier, University Montpellier, 34295 Montpellier, France
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Chin J, Salcedo J, Raidoo S. Over-The-Counter Availability of Levonorgestrel Emergency Contraception in Pharmacies on Oahu. PHARMACY 2020; 8:pharmacy8010020. [PMID: 32075212 PMCID: PMC7151709 DOI: 10.3390/pharmacy8010020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 12/17/2022] Open
Abstract
Since the United States Food and Drug Administration’s approval of over-the-counter levonorgestrel emergency contraception, access to this time-sensitive medication has improved. However, multiple barriers, including the cost of the medication and pharmacy availability, still exist. The objective of this study was to determine the over-the-counter availability of levonorgestrel emergency contraception in pharmacies on Oahu, Hawaii. We conducted a cross-sectional population-based study using in-person simulated patient encounters at all pharmacies on Oahu. Out of 109 chain pharmacies and 13 independent pharmacies, 102 (84%) pharmacies had levonorgestrel emergency contraception available over the counter. Of pharmacies in which it was available, 12.7% required an employee to unlock the medication, 37.3% required the medication to be unlocked at the register, 29.4% were packaged in a large plastic box, and 3.9% were packaged in a blister pack. Levonorgestrel emergency contraception is widely available as an over-the-counter medication in pharmacies on Oahu, yet there are packaging and display practices that make it less accessible. Many of these practices could be improved with pharmacy education or changes in store policies. Systems-based interventions are needed to improve the access to levonorgestrel emergency contraception as an over-the-counter medication.
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Affiliation(s)
- Jennifer Chin
- Department of Obstetrics, Gynecology, and Women’s Health, University of Hawaii, Honolulu, HI 96826, USA;
- Correspondence:
| | - Jennifer Salcedo
- Department of Obstetrics and Gynecology, University of Texas Rio Grande Valley, Edinburg, TX 78501, USA;
| | - Shandhini Raidoo
- Department of Obstetrics, Gynecology, and Women’s Health, University of Hawaii, Honolulu, HI 96826, USA;
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Biggs MA, Kimport K, Mays A, Kaller S, Berglas NF. Young Women's Perspectives About the Contraceptive Counseling Received During Their Emergency Contraception Visit. Womens Health Issues 2018; 29:170-175. [PMID: 30890252 DOI: 10.1016/j.whi.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Research aimed at understanding women's experiences accessing emergency contraception (EC) services and the extent to which providers support women's autonomous contraceptive decision making is limited. This study explores young women's experiences with contraceptive counseling when accessing EC at family planning specialty clinics that serve young adult and adolescent patients. METHODS We conducted 22 in-depth telephone interviews with women ages 15-25 years who had recently accessed EC at two San Francisco Bay Area youth-serving clinics about their thoughts and experiences using and accessing contraception. We analyzed transcripts thematically, using inductive qualitative analytic methods to identify patterns across the interviews. RESULTS Most respondents described their recent clinic visit to access EC positively. Specifically, they expressed appreciation about receiving comprehensive information about other methods of contraception without pressure, judgment, or the expectation that they adopt a particular method. They also pointed to the influence of prior health care experiences in which they felt pressured or judged, leading them to avoid accessing future reproductive health services. CONCLUSIONS We found that young women seeking EC appreciated learning about other contraceptive methods, but do not want to feel pressured to adopt a method in addition to EC. Findings highlight the importance of respecting young women's contraceptive decisions for building and maintaining provider trust and suggest that contraceptive counseling approaches that prioritize specific methods may reduce some young women's trust in providers and use of reproductive health services.
