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Li RHW, Lo SST, Cameron ST. Hormonal methods for emergency contraception. Best Pract Res Clin Obstet Gynaecol 2024; 97:102550. [PMID: 39243521 DOI: 10.1016/j.bpobgyn.2024.102550] [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: 06/14/2024] [Accepted: 09/02/2024] [Indexed: 09/09/2024]
Abstract
The World Health Organization includes oral emergency contraception (EC) in the list of essential medicines. Ulipristal acetate (UPA) and levonorgestrel (LNG) are the recommended oral methods. UPA has superior efficacy and a comparable side effect profile compared with LNG. Both work by inhibiting or delaying ovulation, so that sperm present in the reproductive tract will have lost their fertilising ability by the time the oocyte is eventually released. Neither LNG nor UPA at the EC doses have significant effects on the endometrium and are unable to prevent implantation. Mifepristone can also be used for EC but its availability is limited to few countries. LNG is less effective in women with a body mass index over 26 kg/m2 or weight over 70 kg. Hormonal contraception can be quickstarted immediately following LNG, or five days following UPA. LNG-releasing intrauterine devices and cyclo-oxygenase inhibitors are promising options for EC to be further studied.
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Affiliation(s)
- Raymond Hang Wun Li
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong; The Family Planning Association of Hong Kong, 10th Floor, 130 Hennessy Road, Wan Chai, Hong Kong.
| | - Sue Seen Tsing Lo
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong; The Family Planning Association of Hong Kong, 10th Floor, 130 Hennessy Road, Wan Chai, Hong Kong.
| | - Sharon Tracey Cameron
- Chalmers Sexual Health Centre, NHS Lothian, 2a Chalmers St, Edinburgh, EH3 9ES, United Kingdom; Centre for Reproductive Health, The University of Edinburgh, Edinburgh BioQuarter, Edinburgh, EH16 4UU, United Kingdom.
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Ahmed Z, Gu Y, Sinha K, Mutowo M, Gauld N, Parkinson B. A qualitative exploration of the over-the-counter availability of oral contraceptive pills in Australia. PLoS One 2024; 19:e0305085. [PMID: 38857242 PMCID: PMC11164330 DOI: 10.1371/journal.pone.0305085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/23/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION The prevention of unintended pregnancy is a public health issue affecting women worldwide. In Australia, women are required to get a prescription to obtain the oral contraceptive pill (OCP), which may limit access and be a barrier to its initiation and continuing use. Changing the availability of the OCP from prescription-only to over-the-counter (OTC) is one solution, however, to ensure success policymakers need to understand women's preferences. Telehealth services also might serve as an alternative to obtain prescriptions and increase accessibility to OCPs. This study aims to explore the preferences for OTC OCPs among Australian women, and whether the expansion of telehealth impacted women's preferences. METHODS A mixed methods approach was used to explore women's preferences regarding access to the OCP. Focus group discussions (FGDs) were conducted to organically identify the preferences followed by an empirical ranking exercise. Three FGDs in two phases were conducted, pre and post-expansion of telehealth in Australia due to the COVID-19 pandemic. Convenience sampling was employed. The technique of constant comparison was used for thematic analysis where transcripts were analysed iteratively, and codes were allowed to emerge during the process to give the best chance for the attributes to develop from the data. RESULTS Thematic analysis revealed that women perceived OTC availability of OCPs as a mechanism to increase the accessibility of contraception by reducing cost, travel time, waiting time, and increasing opening hours. They also believed that it would increase adherence to OCPs. However, some potential safety concerns and logistical issues were raised, including pharmacist training, access to patient's medical history, the ability to discuss other health issues or undertake opportunistic health screening, adherence to checklists, and privacy in the pharmacy environment. Following the expansion of telehealth, accessibility issues such as opening hours, travel time, and location of the facility were considered less important. CONCLUSIONS The participants expressed their support for reclassifying OCPs to OTC, particularly for repeat prescriptions, as it would save valuable resources and time. However, some safety and logistical issues were raised. Women indicated they would balance these concerns with the benefits when deciding to use OTC OCPs. This could be explored using a discrete choice experiment. The expansion of telehealth was perceived to reduce barriers to accessing OCPs. The findings are likely to be informative for policymakers deciding whether to reclassify OCPs to OTC, and the concerns of women that need addressing to ensure the success of any policy change.
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Affiliation(s)
- Zobaida Ahmed
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
- Department of Economics, Macquarie Business School, Macquarie University, Sydney, NSW, Australia
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
- Department of Economics, Macquarie Business School, Macquarie University, Sydney, NSW, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Kompal Sinha
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
- Department of Economics, Macquarie Business School, Macquarie University, Sydney, NSW, Australia
| | - Mutsa Mutowo
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Natalie Gauld
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Bonny Parkinson
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
- Department of Economics, Macquarie Business School, Macquarie University, Sydney, NSW, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Okud A, Zareen H, AlSaif H, Alsayil H, Alrashed M, Alhejji A, BoSaleh M, Almuhaini MA, Ibrahim Ali S. Knowledge, Attitudes, and Practice About Emergency Contraception Among Saudi Women of Childbearing Age of Eastern Region in Saudi Arabia. Cureus 2023; 15:e49737. [PMID: 38161876 PMCID: PMC10757679 DOI: 10.7759/cureus.49737] [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] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background and aim Emergency contraception (EC) refers to methods of contraception that are used within 72 hours up to 120 hours after unprotected intercourse to prevent unintended pregnancy. It can postpone ovulation, stopping fertilization. Ella® (progestin receptor modulator), plan B, birth control tablets, and the copper intrauterine device (IUD) are examples of emergency contraception. The aim of the study is to evaluate knowledge, attitudes, and practices of emergency contraception among Saudi women of childbearing age in the eastern province of Saudi Arabia. Methods It is a descriptive cross-sectional study conducted in the eastern region of Saudi Arabia. Data was collected through a pretested online questionnaire after approval from an ethical committee and women's consent to participate in the study. Women between 18 and 49 years old were included in the study. Women aged under 18 and over 49 years were excluded from the study to make the sample population more homogenous. Participants were provided a link to a questionnaire form to be completed from their devices (phone or laptop). Results A total of 648 childbearing Saudi women completed the survey. The majority were between 18 and 25 years old. Approximately 263 (40.6%) had no children, and 348 (53.7%) earned less than 5,000 SAR monthly. Four hundred and sixty-seven (72%) of the participants had never used emergency contraception. Four hundred and seventy-eight (73.8%) did not know the maximum acceptable time for using EC. Three hundred and fourteen (48.5%) did not know the potential risks to the baby in case of failure of emergency contraception. Two hundred and twenty-three (34%) patricians wrongly believed that there would be a potential risk to the baby if the patient got pregnant after using emergency contraception. Three hundred and eight (47.5%) participants supported the idea of the availability of emergency contraception without a prescription, and a majority believed that they would not feel shy in asking for emergency contraception. Five hundred and seventy-one (88%) participants did not visit any family planning clinic last year. A significant source of EC information was a doctor or a family planner, 206 (31.8%). A considerable barrier to EC use was fear of side effects and health risks, as reported by 382 (59%) respondents. Conclusions The current study reveals that participants have positive attitudes towards emergency contraception, but use is deficient because of poor knowledge and lack of awareness. Our study urges the urgent need for awareness campaigns by health professionals to improve learning and remove wrong fears and beliefs about emergency contraception.
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Affiliation(s)
- Amira Okud
- Department of Obstetrics and Genecology, King Faisal University, Alhasa, SAU
| | - Humaira Zareen
- Department of Obstetrics and Genecology, King Faisal University, Alhasa, SAU
| | - Hajer AlSaif
- College of Medicine, King Faisal University, Alhasa, SAU
| | - Hadeel Alsayil
- College of Medicine, King Faisal University, Alhasa, SAU
| | | | - Aeshah Alhejji
- Otolaryngology - Head and Neck Surgery, King Fahad Specialist Hospital, Khobar, SAU
| | - Maryam BoSaleh
- Collage of Medicine, King Faisal University, Alhasa, SAU
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Pfeifer G, Stockburger M. The morning after: Prescription-free access to emergency contraceptive pills. JOURNAL OF HEALTH ECONOMICS 2023; 91:102775. [PMID: 37451144 DOI: 10.1016/j.jhealeco.2023.102775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 07/18/2023]
Abstract
We analyze the introduction of prescription-free access to morning-after pills-emergency contraceptives that aim to prevent unintended pregnancy and subsequent abortion after unprotected sexual intercourse. Exploiting a staggered difference-in-differences setting for Europe combined with randomization inference, we find sharp increases in sales and manufacturers' revenues of more than 90%. However, whilst not reducing abortions significantly, the policy triggers an unexpected increase in fertility of 4%, particularly among women aged 25-34. We elaborate on mechanisms by looking at within-country evidence from several EU countries, which suggests that fertility is driven by decreasing use of birth control pills in response to easier access to morning-after pills.
