Health personnel perceptions about emergency contraception in primary health-care centers

Active-learning instruction on emergency contraception counseling

OBJECTIVE

To increase pharmacy students' knowledge of and confidence in counseling patients regarding emergency contraception and to identify any barriers to counseling patients about emergency contraception.

DESIGN

Approximately 200 third-year pharmacy students participated in the Women's Health Therapeutics workshop at Midwestern University Chicago College of Pharmacy. Students observed a 5-minute skit of a counseling session on emergency contraception and then were asked to pair up with a classmate and practice counseling each other regarding the use of emergency contraception following a checklist of key points.

ASSESSMENT

One hundred eighty-nine students completed pre- and post-workshop survey instruments. Students' knowledge scores increased from 86% to 93% (p<0.001). Approximately 25% of the students stated they were confident in counseling patients on emergency contraception before completing the active-learning exercise compared to 58.5% after (p<0.001). The most common barrier to counseling that students identified on the pre- and post-workshop survey was lack of knowledge.

CONCLUSION

Participation in an active-learning exercise significantly increased pharmacy students' knowledge of and confidence in counseling patients regarding emergency contraception and significantly reduced several barriers to counseling identified prior to participation.

Attitudes towards family planning among women seeking induced abortion in Izmir, Turkey

OBJECTIVES

To assess contraceptive knowledge, use of emergency contraception (EC) and the motives of women seeking induced abortion.

METHODS

A descriptive and cross-sectional study conducted at the T. C. Izmir Dr. Hayri Ekrem Ustundag Gynaecology and Maternity Hospital and the Izmir Ataturk Research and Teaching Hospital, Turkey. The research sample consisted of 440 women who requested an abortion between January and May 2010, and voluntarily agreed to participate.

RESULTS

Sixty-two percent of the women became pregnant while using family planning (FP) methods. The contraceptive used by 42% was the condom, and 45% believed that they had become pregnant because of improper use of the contraceptive. Ninety-three percent had never used EC. Thirty-seven percent wanted their pregnancy terminated because they did not want another child, whereas 26% viewed induced abortion as a method of FP. Sixty-nine percent of the women received FP counselling from health professionals, and 80% found the information provided adequate.

CONCLUSION

The women assessed were insufficiently knowledgeable about FP in general and EC in particular. Many had become pregnant as a result of inaccurate information.

Knowledge and attitudes towards emergency contraception of health-care providers in a region with a high birth rate

OBJECTIVE

To assess the knowledge of, attitude towards and practices of emergency contraception among health-care providers at a university hospital located in a region with a high birth rate.

METHODS

The survey was conducted among 214 health-care providers working at a university hospital located in eastern Turkey.

RESULTS

Two hundred participants completed the questionnaire. Of the respondents, 26.0% said that they did not know anything about emergency contraception, while the remaining 74.0% said that they knew about at least one of the methods of emergency contraception. But among these, the knowledge of 38.5% of the participants about emergency contraception was accurate and that of 61.5% was inaccurate. Thirty-four percent of the respondents stated that they had previously required personally to use emergency contraceptive methods. The most commonly used emergency contraceptive methods were oral contraceptives (69.1%) and intrauterine device (14.7%). None of the respondents knew anything about mifepristone and levonorgestrel.

CONCLUSION

There is a knowledge deficit among health-care providers who play a significant role in the dissemination of the information about emergency contraception.

Providers' knowledge of, attitude to and practice of emergency contraception

OBJECTIVES

Barriers to widespread use of hormonal emergency contraceptives (EC), such as lack of knowledge and prejudices held by health-care providers, still exist today. This study was initiated to evaluate the knowledge, attitudes and prejudices of family-planning (FP) providers.

METHODS

This survey was conducted in FP units of primary-health-care centers in Istanbul. A total of 180 providers were interviewed in 80 units to whom a questionnaire was administered by face-to-face technique.

RESULTS

One-hundred and fifty-two of the providers stated that they had heard of EC. The correct timing and dose interval of EC were known by 50% of them. The participants held the belief that EC caused abortion (39.4%), and that it was harmful for the fetus (31.1%). Other prejudices were the possibility of increased unprotected sexual intercourse (78.9%) and a tendency for men to give up condom use (75%); female providers were more prejudiced concerning these statements. The providers' tendency towards the provision of counseling was significantly related to their prejudices (p = 0.011, p = 0.033) and to the application rate (p = 0.000). Conclusion Providers need more detailed information about EC. During FP training courses, the providers should be encouraged towards counseling EC which would increase the application rate of the users and decrease their own prejudices.

