Emergency contraception, myths and facts

Population Geography and Emergency Contraception Access in Louisiana

We assessed the same-day availability of oral emergency contraception (EC) in five Louisiana communities, and evaluated this data for relationships between availability and local population demographics. Researchers called all retail pharmacies in five municipalities of varying sizes in order to inquire about the same-day stockage of EC products and their availability to teens. Individual pharmacies were then geolocated to a census tract, and call data was analyzed against neighborhood census data regarding population size, income, gender, race, family structure, and educational level. A multivariable logistic regression model was performed to predict the same-day availability of emergency contraception. EC was available on the same day in 66% of all pharmacies. The same-day availability of EC decreased with the local population size (p < 0.001), and the availability increased with higher levels of educational attainment (p = 0.0015). The largest census level predictor of access to same-day EC was the city population, with the availability increasing by 6.6% for every 10,000 person increase in population. Despite changing to over-the-counter sales in 2013, EC is still not widely available in all geographic areas. Its availability is partially predictable by local population demographics, and this difference may represent a health disparity for teens and women seeking EC.

Availability and Accessibility of Emergency Contraception to Adolescent Callers in Pharmacies in Four Southwestern States

PURPOSE

To evaluate the availability and accessibility of emergency contraception (EC) to adolescents in U.S. pharmacies across four Southwestern states, 3 years after the federal Food and Drug Administration (FDA) removed age restrictions for over-the-counter sales of levonorgestrel-only pills.

METHODS

Using a mystery-caller approach, we trained male and female data collectors to phone pharmacies posing as 16-year-olds who wanted to prevent a pregnancy after recent unprotected sex. From April to May 2016, they called 1,475 randomly selected retail pharmacies in Arizona, California, New Mexico, and Utah and completed an online survey about their experience. Caller data were analyzed by state and pharmacy type (i.e., national chains, regional outlets, and individually owned outlets).

RESULTS

Of pharmacies contacted, 80.6% had EC available at the time of the call. Availability of EC varied by state (p < .01) and pharmacy type (p < .01), but not by rural/urban location. Even where EC was available, pharmacy personnel often hindered youths' access to EC by mentioning incorrect point-of-sale restrictions, keeping EC in restrictive store locations, or asking personal questions. Individually owned outlets presented significantly more barriers than larger chains. Overall, EC was completely accessible to an adolescent caller in only 28% of pharmacies. Lower EC accessibility was found in states with higher teen pregnancy rates.

CONCLUSIONS

This study found that EC is still not sufficiently available or accessible to adolescents in Southwestern states. Differences in accessibility vary significantly by state and pharmacy type and may be a contributor to teen pregnancy rates.

Emergency contraception considerations and use among college women

BACKGROUND

Emergency contraception (EC) has been available behind the counter without a prescription since 2006. Evidence has shown increased use of EC among young women, but no recent findings have been published to date of current use.

METHODS

This cross-sectional study surveyed 482 college heterosexually active college women attending a large public university who either visited the college-based health clinic or were enrolled in selected undergraduate classes. Prediction models were created for each outcome, EC consideration and use, using Poisson regression with robust variance estimates.

RESULTS

Just over 58% of college women sampled reported ever considering EC, and just under 47% reported actual use. Consideration and actual EC use were highest for students who were nonwhite and who reported more sexual partners. Although female students who did not use condoms were more likely to use EC, there was no difference in EC relative to hormonal contraception use.

CONCLUSIONS

As EC becomes both better known and more readily available, use is expected to grow. Moving forward, greater attention is needed to the efficacy of EC use on preventing unwanted pregnancies.

A Jewish response to the Vatican's new bioethical guidelines

The Vatican recently published directives (Dignitas Personae) regarding "beginning of life" issues that explain the Catholic Church's position regarding new technologies in this area. We think that it is important to develop a response that presents the traditional Orthodox Jewish position on these same issues in order to present an alternative, parallel system. There are many points of commonality between the Vatican document and traditional Jewish thought as well as several important issues where there is a divergence of opinion. The latter include the status of the zygote as produced during in vitro fertilization (IVF), the acceptable of procreation in a method other than through the conjugal act, and the permissibility of deriving benefit from the products of an illicit act. These points of agreement and disagreement are discussed in detail in this article.

Computer-assisted provision of emergency contraception a randomized controlled trial

BACKGROUND

Emergency contraception (EC) can prevent unintended pregnancy. However, many women continue to lack information needed to use EC effectively and clinician time to counsel women about EC is limited.

OBJECTIVE

To evaluate whether computer-assisted provision of EC can increase knowledge and use of EC among women able to access EC without a prescription.

DESIGN

We conducted a randomized controlled trial in which the intervention group received a 15-minute computerized educational session and 1 pack of EC. The control group received education about periconception folate supplementation, but no information about EC. Participants were contacted 7 months after enrollment.

PARTICIPANTS

Four hundred forty-six women recruited from 2 urgent care clinics in San Francisco in 2005.

MEASUREMENTS

Knowledge of EC, use of EC, and self-reported pregnancy.

RESULTS

At follow-up, women in the intervention group answered an average of 2 more questions about EC correctly than they had at baseline, whereas women in the control group answered only 1 more item correctly (2.0 vs 1.2, p < .001). There was a trend toward more use of EC during the study period in the intervention group (10% vs 4% of women followed, p = .06; 6% vs 3%, p = .09 of women enrolled). Fewer women in the intervention group were pregnant at the time of follow-up (0.8% vs 6.5%, p = .01 of women followed; 0.5% vs 4.0%, p = .01 of women enrolled).

CONCLUSIONS

Computer-assisted provision of EC in urgent care waiting areas increased knowledge of EC in a state where EC had been available without a prescription for 3 years.