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Affiliation(s)
- Gregor Pfeifer
- University of Sydney, School of Economics, Social Sciences Building, NSW 2006, Australia; CESifo, Germany; IZA, Germany
| | - Mirjam Stockburger
- Justus Liebig University Giessen, Economics and Business Studies, Licher Straße 66, 35394 Giessen, Germany.
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Amorim RV, Barbieri MA, Bôtto-Menezes C, Carmona F, Ferraro AA, Bettiol H. Why are pediatricians uncomfortable with prescribing emergency contraception for adolescents? REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2022060. [PMID: 37255109 DOI: 10.1590/1984-0462/2023/41/2022060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/21/2022] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Emergency contraception (EC) is an effective and safe method for preventing unplanned pregnancy after unprotected sexual intercourse among adolescents but is infrequently prescribed by pediatricians. Because of the scarcity of data on the discomfort with EC prescription among physicians in Brazil, this study aimed to identify associated factors with discomfort with EC prescription among pediatricians in the state of Amazonas. METHODS A web-based, cross-sectional study including sociodemographic data, knowledge, attitudes, and discomfort with EC prescription was used. Multivariate logistic regression and artificial intelligence methods such as decision tree and random forest analysis were used to identify factors associated with discomfort with EC prescriptions. RESULTS Among 151 physicians who responded to the survey, 53.0% were uncomfortable with prescribing EC, whereas only 33.1% had already prescribed it. Inexperience was significantly associated with discomfort with EC prescription (odds ratio 4.47, 95% confidence interval 1.71-11.66). Previous EC prescription was protective against discomfort with EC prescription in the three models. CONCLUSIONS EC is still infrequently prescribed by pediatricians because of inexperience and misconceptions. Training these professionals needs to be implemented as part of public health policies to reduce unplanned adolescent pregnancy.
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Affiliation(s)
| | | | - Camila Bôtto-Menezes
- Universidade do Estado do Amazonas, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Fábio Carmona
- Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Doan YP, Lehman EB, Chuang CH. Effect of Neighborhood-Level Income on Access to Emergency Contraception. Contraception 2022; 112:120-123. [PMID: 35247367 DOI: 10.1016/j.contraception.2022.02.006] [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: 10/16/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aim to investigate whether availability of over-the-counter EC varies by neighborhood income level, independent vs chain pharmacies, or urban vs rural pharmacies. STUDY DESIGN We conducted a cross-sectional "mystery shopper" telephone survey in July 2019 to ascertain whether sampled pharmacies stocked EC. Pharmacies located in 12 Pennsylvania counties were randomly sampled after stratification by neighborhood income level. RESULTS Of 200 pharmacies sampled, 195 responded. Only 76% had EC available for same day purchase, which did not differ by neighborhood-level income. The odds that chain pharmacies stocked EC were nearly 10 times the odds that independent pharmacies stocked EC, with 96 out of 105 chain pharmacies versus 52 out of 90 independent pharmacies having EC available for same day purchase (91% vs. 58%; OR 9.50, 95% CI 4.03-22.42). The mean number of barriers (stocking over-the-counter EC behind-the-counter, cost >$40, and requiring identification for purchase) was lower among chain vs. independent pharmacies. Pharmacies in low/moderate income areas (64% vs. 44%, p=0.02) and independent pharmacies (94% vs. 32%, p<0.01) were more likely to keep over-the-counter EC behind-the-counter. Independent pharmacies were more likely to require identification for purchase (29% vs. 59%, p < 0.01). CONCLUSION More than a decade after over-the-counter approval, EC is still not uniformly available at pharmacies in Pennsylvania. Barriers including behind-the-counter stocking and identification requirements disproportionally limit access in low-income neighborhoods and independent pharmacies, threatening equitable access to this contraceptive method.
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Affiliation(s)
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State College of Medicine
| | - Cynthia H Chuang
- Division of General Internal Medicine, Pennsylvania State College of Medicine, Hershey, PA
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Cheung TS, Goldstuck ND, Gebhardt GS. The intrauterine device versus oral hormonal methods as emergency contraceptives: A systematic review of recent comparative studies. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 28:100615. [PMID: 33799166 DOI: 10.1016/j.srhc.2021.100615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 12/01/2022]
Abstract
Oral emergency contraceptives do not appear to be as effective as the copper IUD as an emergency contraceptive. There is as yet no estimation of the relative efficacy rates rather than the failure rates. The references for this study were obtained by entering the terms "intrauterine device" "and "emergency contraception" in Medline, PubMed, Popline, Global Health and ClinicalTrials.gov. Chinese references were obtained from the Wanfang database. For the short term study articles with a defined population who were followed up after the index cycle were eligible. Women who were adequately followed for at least 6 months were included in the long term study. There were 13(of 228) studies which met our selection criteria and were conducted between August 2011 and January 2019. There were 960 insertions of four types of copper IUD with a failure rate of 0.104%. There were 22 failures out of 1453 oral emergency contraception users with a failure rate of 1.51%. The relative risk of failure for an intrauterine device versus an oral method was 0.1376(95% CI -0.03-0.58). The 6 month to 12 month pregnancy rate was 0-6% for IUDs and 2.7-12% for oral methods. The copper IUD appears to be more effective than oral methods as an emergency contraceptive. The 6 to 12 month pregnancy rates after using either method is 4-10%. Emergency contraception is not a solution to unintended pregnancy.
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Affiliation(s)
- Tik Shan Cheung
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Francie van Zyl Dr, Tygerberg Hospital, Bellville, Cape Town 7505, South Africa
| | - Norman D Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Francie van Zyl Dr, Tygerberg Hospital, Bellville, Cape Town 7505, South Africa.
| | - Gabriel S Gebhardt
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Francie van Zyl Dr, Tygerberg Hospital, Bellville, Cape Town 7505, South Africa
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Berglas NF, Kaller S, Mays A, Biggs MA. The Role of Health Care Providers in Young Women's Attitudes about and Willingness to Use Emergency Contraceptive Pills. Womens Health Issues 2021; 31:286-293. [PMID: 33536133 DOI: 10.1016/j.whi.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/16/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Emergency contraceptive pills (ECPs) are an underused resource among adolescent and young adult women who have unprotected sex. This analysis examines young women's attitudes about and willingness to use ECPs, with particular attention to their experiences with health care providers. METHODS Sexually active young women (ages 15-25, assigned female at birth, N = 212) completed a self-administered survey at 10 family planning clinics in the San Francisco Bay Area. Participants reported attitudes about ECP effectiveness, safety, effect on sex drive, and whether it should not be taken often, and their willingness to use ECPs in the next 3 months. The predictors of interest were past and current contraceptive experiences with health care providers. Data were analyzed through descriptive statistics and multivariable logistic regression analyses controlling for sociodemographic characteristics, prior contraceptive use, pregnancy history, and pregnancy intentions. RESULTS Most young women agreed that ECPs are effective at preventing pregnancy (75%) and safe to use (71%); few reported that they reduce sex drive (11%). Yet, the majority (62%) believed ECPs should not be taken often and only 35% reported willingness to use ECPs. In multivariable analyses, more positive health care experiences were associated with more positive attitudes about ECP safety, less concern that ECPs should not be taken often, and greater willingness to use ECPs (p < .05). CONCLUSIONS Health care providers play an important role in the acceptance and provision of ECPs, especially for young women who prefer ECPs over other contraceptive methods. In particular, providers can use the contraceptive visit as an opportunity to destigmatize repeat ECP use.
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Affiliation(s)
- Nancy F Berglas
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California.
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
| | - Aisha Mays
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
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Shukla P, Pullabhotla HK, Arends-Kuenning M. Choosing Plan B Over Plan A: Risk Compensation Theory and Contraceptive Choice in India. Demography 2021; 58:273-294. [PMID: 33834245 DOI: 10.1215/00703370-8932007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Can women's contraceptive method choice be better understood through risk compensation theory? This theory implies that people act with greater care when the perceived risk of an activity is higher and with less care when it is lower. We examine how increased over-the-counter access to emergency contraceptive pills (ECPs) accompanied by marketing campaigns in India affected women's contraceptive method choices and incidence of sexually transmitted infections (STIs). Although ECPs substantially reduce the risk of pregnancy, they are less effective than other contraceptive methods and do not reduce the risk of STIs. We test whether an exogenous policy change that increased access to ECPs leads people to substitute away from other methods of contraception, such as condoms, thereby increasing the risk of both unintended pregnancy and STIs. We find evidence for risk compensation in terms of reduced use of condoms but not for increases in rates of STIs.