Emergency contraception: a review

Emergency contraception (EC), also known as 'the morning after pill', or post-coital contraception, is a modality of preventing the establishment of a pregnancy after unprotected intercourse. Both a hormonal and an intrauterine form are available. Modern hormonal EC, with low side effects, was first proposed by Yuzpe in 1974. More recently, a new regimen, consisting of levonorgestrel administered alone, was introduced and found in clinical trials to be more effective (if taken as early as possible), and associated with less side effects than the Yuzpe regimen, which it has gradually replaced. The WHO developed another regimen based on the use of the selective progesterone receptor modulator (antiprogestin) mifepristone and conducted trials with different dosages. Intrauterine EC was first proposed by Lippes in 1976. It has the advantage of being applicable for almost a week and the disadvantage of a greater complexity. In addition, this modality is solely interceptive, acting by preventing implantation. Pregnancy rates reported following EC using an intrauterine device with more than 300 mm2 of copper are consistently low (0.1-0.2%).

Emergency contraception: knowledge and attitudes of Turkish nursing and midwifery students

OBJECTIVES

To assess the knowledge and attitudes of emergency contraception (EC) among nursing and midwifery students of a university in the Eastern-Mediterranean region of Turkey.

METHODS

The survey was conducted among 210 nursing and midwifery students.

RESULTS

One hundred and twenty-five participants (59.5%) knew at least one method of EC. One hundred and fourteen participants (54.3%) had heard about emergency contraceptive pills (ECPs), but only 17 (8.1%) knew what they contained. Rates of hearing about ECPs were statistically higher in third and fourth classes than first and second classes, and in midwifery students than in nursing students (P < 0.001). In spite of their very unsatisfactory level of knowledge, 166 students (79.0%) thought that ECPs should be sold in pharmacies.

CONCLUSION

The nursing and midwifery students we assessed have a very insufficient knowledge of EC. Probably therefore, many are prejudiced against it. They should be much better acquainted with this modality of contraception since, after graduation, they will play an important role in the dissemination of information about EC in the population.

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.

Access to emergency contraception

The introduction of emergency contraception (EC) has encountered barriers derived from the erroneous perception of EC as an abortificient and conservative attitudes. In several countries, "prolife" groups have initiated lawsuits against national regulatory bodies for approving EC. Other barriers are limited availability and high price of dedicated products, lack of information among providers about EC and the requirement of medical prescription for EC. The availability of EC has increased in the last years due to efforts of multiple stakeholders. Facilitating factors include the acceptability of EC by users and providers; dissemination of information about EC; advocacy among policymakers; training of providers; registration of dedicated products; over the counter sales and inclusion of EC in the national norms. By 2005, 109 countries have registered around 50 dedicated products that are available in public services, pharmacies, NGOs or through social marketing and 45 countries have included EC in their national norms.

Reproductive health, the Arab world and the internet: usage patterns of an Arabic-language emergency contraception web site

Emergency contraception (EC) has the potential to reduce significantly the incidence of unintended pregnancy worldwide. In May 2003, the first Arabic-language web site dedicated to disseminating information about and increasing awareness of EC was launched. This paper examines patterns of web site use and user profiles over a 19-month period. Analysis of use shows that the Arabic web site users are interested in different aspects of EC than the English web site users, suggesting the importance of creating culturally specific content when adapting and translating health education materials. Arabic web site users demonstrate significant interest in general reproductive health issues not specific to EC, suggesting a need for greater availability of Arabic-language health education resources through the Internet.

Do Indonesian medical practitioners approve the availability of emergency contraception over-the-counter? A survey of general practitioners and obstetricians in Jakarta

Background

Few studies have examined the attitude of medical practitioners towards the availability of emergency contraception (EC) without prescription. In Indonesia, EC (either Yuzpe regimen or Postinor-2) is available by prescription only. We aimed to examine the level of knowledge, attitudes and practices of medical practitioners in Indonesia about EC, in particular their attitudes to the availability of EC over-the-counter (OTC), using a questionnaire.

Methods

Data were collected by an anonymous structured questionnaire. Questionnaires were distributed to general practitioners in 36 Community Health Centres and 25 private clinics using stratified random sampling according to area in Jakarta, and to obstetricians practicising in 24 government and private hospitals and eight private clinics in Jakarta. Two hundred and five general practitioners and 142 obstetricians and gynaecologists participated; overall response rate was 75%.

Results

Although most participants were familiar with EC, only 22% received a very good knowledge score (4 or 5/5 answers correct), while 52% received a poor score (0–2/5 correct). Most participants did not support the OTC availability of EC (70%). Logistic regression identified that participants who prescribed EC had an Odds of 3.8 (95% CI 1.90, 7.73) of approving OTC EC, after adjustment for age and speciality.

Conclusion

Although many organisations are working towards OTC availability of EC, it needs to be recognized and addressed that doctors who do not prescribe EC are unlikely to support the increased availability of EC.