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Affiliation(s)
- M Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, Oakland, California.
| | - Katrina Kimport
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, Oakland, California
| | - Aisha Mays
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, Oakland, California
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, Oakland, California
| | - Nancy F Berglas
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, Oakland, California
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Rozenberg S, Praet J, Pazzaglia E, Gilles C, Manigart Y, Vandromme J. The use of selective progestin receptor modulators (SPRMs) and more specifically ulipristal acetate in the practice of gynaecology. Aust N Z J Obstet Gynaecol 2017; 57:393-399. [PMID: 28567743 DOI: 10.1111/ajo.12641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 04/10/2017] [Indexed: 12/14/2022]
Abstract
This review discusses the development of selective progestin receptor modulators (SPRMs) for use in women's health and specifically the use of ulipristal acetate (UPA) as emergency contraception (EC) and as a treatment for symptomatic fibroids in women who want to preserve their fertility or avoid a hysterectomy. As an EC, UPA 30 mg should be recommended for women, within 102 h of unprotected intercourse. As a treatment of fibroids, UPA (5 mg daily dose) should be administered for periods of three months as a pre-surgical strategy, reducing bleeding and fibroid size and facilitating surgery. A proportion of these patients may even avoid surgery. Future developments will demonstrate whether UPA can be used for other indications such as endometriosis and breast cancer prevention or treatment.
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Affiliation(s)
- Serge Rozenberg
- Department of Obstetrics & Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - Julie Praet
- Department of Obstetrics & Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eliza Pazzaglia
- Department of Obstetrics & Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - Christine Gilles
- Department of Obstetrics & Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yannick Manigart
- Department of Obstetrics & Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jean Vandromme
- Department of Obstetrics & Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, Vrije Universiteit Brussel, Brussels, Belgium
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Practice Guideline: Contraception for Adolescents with Chronic Illness. J Pediatr Health Care 2017; 31:409-420. [PMID: 28433065 DOI: 10.1016/j.pedhc.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 11/20/2022]
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Nelson TK. Emergency Life Prevention. Mayo Clin Proc 2016; 91:1840-1841. [PMID: 27916157 DOI: 10.1016/j.mayocp.2016.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/20/2016] [Indexed: 11/17/2022]
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Casey PM, Kransdorf LN, Batur P. In Reply-Emergency Life Prevention. Mayo Clin Proc 2016; 91:1841-1842. [PMID: 27916158 DOI: 10.1016/j.mayocp.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/07/2016] [Indexed: 11/15/2022]
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Smith NK, Cleland K, Wagner B, Trussell J. "I don't know what I would have done." Women's experiences acquiring ulipristal acetate emergency contraception online from 2011 to 2015. Contraception 2016; 95:414-418. [PMID: 27769767 DOI: 10.1016/j.contraception.2016.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study describes women's reasons for seeking ulipristal acetate (UPA) for emergency contraception (EC) through the only authorized online retailer for UPA EC in the US. STUDY DESIGN Women aged 14 to 59 years, living in states that allow prescription medications to be shipped from out-of-state, accessed the KwikMed online pharmacy between January 2011 and December 2015. After completing a medical eligibility screener, women answered optional multiple-choice questions. To obtain UPA through KwikMed, individuals must be female, 50 years of age or younger, not currently pregnant or breastfeeding and not attempting to order UPA more than once within 30 days or more than four times per year. RESULTS Over the 5-year period, KwikMed provided 8019 prescriptions for UPA, and the number of women using this service more than tripled over time. Among women who responded to the survey questions (n=7133; response rate = 89%), most sought EC because of a condom failure (45.3%) or because they did not use regular contraception (41.2%). More than half (53.5%) of women reported that they chose UPA because of its effectiveness compared to levonorgestrel EC pills, and 58.9% preferred ordering UPA online because they found it easier than getting it from a doctor, clinic or pharmacy. CONCLUSIONS This study documents the importance of providing confidential services for acquiring EC online. Benefits of online access include convenience, less embarrassment, avoiding situations in which a provider might refuse to provide EC because of their own ideological belief and more reliable availability for this time-sensitive contraceptive. IMPLICATIONS Though physical, logistical and societal barriers can restrict women's access to EC, this study demonstrates that providing access to UPA online empowers women to obtain EC when they need it.
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Affiliation(s)
| | - Kelly Cleland
- Office of Population Research, Princeton University.
| | - Brandon Wagner
- Office of Population Research, Princeton University; Texas Tech University
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