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Affiliation(s)
- Pallavi Shukla
- Department of Environmental Health and Engineering, a joint department of the Bloomberg School of Public Health and the Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Mary Arends-Kuenning
- Agricultural and Consumer Economics Department, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Turnbull G, Scott RH, Mann S, Wellings K. Accessing emergency contraception pills from pharmacies: the experience of young women in London. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:27-31. [PMID: 32576555 DOI: 10.1136/bmjsrh-2019-200339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Over-the-counter provision of emergency contraception pills (ECP) has increased since deregulation of progestogen-only formulations and is now the most common public health service provided by UK pharmacists. Important questions relate to women's perceptions of their experience of receiving ECPs from pharmacists. METHODS Qualitative study: in-depth interviews with young women reporting ECP use, recruited from clinic (10); pharmacy (6) and community settings (5) in London. RESULTS Key advantages of pharmacy provision were ease and speed of access and convenience. Disadvantages included a less personal service, inadequate attention to information needs and to prevention of recurrence of ECP need, and unsupportive attitudes of pharmacy staff. Suggested service improvements included increasing privacy, providing more contraceptive advice, adopting a more empathetic approach and signposting follow-up services. CONCLUSION Pharmacies are important in the choice of settings from which ECPs can be obtained and many aspects of pharmacy provision are appreciated by young women. There is scope to further enhance pharmacists' role.
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Affiliation(s)
| | - Rachel H Scott
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Sue Mann
- Reproductive Health, Public Health England, London, UK
| | - Kaye Wellings
- London School of Hygiene and Tropical Medicine, London, UK
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Cegolon L, Bortolotto M, Bellizzi S, Cegolon A, Mastrangelo G, Xodo C. Birth control knowledge among freshmen of four Italian universities. Sci Rep 2020; 10:16466. [PMID: 33020531 PMCID: PMC7536290 DOI: 10.1038/s41598-020-72200-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022] Open
Abstract
Since sexual health education (SHE) is not mandatory in Italian schools, we conducted a survey on freshmen of four Italian university campuses in 2012 to investigate the respective level of sexual health knowledge (SHK) in relation to birth control, with the aim to inform public health policy makers. A convenience strategy was employed to sample 4,552 freshmen registered with various undergraduate courses at four Italian universities: Padua university (Veneto Region); university of Milan (Lombardy Region); university of Bergamo (Lombardy Region); university of Palermo (Sicily Region). We investigated the level of SHK on birth control using 6 proxy indicators: (1) the average length of a woman’s period [outcome with 3 levels: wrong (base) vs. acceptable vs. correct]; (2) the most fertile interval within a woman’s period (binary outcome: correct vs. wrong answer); (3) the event between the end of a period and the beginning of the next cycle (binary outcome: correct vs. wrong answer); (4) the average survival of spermatozoa in the womb (binary outcome: correct vs. wrong answer); (5) the concept of contraception (binary outcome: correct vs. wrong answer); (6) the efficacy of various contraceptives to prevent unintended pregnancies (linear score: 0–17). We fitted 6 separate models of multiple regression: multinomial for outcome 1; logistic for outcomes 2, 3, 4, 6; linear for outcome 6. Statistical estimates were adjusted for a number of socio-demographic factors. Results were expressed as odds ratios (OR) for the 4 multiple logistic regression models, linear coefficients (RC) for the linear regression model and relative risk ratio (RRR) for the multinomial logistic regression model. The level of significance of each risk estimate was set at 0.05. The level of SHK of freshmen sampled was rather low, as 60% interviewees did not know the average length of a woman’s period, the average survival of spermatozoa in the womb and the concept of contraception, whilst the most fertile interval within a woman’s period was known only to 55% of interviewees. The mean score of SHK on the efficacy of various contraceptive methods was only 5 (scale 0–17). Some categories of students were consistently and significantly less knowledgeable on birth control at multivariable analysis: males; students from the university of Palermo; those with vocational secondary school education and those not in a romantic relationship at the time the survey was conducted. The results of this survey clearly call for the introduction of SHE programs in Italian schools, as already done in several European countries. School SHE should start as early as possible, ideally even before secondary school. SHE should be holistic and delivered with a multiple agency coordinated approach involving the Ministry of Health, the Ministry of Education, University and Scientific Research (MIUR), families, schools, public health departments, primary health care providers, pharmacists, media, other.
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Affiliation(s)
- L Cegolon
- Public Health Department, Local Health Unit N.2 "Marca Trevigiana", Treviso, Italy.
| | - M Bortolotto
- FISPPA Department, Padua University, Padua, Italy
| | - S Bellizzi
- Medical Epidemiologist, Independent Consultant, Geneva, Switzerland
| | - A Cegolon
- Department of Political Sciences, Communication and International Relations, University of Macerata, Macerata, Italy
| | - G Mastrangelo
- Department of Cardiac, Thoracic & Vascular Sciences and Public Health, Padua University, Padua, Italy
| | - C Xodo
- FISPPA Department, Padua University, Padua, Italy
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Paton D, Bullivant S, Soto J. The impact of sex education mandates on teenage pregnancy: International evidence. HEALTH ECONOMICS 2020; 29:790-807. [PMID: 32329952 DOI: 10.1002/hec.4021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/12/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
To date most studies of the impact of school-based sex education have focused either on specific, local interventions or experiences at a national level. In this paper, we use a new cross-country dataset to explore the extent to which laws on sex education affect teenage pregnancy rates in developed countries. We find some evidence that laws mandating sex education in schools are associated with higher rates of teenage fertility. Parental opt out laws may minimise adverse effects of sex education mandates for younger teens. The estimated effects of mandatory sex education are robust to some but not all of our specifications designed to tease out causality. Taken together, changes in national laws relating to sexual health are unable to explain the significant declines in teenage pregnancy rates, which have been observed in many developed countries in recent years.
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Affiliation(s)
- David Paton
- Nottingham University Business School, Jubilee Campus, Nottingham, UK
| | | | - Juan Soto
- Theology, St Mary's University, Twickenham, UK
- Fundación Civismo, Madrid, Spain
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Said A, Ganso M, Freudewald L, Schulz M. Trends in dispensing oral emergency contraceptives and safety issues: a survey of German community pharmacists. Int J Clin Pharm 2019; 41:1499-1506. [DOI: 10.1007/s11096-019-00911-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/12/2019] [Indexed: 12/01/2022]
Abstract
Abstract
Background Oral emergency contraceptives containing levonorgestrel or ulipristal acetate are available without prescription and only in pharmacies in Germany since March 2015. Due to this change community pharmacists are responsible for evaluating whether the product is appropriate and to educate women on proper use. Objective To measure the utilization of emergency contraceptives without a prescription and describe potential concerns and safety issues identified by community pharmacists in Germany. Setting The Drug Commission of German Pharmacists' nationwide network of reference pharmacies which includes 860 community pharmacies. Methods Reference community pharmacies were asked to participate in the eleven-questions online survey. Respondents were asked to recall their experiences with oral emergency contraceptives in the past 3 months. Data were collected between January 8 and February 19, 2018. Main outcome measure The survey focused on the utilization of emergency contraceptives without a prescription in Germany, and on the pharmacists’ experiences with (potential) problems and concerns regarding safe use. Results In total, 555 community pharmacies (64.5%) participated. Overall 38.2% of community pharmacists stated they dispensed six to ten courses of emergency contraceptives within the past 3 months. In addition, 54.3% of the pharmacists estimated they dispensed emergency contraceptives exclusively without prescription and 35.9% dispensed more than 30% of emergency contraceptives during night-time and emergency services. Moreover, 82.8% of pharmacists stated that emergency contraceptives were requested not by the women concerned but a third person and 44.3% identified uncertainties in woman's self-diagnosis. Three out of four pharmacists had concerns about the effective and safe use of emergency contraceptives. In situations suggesting sexually transmitted diseases, or suspicion for use of force, 59.5% and 55.8% of the pharmacists, respectively, dispensed emergency contraceptives. In cases of acute health impairment or chronic disease, or (potentially) relevant drug/drug interaction, the vast majority (91.0% and 90.5%) did not. Here, most pharmacists referred to gynecologists. Conclusion Pharmacists had safety concerns when dispensing emergency contraceptives. Professional expertise in evaluating the need for oral emergency contraceptives and the proper use is needed.
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Lete I, Doval JL, Pérez-Campos E, Alonso MJ, Sellers G, Sánchez-Borrego R. Prevention of unintended pregnancies by using emergency contraception: the differences between levonorgestrel and ulipristal acetate. A theoretical model using data from a survey on the use of emergency contraception in Spain, 2017. Gynecol Endocrinol 2019; 35:582-585. [PMID: 30614295 DOI: 10.1080/09513590.2018.1559286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To estimate the differences in unintended pregnancies avoided using either levonorgestrel (LNG) or ulipristal acetate (UPA) emergency contraception (EC). Design: Cross-sectional study. Setting: Survey carried out in Spain. Participants: 1000 Spanish women reporting unprotected sex in 2017. Main measurements: EC use, reasons for not using EC, calculation of the number of unintended pregnancies avoided. Results: 39% of Spanish women having had unprotected sex used EC. 61% of those women did not use EC and 11% did not know the existence of this resource. In 2017 the use of EC prevented 101,271 unintended pregnancies. If instead of using LNG every woman had used UPA another 15,979 additional pregnancies could have been prevented. Conclusions: If all Spanish women having unprotected sex used EC we could expect a significant decrease in the number of unintended pregnancies and abortions. Using UPA instead of LNG would have a greater impact on that reduction with the corresponding benefit for women and society as a whole.
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Affiliation(s)
- Iñaki Lete
- a Faculty of Medicine, University of the Basque Country, Obstetrics and Gynaecology Clinical Management Unit , Araba University Hospital , Vitoria , Spain
| | - José Luis Doval
- b Obstetrics and Gynaecology Department , Ourense Hospital Complex , Ourense , Spain
| | - Ezequiel Pérez-Campos
- c Obstetrics and Gynaecology Department , Associate University Hospital of Requena , Requena , Spain
| | - María Jesús Alonso
- d Sexual Orientation Centre for Young People, Andalusian Health Service , Malaga , Spain
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Bauzà ML, Esteva M, Molina J, Pereiró I, Ingla M, March S. Emergency contraception and risk habits in a university population. EUR J CONTRACEP REPR 2018; 23:427-433. [PMID: 30499726 DOI: 10.1080/13625187.2018.1533547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of our study was to determine the self-reported prevalence of use of emergency contraception (EC), identify factors associated with EC use, and measure the prevalence in university students of pregnancy and abortion among users and non-users of EC. METHODS A cross-sectional descriptive study of university students using a self-administered questionnaire was carried out in 2016. The main dependent variable was EC use at any time. Independent variables included sociodemographic factors and factors related to harmful habits and sexual behaviour. RESULTS The study sample consisted of 1309 students (median age 20 years). Forty per cent of participants reported using EC; condom failure was given as the main reason. Variables associated with EC use in both men and women were illegal drug consumption and having had more than 10 sexual partners. In women, other factors associated with EC use were age at first coitus and non-centrist political views. The prevalence of pregnancy was 6.5% and the prevalence of voluntary abortion was 2.9%. This prevalence was similar for men and women and for EC users and non-users. CONCLUSION EC use in university students was more likely in those who experienced contraceptive failure or used no contraception. There were differences between men and women. Those at higher risk of unplanned pregnancy were more likely to report EC use, which may explain why there was no difference in the rates of unwanted pregnancies between EC users and non-users.
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Affiliation(s)
- M L Bauzà
- a Department of Nursing and Physiotherapy , University of the Balearic Islands , Palma , Spain.,b Research Group of Balearic Islands - Cancer Preventive Activities , University Institute of Research in Health Sciences (IUNICS) , Palma , Spain
| | - M Esteva
- c Unit for Research , Primary Health Care Management , Palma , Spain.,d Balearic Islands Health Research Institute (iDisBA) , Palma , Spain
| | - J Molina
- a Department of Nursing and Physiotherapy , University of the Balearic Islands , Palma , Spain
| | - I Pereiró
- e Puerto de Sagunto II Health Centre , Primary Health Care Management , Valencia , Spain
| | - M Ingla
- f Health Promotion Agency , Palma , Spain
| | - S March
- c Unit for Research , Primary Health Care Management , Palma , Spain.,d Balearic Islands Health Research Institute (iDisBA) , Palma , Spain
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Bauzà ML, Esteva M, Molina J, Pereiró I, Ingla M, March S. Emergency contraception and risk habits in a university population. EUR J CONTRACEP REPR 2018. [DOI: https://doi.org/10.1080/13625187.2018.1533547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M. L. Bauzà
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Spain
- Research Group of Balearic Islands – Cancer Preventive Activities, University Institute of Research in Health Sciences (IUNICS), Palma, Spain
| | - M. Esteva
- Unit for Research, Primary Health Care Management, Palma, Spain
- Balearic Islands Health Research Institute (iDisBA), Palma, Spain
| | - J. Molina
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Spain
| | - I. Pereiró
- Puerto de Sagunto II Health Centre, Primary Health Care Management, Valencia, Spain
| | - M. Ingla
- Health Promotion Agency, Palma, Spain
| | - S. March
- Unit for Research, Primary Health Care Management, Palma, Spain
- Balearic Islands Health Research Institute (iDisBA), Palma, Spain
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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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Haeger KO, Lamme J, Cleland K. State of emergency contraception in the U.S., 2018. Contracept Reprod Med 2018; 3:20. [PMID: 30202545 PMCID: PMC6123910 DOI: 10.1186/s40834-018-0067-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/20/2018] [Indexed: 12/30/2022] Open
Abstract
Emergency contraception is indicated in instances of unprotected sexual intercourse, including reproductive coercion, sexual assault, and contraceptive failure. It plays a role in averting unintended pregnancies due to inconsistent use or non-use of contraception. Options for emergency contraception vary by efficacy as well as accessibility within the U.S. This paper provides an overview of levonorgestrel (Plan B One-Step and generic counterparts), ulipristal acetate (sold as ella), and the copper intrauterine device (IUD, sold as ParaGard), including the mechanisms of action, administration, efficacy, drug interactions, safety, side effects, advantages, and drawbacks. It will also review current misconceptions about emergency contraception and access for subpopulations, including adolescents, immigrants, survivors of sexual assault, rural populations, and military/veteran women. This paper will address barriers such as gaps in knowledge, and financial, health systems, and practice barriers. Continuing areas of research, including the impact of body weight on the efficacy of emergency contraceptive pills and potential interactions between ulipristal acetate and ongoing hormonal contraceptives, are also addressed.
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Affiliation(s)
- Kristin O. Haeger
- Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Women’s Health Services, 810 Vermont Ave., NW, Washington, DC, 20420 USA
| | - Jacqueline Lamme
- Department of Obstetrics & Gynecology, U.S. Naval Hospital Okinawa, Okinawa, Japan
| | - Kelly Cleland
- Office of Population Research, Princeton University, 218 Wallace Hall, Princeton, NJ 08544 USA
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Abstract
PURPOSE OF REVIEW Emergency contraception provides a critical and time-sensitive opportunity for women to prevent undesired pregnancy after intercourse. Both access and available options for emergency contraception have changed over the last several years. RECENT FINDINGS Emergency contraceptive pills can be less effective in obese women. The maximum achieved serum concentration of levonorgestrel (LNG) is lower in obese women than women of normal BMI, and doubling the dose of LNG (3 mg) increases its concentration maximum, approximating the level in normal BMI women receiving one dose of LNG. Repeated use of both LNG and ulipristal acetate (UPA) is well tolerated. Hormonal contraception can be immediately started following LNG use, but should be delayed for 5 days after UPA use to avoid dampening the efficacy of UPA. The copper intrauterine device (IUD) is the only IUD approved for emergency contraception (and the most effective method of emergency contraception), but use of LNG IUD as emergency contraception is currently being investigated. Accurate knowledge about emergency contraception remains low both for patients and healthcare providers. SUMMARY Emergency contraception is an important yet underutilized tool available to women to prevent pregnancy. Current options including copper IUD and emergency contraceptive pills are safe and well tolerated. Significant gaps in knowledge of emergency contraception on both the provider and user level exist, as do barriers to expedient access of emergency contraception.
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Cintina I. Behind-the-Counter, but Over-the-Border? The Assessment of the Geographical Spillover Effects of Emergency Contraception on Abortions. HEALTH ECONOMICS 2017; 26:1249-1263. [PMID: 27539681 DOI: 10.1002/hec.3394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 04/28/2016] [Accepted: 07/11/2016] [Indexed: 06/06/2023]
Abstract
Washington was the first state to ease the prescription requirements making emergency contraception (EC) available behind-the-counter at pharmacies to women of any age in 1998. Using county-level vital statistics data in conjunction with the pharmacy specific location data from the Not-2-Late Hotline database, I study whether the increased access to EC affects fertility rates within the state and beyond the borders of the state that allows it. Unlike other studies that rely on geographic variations in access, I show that increased availability of EC in Washington, measured by the distance to the closest 'no-prescription EC pharmacy', is associated with a statistically significant albeit economically moderate decrease in abortion rates in Washington counties where women had access to 'no-prescription EC'. These effects are localized (i.e., decrease with travel distance) and robust in a number of specifications. Finally, I find some evidence in support of geographical spillover effects in Idaho, but not in Oregon. However, after accounting for the availability of abortion services, the decrease in 'treated' Idaho counties is rather small. Copyright © 2016 John Wiley & Sons, Ltd.
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Sanders JN, Turok DK, Royer PA, Thompson IS, Gawron LM, Storck KE. One-year continuation of copper or levonorgestrel intrauterine devices initiated at the time of emergency contraception. Contraception 2017; 96:99-105. [PMID: 28596121 PMCID: PMC6040824 DOI: 10.1016/j.contraception.2017.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE(S) This study compares 1-year intrauterine device (IUD) continuation among women presenting for emergency contraception (EC) and initiating the copper (Cu T380A) IUD or the levonorgestrel (LNG) 52 mg IUD plus 1.5 mg oral LNG. STUDY DESIGN This cohort study enrolled 188 women who presented at a single family planning clinic in Utah between June 2013 and September 2014 and selected either the Cu T380A IUD or LNG 52 mg IUD plus oral LNG for EC. Trained personnel followed participants by phone, text or e-mail for 12 months or until discontinuation occurred. We assessed reasons for discontinuation and used Cox proportional hazard models, Kaplan-Meier estimates and log-rank tests to assess differences in continuation rates between IUDs. RESULTS One hundred seventy-six women received IUDs; 66 (37%) chose the Cu T380A IUD and 110 (63%) chose the LNG 52 mg IUD plus oral LNG. At 1 year, we accounted for 147 (84%) participants, 33 (22%) had requested removals, 13 (9%) had an expulsion and declined reinsertion, 3 (2%) had a pregnancy with their IUD in place and 98 (67%) were still using their device. Continuation rates did not differ by IUD type; 60% of Cu T380A IUD users and 70% of LNG 52 mg IUD plus oral LNG users were still using their device at 12 months (adjusted hazard ratio 0.72, 95% confidence interval 0.40-1.3). CONCLUSION(S) Two-thirds of women who chose IUD placement at the EC clinical encounter continued use at 1 year. Women initiating Cu T380A IUD and LNG 52 mg IUD had similar 1-year continuation rates. These findings support same-day insertion of IUDs for women who are seeking EC and would like to use a highly effective reversible method going forward. IMPLICATIONS Providing IUD options for EC users presents an opportunity to increase availability of highly effective contraception.
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Affiliation(s)
- J N Sanders
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209, USA.
| | - D K Turok
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209, USA
| | - P A Royer
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209, USA
| | - I S Thompson
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209, USA
| | - L M Gawron
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209, USA
| | - K E Storck
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209, USA
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Han L, Saavedra-Avendano B, Lambert W, Fu R, Rodriguez MI, Edelman A, Darney B. Emergency Contraception in Mexico: Trends in Knowledge and Ever-Use 2006–2014. Matern Child Health J 2017; 21:2132-2139. [DOI: 10.1007/s10995-017-2328-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Paton D, Wright L. The effect of spending cuts on teen pregnancy. JOURNAL OF HEALTH ECONOMICS 2017; 54:135-146. [PMID: 28558295 DOI: 10.1016/j.jhealeco.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 04/27/2017] [Accepted: 05/15/2017] [Indexed: 06/07/2023]
Abstract
In recent years, English local authorities have been forced to make significant cuts to devolved expenditure. In this paper, we examine the impact of reductions in local expenditure on one particular public health target: reducing rates of teen pregnancy. Contrary to predictions made at the time of the cuts, panel data estimates provide no evidence that areas which reduced expenditure the most have experienced relative increases in teenage pregnancy rates. Rather, expenditure cuts are associated with small reductions in teen pregnancy rates, a result which is robust to a number of alternative specifications and tests for causality. Underlying socio-economic factors such as education outcomes and alcohol consumption are found to be significant predictors of teen pregnancy.
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Affiliation(s)
- David Paton
- Nottingham University Business School, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, United Kingdom.
| | - Liam Wright
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield, S1 4DA, United Kingdom.
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Ajayi AI, Nwokocha EE, Adeniyi OV, Ter Goon D, Akpan W. Unplanned pregnancy-risks and use of emergency contraception: a survey of two Nigerian Universities. BMC Health Serv Res 2017; 17:382. [PMID: 28577526 PMCID: PMC5455101 DOI: 10.1186/s12913-017-2328-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The vulnerabilities of young women of low socio-economic status and those with little or no formal education tend to dominate the discourse on unplanned pregnancy, unsafe abortion and emergency contraception (EC) in sub-Saharan Africa. This article draws on a survey conducted among female undergraduate students to shed light on sexual behaviour and the dynamics of emergency contraceptive use among this cohort. METHODS The survey involved 420 female undergraduate students drawn using a multistage sampling technique, while a self-administered questionnaire was used for data collection. Univariate and bivariate analyses were applied to examine the factors associated with the use of emergency contraception. RESULTS Of the 176 female students who reported being sexually active in the year preceding the survey, only 38.6% reported the use of condom during the entire year. Of those who reported unplanned pregnancy anxiety n = 94, about 30.1% used EC, 20.4% used non-EC pills as EC, while others reported having used no EC. A few respondents (n = 3) had terminated a pregnancy under unsafe conditions. Awareness of EC (p < 0.001), knowledge of timing of EC (p = 0.001), perceived risk of unplanned pregnancy (p < 0.001), and level of study (p = 0.013), were significantly correlated with the use of EC. CONCLUSION The study revealed that educated youths engaged in high-risk sexual activities and also, sought recourse to unproven and unsafe contraceptive methods. Poor knowledge of EC methods and timing of use, as well as wrong perception about EC side effects, are barriers to the utilisation of EC for the prevention of unplanned pregnancy among the study participants.
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Affiliation(s)
- Anthony Idowu Ajayi
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, 50, Church Street, East London, 5201, South Africa.
| | | | - Oladele Vincent Adeniyi
- Department of Family Medicine & Rural Health, Walter Sisulu University/Cecilia Makiwane Hospital, East London, South Africa
| | - Daniel Ter Goon
- Department of Nursing Sciences, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Wilson Akpan
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, East London, South Africa
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Wise A, Geronimus A, Smock P. The Best of Intentions: A Structural Analysis of the Association between Socioeconomic Disadvantage and Unintended Pregnancy in a Sample of Mothers from the National Longitudinal Survey of Youth (1979). Womens Health Issues 2017; 27:5-13. [PMID: 27913056 PMCID: PMC5219931 DOI: 10.1016/j.whi.2016.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 10/16/2016] [Accepted: 10/21/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Births to less educated women are more likely to be classified as unintended than other births. We question a common interpretation that this association reflects a lack of contraceptive knowledge or self-efficacy among less educated women. We theorize that differences in early life educational advantages structure pregnancy desires and the salience and opportunity costs of precise fertility timing. We hypothesize that net of covariates indicative of early educational disadvantage, mothers with less education are not more likely to report births as unintended compared with mothers who have attained higher levels of education before becoming mothers. METHODS Using multivariate regression, we analyze a sample of women in the National Longitudinal Survey of Youth (1979) who had their first births by 1994. We test whether an index measure of educational advantage in youth predicts unintended first birth. RESULTS Unadjusted results confirm well-documented associations between educational disadvantage and greater likelihood of unintended pregnancy. However, once covariates are controlled, those with high educational advantage in youth are more likely to report their first birth as mistimed (relative risk ratio, 1.57). DISCUSSION Educational advantage captures expectations about how much education a young woman will obtain before giving birth and is a structural dynamic that precedes proximate factors related to family planning access and behaviors. CONCLUSIONS These findings highlight the need to incorporate structural factors that condition perceptions of pregnancy intention in the study of unintended pregnancy and to critically reevaluate the conceptualization and interpretation of pregnancy intention measures.
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Affiliation(s)
- Akilah Wise
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109,
| | - Arline Geronimus
- University of Michigan, Population Studies Center, 426 Thompson Street, Ann Arbor, MI 48108,
| | - Pamela Smock
- University of Michigan, Population Studies Center, 426 Thompson Street, Ann Arbor, MI 48108,
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Sexual and Contraceptive Behaviors among Adolescents Requesting Emergency Contraception. J Pediatr Adolesc Gynecol 2016; 29:643-647. [PMID: 27321899 DOI: 10.1016/j.jpag.2016.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/29/2016] [Accepted: 06/08/2016] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE AND DESIGN Unintended pregnancy rates in the United States remain high among adolescents. Emergency contraception (EC) provides the only option for pregnancy prevention after unprotected sex. To better define the population of adolescents who request and use EC pills, we performed a post hoc analysis of an over-the-counter simulation study of EC pills. SETTING Teen reproductive health clinics in 5 cities. PARTICIPANTS Adolescents between the ages of 13 and 17 years who requested EC. INTERVENTIONS Single-tablet levonorgestrel 1.5 mg. MAIN OUTCOME MEASURES We calculated the correlations between age and baseline sexual and contraceptive behaviors. χ2 Tests were used to compare behaviors of first-time and repeat EC users. RESULTS Overall, the most commonly reported contraceptive methods ever used were condoms, oral contraceptives, none, and withdrawal; the most common method ever used in each age group was no method for 13- to 14-year-olds and condom for 15-, 16-, and 17-year-olds. The percentage of participants who had never used contraception before requesting EC decreased with age (53% [20/28] of 13- to 14-year-olds vs 15% [10/65] of 17-year-olds). First-time EC users were more likely to report no previous contraceptive use compared with repeat EC users (42% [88/208] vs 10% [13/135]; P < .001). Regardless of age, the most commonly reported reason for requesting EC was nonuse of any contraceptive method (ie, "unprotected sex"). CONCLUSION Adolescents who requested EC most commonly reported ever-use of contraceptive methods that rely on user adherence or no method at all, with younger adolescents more likely than older adolescents to have used no previous method. The provision of EC presents an opportunity to provide education and access to highly effective, long-term contraceptive methods.
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Seetharaman S, Yen S, Ammerman SD. Improving adolescent knowledge of emergency contraception: challenges and solutions. Open Access J Contracept 2016; 7:161-173. [PMID: 29386948 PMCID: PMC5683156 DOI: 10.2147/oajc.s97075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Globally, unintended adolescent pregnancies pose a significant burden. One of the most important tools that can help prevent unintended pregnancy is the timely use of emergency contraception (EC), which in turn will decrease the need for abortions and complications related to adolescent pregnancies. Indications for the use of EC include unprotected sexual intercourse, contraceptive failure, or sexual assault. Use of EC is recommended within 120 hours, though is most effective if used as soon as possible after unprotected sex. To use EC, adolescents need to be equipped with knowledge about the various EC methods, and how and where EC can be accessed. Great variability in the knowledge and use of EC around the world exists, which is a major barrier to its use. The aims of this paper were to 1) provide a brief overview of EC, 2) discuss key social determinants affecting knowledge and use of EC, and 3) explore best practices for overcoming the barriers of lack of knowledge, use, and access of EC.
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Affiliation(s)
- Sujatha Seetharaman
- Division of Adolescent Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | - Sophia Yen
- Division of Adolescent Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | - Seth D Ammerman
- Division of Adolescent Medicine, Stanford University Medical Center, Palo Alto, CA, USA
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Ajayi AI, Nwokocha EE, Akpan W, Adeniyi OV. Use of non-emergency contraceptive pills and concoctions as emergency contraception among Nigerian University students: results of a qualitative study. BMC Public Health 2016; 16:1046. [PMID: 27716213 PMCID: PMC5050919 DOI: 10.1186/s12889-016-3707-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/23/2016] [Indexed: 12/02/2022] Open
Abstract
Background Emergency contraception (EC) can significantly reduce the rate of unintended pregnancies and unsafe abortions especially in sub-Saharan Africa. Despite the increasing awareness of EC among educated young women in Nigeria, the rate of utilisation remains low. This study therefore explores the main barriers to the use of EC among female university students by analysing their knowledge of emergency contraception, methods ever used, perceived efficacy, and its acceptability. Methods This paper brings together the findings from several focus groups (N = 5) and in-depth interviews (N = 20) conducted amongst unmarried female undergraduate students in two Nigerian universities. Results Participants considered the use of condom and abstinence as the most effective methods of preventing unplanned pregnancy. However, many participants were misinformed about emergency contraception. Generally, participants relied on unconventional and unproven ECs; Ampiclox, “Alabukun”, salt water solution, and lime and potash and perceived them to be effective in preventing unplanned pregnancies. Furthermore, respondents’ narratives about methods of preventing unwanted pregnancies revealed that inadequate information on emergency contraception, reliance on unproven crude contraceptive methods, and misconception about modern contraception constitute barriers to the use of emergency contraception. Conclusions The findings suggested that female university students are misinformed about emergency contraception and their reliance on unproven ECs constitutes a barrier to the use of approved EC methods. These barriers have serious implications for prevention of unplanned pregnancies in the cohort. Behavioural interventions targeting the use of unproven emergency contraceptive methods and misperceptions about ECs would be crucial for this cohort in Nigeria.
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Affiliation(s)
- Anthony Idowu Ajayi
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, East London, South Africa.
| | | | - Wilson Akpan
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, East London, South Africa
| | - Oladele Vincent Adeniyi
- Department of Family Medicine, Walter Sisulu University, Cecilia Makiwane Hospital, East London Hospital Complex, East London, South Africa
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Osa-Izeko O, Govender RD, Ross AJ. Self-reported knowledge and use of emergency contraception among women presenting for termination of pregnancy. S Afr Fam Pract (2004) 2016. [DOI: 10.1080/20786190.2016.1223797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Moreau C, Bohet A. Frequency and correlates of unintended pregnancy risk perceptions. Contraception 2016; 94:152-9. [DOI: 10.1016/j.contraception.2016.02.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/26/2016] [Accepted: 02/28/2016] [Indexed: 11/17/2022]
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Saxena P, Mishra A, Nigam A. Evaluation of Pharmacists' Services for Dispensing Emergency Contraceptive Pills in Delhi, India: A Mystery Shopper Study. Indian J Community Med 2016; 41:198-202. [PMID: 27385872 PMCID: PMC4919932 DOI: 10.4103/0970-0218.183595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Although emergency contraceptive pills are available over the counter, the quality of consultation, including key areas of contraceptive counseling and prevention of sexually transmitted infections (STI), has not been well documented. Objective: To evaluate actual pharmacist services while dispensing emergency contraception through a mystery shopper technique. Material and Methods: This cross-sectional study was conducted in 81 pharmacies situated in Delhi by 4 trained mystery shoppers posed as customers over a period of 6 months. Results: None of the pharmacists asked about the time lapsed since last unprotected sexual intercourse or last menstrual period before deciding the eligibility of the customer. The majority were unclear about side effects associated with emergency contraception (78.57%) or with anticipated changes in menstrual flow (78.57%); 85.71% did not know whether subsequent unprotected intercourse would be protected. Only 15.71% counseled shoppers regarding risk of STI on asking leading questions and 88.5% did not provide any contraceptive advice. Conclusion: There is a huge gap in the technical knowledge and mindset of the pharmacists when it comes to checking for the eligibility of the client and providing advice regarding use of regular contraception and barrier for protection from STI, which needs to be addressed in order to realize the full benefit of making emergency contraceptive pills available over the counter.
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Affiliation(s)
- Pikee Saxena
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College and SSKM, New Delhi, India
| | - Archana Mishra
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Aruna Nigam
- Hamdard Institute of Medical Sciences and Research, New Delhi, India
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Chin-Quee DS, Stanback J, Graham V. In support of community-based emergency contraception. Contraception 2016; 94:1-5. [DOI: 10.1016/j.contraception.2016.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 12/30/2022]
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Thapa S. A new wave in the quiet revolution in contraceptive use in Nepal: the rise of emergency contraception. Reprod Health 2016; 13:49. [PMID: 27141949 PMCID: PMC4855319 DOI: 10.1186/s12978-016-0155-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/25/2016] [Indexed: 12/04/2022] Open
Abstract
Background In Nepal, while the use of the emergency contraceptive pill (ECP) has been increasing rapidly in recent years, very little is known about the profile of ECP users. This study assesses the increasing role of ECP and the profile of ECP users in Nepal. Some policy and programmatic concerns are also addressed. Methods Survey interviews were undertaken involving 185 women who visited five metropolitan medical shops located in Pokhara seeking to purchase ECP for their own use. Descriptive statistics were calculated for data analysis. Results ECP is popular among young (<25 years old) and educated women. Also, nearly 70 % of the ECP users described their most recent sexual relationship as infrequent/casual. The overwhelming majority of users are aware that ECP is for emergency use only. Most ECP users are also aware of other options like condoms, the oral pill, and injectable contraceptives; and a considerable proportion of women using ECP had also used these methods before. Conclusion ECP is filling an important and unique role in reducing unplanned or unwanted pregnancy, especially among young, educated women, and those with infrequent sexual relationships.
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Affiliation(s)
- Shyam Thapa
- Nepal Public Health Foundation, Kathmandu, Nepal. .,Pokhara University, Kaski District, Nepal.
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Milosavljevic J, Bogavac-Stanojevic N, Krajnovic D, Mitrovic-Jovanovic A. Serbian gynecologists' and pharmacists' beliefs about emergency contraception. Women Health 2016; 57:508-519. [PMID: 27067019 DOI: 10.1080/03630242.2016.1176099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Emergency contraception (EC) in Serbia is available in two products: Levonorgestel, which has nonprescription status, and Ulipristal acetate, which is a prescription-only medicine. Considering their dispensing statuses, gynecologists and pharmacists are health care professionals (HCPs) with the widest impact on EC use. Yet little is known about their beliefs and practices regarding these medicines. We surveyed 166 gynecologists (during October 2012-October 2013) and 452 community pharmacists (during January-April 2014). Results showed significant differences between these two groups, suggesting that provision of EC to users may be inconsistent. Gynecologists were more convinced than pharmacists that EC would reduce the abortion rate (86% versus 53%, p < .001). However, they were more concerned than pharmacists that easy access to EC would cause less regular contraceptive use (66% versus 29%, p < .001) and risky sexual behaviors, including initiating sexual activity at a younger age (37% versus 19%, p < .001) and having more sexual partners (33% versus 12%, p < .001). Additionally, more pharmacists than gynecologists (12% versus 2%, p < .001) said they would not provide EC to anyone under any circumstance, even to victims of sexual assault. These results indicated a need for reevaluating and establishing official guidelines for dispensing practices.
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Affiliation(s)
- Jelena Milosavljevic
- a Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia.,b Bayer d.o.o ., Belgrade , Serbia
| | - Natasa Bogavac-Stanojevic
- c Department of Medical Biochemistry, Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
| | - Dusanka Krajnovic
- a Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
| | - Ana Mitrovic-Jovanovic
- d "Narodni Front" University Clinic of Gynaecology and Obstetrics, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
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Mulligan K. Access to Emergency Contraception and its Impact on Fertility and Sexual Behavior. HEALTH ECONOMICS 2016; 25:455-469. [PMID: 25663392 DOI: 10.1002/hec.3163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/02/2015] [Accepted: 01/17/2015] [Indexed: 06/04/2023]
Abstract
Half of all pregnancies in the USA are unintended, suggesting a high incidence of either improper or nonuse of contraceptives. Emergency birth control (EBC) provides individuals with additional insurance against unplanned pregnancy in the presence of contraception failure. This study is the first to estimate the impact of switching EBC from prescription to nonprescription status in the USA on abortions and risky sexual behavior as measured by STD rates. Utilizing state-level variation in access to EBC, we find that providing individuals with over-the-counter access to EBC leads to increase STD rates and has no effect on abortion rates. Moreover, individual-level analysis using the National Longitudinal Survey of Youth indicates that risky sexual behavior such as engaging in unprotected sex and number of sexual encounters increases as a result of over-the-counter access to EBC, which is consistent with the state-level STD findings.
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Affiliation(s)
- Karen Mulligan
- Economics and Finance, Middle Tennessee State University, Murfreesboro, TN, USA
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Stanford JB. Population, Reproductive, and Sexual Health: Data Are Essential Where Disciplines Meet and Ideologies Conflict. Front Public Health 2016; 4:27. [PMID: 27014671 PMCID: PMC4779970 DOI: 10.3389/fpubh.2016.00027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joseph B Stanford
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Turok DK, Sanders JN, Thompson IS, Royer PA, Eggebroten J, Gawron LM. Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: a prospective cohort study. Contraception 2016; 93:526-32. [PMID: 26944863 DOI: 10.1016/j.contraception.2016.01.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/19/2016] [Accepted: 01/19/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We assessed intrauterine device (IUD) preference among women presenting for emergency contraception (EC) and the probability of pregnancy among concurrent oral levonorgestrel (LNG) plus LNG 52 mg IUD EC users. METHODS We offered women presenting for EC at a single family planning clinic the CuT380A IUD (copper IUD) or oral LNG 1.5 mg plus the LNG 52 mg IUD. Two weeks after IUD insertion, participants reported the results of a self-administered home urine pregnancy test. The primary outcome, EC failure, was defined as pregnancies resulting from intercourse occurring within five days prior to IUD insertion. RESULTS One hundred eighty-eight women enrolled and provided information regarding their current menstrual cycle and recent unprotected intercourse. Sixty-seven (36%) chose the copper IUD and 121 (64%) chose oral LNG plus the LNG IUD. The probability of pregnancy two weeks after oral LNG plus LNG IUD EC use was 0.9% (95% CI 0.0-5.1%). The only positive pregnancy test after treatment occurred in a woman who received oral LNG plus the LNG IUD and who had reported multiple episodes of unprotected intercourse including an episode more than 5 days prior to treatment. CONCLUSIONS Study participants seeking EC who desired an IUD preferentially chose oral LNG 1.5 mg with the LNG 52 mg IUD over the copper IUD. Neither group had EC treatment failures. Including the option of oral LNG 1.5 mg with concomitant insertion of the LNG 52 mg IUD in EC counseling may increase the number of EC users who opt to initiate highly effective reversible contraception. IMPLICATIONS Consideration should be given to LNG IUD insertion with concomitant use of oral LNG 1.5 mg for EC. Use of this combination may increase the number of women initiating highly effective contraception at the time of their EC visit.
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Affiliation(s)
- David K Turok
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209.
| | - Jessica N Sanders
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Ivana S Thompson
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Pamela A Royer
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Jennifer Eggebroten
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Lori M Gawron
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
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Schneider AP, Kubat C, Zainer CM. Appreciation for Analysis of how Levonorgestrel Works and Reservations with the use of Meloxicam as Emergency Contraception. Linacre Q 2016; 83:52-68. [DOI: 10.1080/00243639.2016.1145894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This paper is a response to Dr. Kathleen Raviele's recent article on her critical analysis of the use of levonorgestrel given to women postsexual assault and her suggestion that the use of Meloxicam may be an ethical alternative.
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Affiliation(s)
| | - Christopher Kubat
- Catholic Social Services of Southern Nebraska, Lincoln, Nebraska, USA
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Hussainy SY, Ghosh A, Taft A, Mazza D, Black KI, Clifford R, Gudka S, Mc Namara KP, Ryan K, Jackson JK. Protocol for ACCESS: a qualitative study exploring barriers and facilitators to accessing the emergency contraceptive pill from community pharmacies in Australia. BMJ Open 2015; 5:e010009. [PMID: 26656987 PMCID: PMC4679989 DOI: 10.1136/bmjopen-2015-010009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The rate of unplanned pregnancy in Australia remains high, which has contributed to Australia having one of the highest abortion rates of developed countries with an estimated 1 in 5 women having an abortion. The emergency contraceptive pill (ECP) offers a safe way of preventing unintended pregnancy after unprotected sex has occurred. While the ECP has been available over-the-counter in Australian pharmacies for over a decade, its use has not significantly increased. This paper presents a protocol for a qualitative study that aims to identify the barriers and facilitators to accessing the ECP from community pharmacies in Australia. METHODS AND ANALYSIS Data will be collected through one-on-one interviews that are semistructured and in-depth. Partnerships have been established with 2 pharmacy groups and 2 women's health organisations to aid with the recruitment of women and pharmacists for data collection purposes. Interview questions explore domains from the Theoretical Domains Framework in order to assess the factors aiding and/or hindering access to ECP from community pharmacies. Data collected will be analysed using deductive content analysis. The expected benefits of this study are that it will help develop evidence-based workforce interventions to strengthen the capacity and performance of community pharmacists as key ECP providers. ETHICS AND DISSEMINATION The findings will be disseminated to the research team and study partners, who will brainstorm ideas for interventions that would address barriers and facilitators to access identified from the interviews. Dissemination will also occur through presentations and peer-reviewed publications and the study participants will receive an executive summary of the findings. The study has been evaluated and approved by the Monash Human Research Ethics Committee.
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Affiliation(s)
| | - Ayesha Ghosh
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
| | - Angela Taft
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Kirsten Isla Black
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rhonda Clifford
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Sajni Gudka
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Peter Mc Namara
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
- Deakin University and Flinders University, Melbourne, Victoria, Australia
| | - Kath Ryan
- School of Pharmacy, University of Reading, Reading, UK
| | - John Keith Jackson
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
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Barriers and Misperceptions Limiting Widespread Use of Intrauterine Contraception Among Canadian Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:606-616. [PMID: 26366817 DOI: 10.1016/s1701-2163(15)30198-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Unintended pregnancy is a major social and public health problem with adverse effects on neonatal and developmental outcomes, as well as maternal health and wellbeing. Traditionally, family planning policies have focused on increasing contraceptive uptake in non-users; however, rates of non-use are low in many developed nations. A high proportion of unintended pregnancies are attributable to contraceptive failure, particularly when using barrier and short-acting hormonal contraceptives. Intrauterine contraceptive devices (IUCDs) are highly effective and have been shown to reduce unintended pregnancy rates. Despite this, global utilization rates are low, and IUCD uptake in Canada has been particularly low. In this review we explore why IUCDs are not more widely used, and specifically focus on barriers and misperceptions that may influence IUCD uptake, particularly in Canada. We reviewed relevant articles published in English between 1990 and 2014, through searches of PubMed and Medline, including primary studies of any design containing information on the knowledge and attitudes of health care providers and women. Providing education to care providers, women, and policy makers may help overcome misperceptions about the use of IUCDs, and may facilitate greater use. Increased support from federal and provincial health programs may also encourage the use of IUCDs in Canadian women, and help to reduce unintended pregnancy rates.
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Wright RL, Fawson PR, Frost CJ, Turok DK. U.S. Men's Perceptions and Experiences of Emergency Contraceptives. Am J Mens Health 2015; 11:469-478. [PMID: 26186949 DOI: 10.1177/1557988315595857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Research suggests that men should be included in reproductive health decision making to help enhance positive health outcomes for their partners. Men affect the use of contraception and what method is used. Men's decisions may be affected by different factors such as gender, education, and the nature of their sexual relationship. A qualitative study was conducted to explore males' experiences and perceptions about emergency contraception (EC), and the meanings males assign to EC. Semistructured in-depth focus groups were held with 15 men who engage in heterosexual activity recruited from a university setting in the United States. Participants expressed egalitarian views of the contraception decision-making processes, a sense of responsibility regarding reproductive decision making, and that society has a negative stigma toward those who use EC. However, there was a lack of knowledge regarding the copper intrauterine device, which was not viewed as a method of EC. Exploring the role and needs of men in reproductive health care discussions and research is an important and growing area. Recommendations are provided for health care practitioners, policy, and future research around men and EC.
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Kearney MS, Levine PB. Investigating recent trends in the U.S. teen birth rate. JOURNAL OF HEALTH ECONOMICS 2015; 41:15-29. [PMID: 25647142 DOI: 10.1016/j.jhealeco.2015.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 12/23/2014] [Accepted: 01/12/2015] [Indexed: 05/10/2023]
Abstract
We investigate trends in the U.S. rate of teen childbearing between 1981 and 2010, focusing specifically on the sizable decline since 1991. We focus on establishing the role of state-level demographic changes, economic conditions, and targeted policies in driving recent aggregate trends. We offer three main observations. First, the recent decline cannot be explained by the changing racial and ethnic composition of teens. Second, the only targeted policies that have had a statistically discernible impact on aggregate teen birth rates are declining welfare benefits and expanded access to family planning services through Medicaid, but these policies can account for only 12.6 percent of the observed decline since 1991. Third, higher unemployment rates lead to lower teen birth rates and can account for 16 percent of the decline in teen birth rates since the Great Recession began.
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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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Sexual experiences and emergency contraceptive use among female university students: a cross-sectional study at Wachamo University, Ethiopia. BMC Res Notes 2015; 8:112. [PMID: 25888876 PMCID: PMC4381372 DOI: 10.1186/s13104-015-1070-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background Although unintended pregnancy rate is declining in both developed and developing countries, it remains higher in developing countries. Ethiopia is one country with a high prevalence of unintended pregnancy. In spite of this fact, very little is known about utilization of emergency contraception (EC) among young women. Therefore, this study aims to assess sexual experiences and emergency contraception use among female students at Wachamo University in Ethiopia. Methods A cross-sectional study was conducted from March to April 2013 at Wachamo University in Ethiopia. A pretested self-administered questionnaire was used to assess sexual experiences and emergency contraception use among female students. The study participants (n = 424) were selected using a multistage sampling procedure. A simple random sampling technique was applied to select the study participants from a list obtained in registrar’s office. Data was entered into EpiInfo and exported to SPSS for analysis. Bivariate and multivariate logistic regression analyses were used to determine factors associated with emergency contraception use. Result The majority of respondents (62.0%) were 20–24 years old and 31.4% were sexually active. Among sexually active, the mean (standard deviation) age at first sex was 18.22 (SD = 1.69). About one-half participants had high levels of knowledge about EC (49.8%) and positive attitudes towards EC (47.6%). Moreover, 44.4% of sexually active participants used EC at least once after unprotected sexual intercourse. The bivariate logistic regression revealed that age, marital status, religion, previous & current residence, parent’s educational status, knowledge about and attitude towards EC has a significant (P < 0.005) association with EC use. Furthermore, the multivariate analysis indicated that female students who have good knowledge, and ever got married were more likely to use EC than their counterparts (P < 0.05). Conclusions Emergency Contraception use, knowledge about and attitude on Emergency Contraception were very low among female students. Overall, knowledge on EC and marital status were predictors for EC use. Thus, it is an indication that there is a need for health education and promotion programs in university set-up to improve EC use to prevent unintended pregnancies.
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Abstract
This paper examines potential explanations for recent declines in teenage pregnancy in England. We estimate panel data models of teenage conception, birth and abortion rates from regions in England. Although point estimates are consistent with the promotion of long acting reversible contraception (LARC) having a negative impact on teenage pregnancy rates, the effects are generally small and statistically insignificant. In contrast, improvements in educational achievement and, to a lesser extent, increases in the non-white proportion of the population are associated with large and statistically significant reductions in teenage pregnancy.
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Diamond-Smith NG, Moreau C, Bishai DM. Reducing unintended pregnancies: a microsimulation of contraceptive switching, discontinuation, and failure patterns in france. Stud Fam Plann 2015; 45:429-41. [PMID: 25469928 DOI: 10.1111/j.1728-4465.2014.00006.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although the rate of contraceptive use in France is high, more than one-third of pregnancies are unintended. We built a dynamic microsimulation model that applies data from the French COCON study on method switching, discontinuation, and failure rates to a hypothetical population of 20,000 women, followed for five years. We use the model to estimate the adjustment factor needed to make the survey data fit the demographic profile of France by adjusting for underreporting of contraceptive nonuse and abortion. We then test three behavior-change scenarios that could reduce unintended pregnancies: decreasing method failure, increasing time using effective methods, and increasing switching from less effective to more effective methods. Our model suggests that decreasing method failure is the most effective means of reducing unintended pregnancies, but we found that all of the scenarios reduced unintended pregnancies by at least 25 percent. Dynamic microsimulations may have great potential in reproductive health research and prove useful for policymakers.
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Affiliation(s)
- Nadia G Diamond-Smith
- Postdoctoral fellow, Global Health Group, University of California, San Francisco, 50 Beale Street, 12th Floor, San Francisco, CA 94105..
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Dixit A, Khan ME, Bhatnagar I. Mainstreaming of emergency contraception pill in India: challenges and opportunities. Indian J Community Med 2015; 40:49-55. [PMID: 25657513 PMCID: PMC4317981 DOI: 10.4103/0970-0218.149271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/08/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emergency Contraception Pill (ECP) is an essential intervention to prevent unwanted pregnancies. However, its use has remained low due to various barriers including reservations among medical fraternity. MATERIALS AND METHODS This paper presents findings on barriers to ECP's easy access for potential users from (i) a cross-sectional survey of providers' attitudes, beliefs, and practices and interviews with key opinion leaders, (ii) three consultations organized by Population Council with policymakers and public health experts, and (iii) evidence from scientific literature. RESULTS The major barriers to easy access of ECP include misconceptions and reservations of providers (disapproval of ECP provision by CHWs, opposition to its being an OTC product, and myths, misconceptions, and moral judgments about its users) including influential gynecologists. CONCLUSION For mainstreaming ECP, the paper recommends educational campaign focusing on gynecologists and CHWs, relaxing restrictive policy on advertisement of ECP, involving press media and strengthening supply chain to ensure its regular supply to ASHA (CHW).
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Affiliation(s)
- Anvita Dixit
- Reproductive Health Program, Population Council, New Delhi, India
| | - M. E. Khan
- Reproductive Health Program, Population Council, New Delhi, India
| | - Isha Bhatnagar
- Reproductive Health Program, Population Council, New Delhi, India
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