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Strong J. "Even when you write with a pencil there is an eraser to clean it": Examining men's conceptualisations of and involvement in emergency contraceptive use in Accra, Ghana. Soc Sci Med 2024; 344:116635. [PMID: 38324975 DOI: 10.1016/j.socscimed.2024.116635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 12/01/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024]
Abstract
Emergency contraceptive pills are an essential and unique post-coital method to avoid a pregnancy, with evidence showing the significant role men can have in procurement and decisions to use. Global Health recommendations specify that emergency contraceptive pills be used sparingly and under specific conditions. This increasingly misaligns with the myriad conceptualisations and rationales among the public for why they choose to use emergency contraceptive pills. There has been a paucity of research aiming to understanding men's involvement and how they shape women's access, choice, and autonomy. This study interrogates how emergency contraceptive pills are conceptualised by men in James Town, Ghana, and how this intersects with their motivations to be involved in its use. Mixed method data from a survey (n = 270) and in-depth interviews (n = 37) were collected between July 2020 and January 2021. The analysis examines men's framings of emergency contraceptive pills and how these shape their involvement in its use. Men's knowledge of post-coital contraceptives was high, while knowledge of the specific term 'emergency contraception' was lower. While some men understood the pills in ways that aligned to Global Health framings, many more men saw emergency contraceptive pills as another means of pregnancy prevention in line with other contraceptives. This included its conceptualisation as a contraceptive that facilitates pleasurable (condomless) and spontaneous sex. Gendered perceptions of women who use emergency contraceptive pills were bound in sexual stigma, and men indicated that emergency contraceptive pills were a directly observable form of contraception that they could pressure their partner into using. Understanding plural conceptualisations away from 'emergency' are necessary to create policies and programmes that account for men's involvement. This includes understanding how emergency contraceptive pills are located within people's sexual and reproductive lives and gendered power dynamics, to reflect the public's own rationales for and experiences using post-coital contraceptives.
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Affiliation(s)
- Joe Strong
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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Bury F, Iguyovwe V, Trivett M, Baraitser P. Patterns of use of emergency and oral contraceptives from an online service in the United Kingdom during the COVID-19 pandemic: A quantitative study of routinely collected data. Contraception 2023; 122:109992. [PMID: 36849031 PMCID: PMC9968475 DOI: 10.1016/j.contraception.2023.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES Our study aimed to describe users of a free online contraception service, compare online emergency contraceptive pill (ECP) users with online oral contraceptive (OC) users, and describe patterns of use of online ECP and OC over time, including transition from ECP to more effective forms of contraception. STUDY DESIGN Analysis of routinely collected, anonymized data from a large, publicly funded, online contraceptive service in the United Kingdom from April 1, 2019 to October 31, 2021. RESULTS The online service provided 77,447 prescriptions during the study period. About 84% for OC and 16% for ECP, of which 89% were ulipristal acetate. ECP users were younger, lived in more deprived areas, and were less likely to be of white ethnicity than OC users. About 53% ordered OC only, but 37% ordered both ECP and OC. Among those prescribed both OC and ECP (n = 1306), 40% had one method as dominant, 25% appeared to move from one method to the other (11% ECP to OC, 14% OC to ECP), and 35% continued to use both methods. CONCLUSIONS Online services are accessible to diverse young populations. While the majority of users order OC only, our study suggests that where there is free, online access to both OC and ECP, and those ordering ECP are always offered free OC, transition to more effective ongoing forms of contraception is uncommon. Further research is needed to understand whether online access to ECP increases its attractiveness and reduces likelihood of transition to OC. IMPLICATIONS This study demonstrates that free, online contraceptive services are accessible to ethnically and socioeconomically diverse users. It identifies a subgroup of contraceptive users who combine use of OC and ECPs over time, and suggests that improved access to ECP may alter contraceptive choices.
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Leon-Larios F, Ruiz-Ferron C, Jalon-Neira RM, Praena-Fernández JM. Nursing Students' Knowledge, Awareness, and Experiences of Emergency Contraception Pills' Use. J Clin Med 2022; 11:jcm11020418. [PMID: 35054112 PMCID: PMC8780468 DOI: 10.3390/jcm11020418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 02/04/2023] Open
Abstract
The emergency contraception pill (ECP) is a non-prescribed medication in Spain. However, there is not enough evidence of its use among young people to define sex education contents. The aims of this research were to describe the experiences of the use of the ECP in university students and analyze their knowledge, attitude, and awareness regarding the ECP. The cross-sectional, analytic study was conducted with nursing degree students at the University of Seville. A total of 478 students answered the questionnaire. All of the students (100%) had heard about the ECP and had a positive attitude towards this contraceptive. A total of 25.7% had used the ECP, mainly because a condom had failed or because they did not use any contraceptive at all. Deficiencies in knowledge are related with the ECPs' mechanism of action, efficacy after repeated use, and the type of ECP available. Female students who used no method at all or withdrawal, and who were over 20 years old, used ECP to a greater extent (p < 0.005). Further education initiatives focused on the use of the ECP, its efficacy, and typology are needed, particularly among future health professionals who will later educate other young people.
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Affiliation(s)
- Fatima Leon-Larios
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (F.L.-L.); (J.-M.P.-F.)
| | - Cecilia Ruiz-Ferron
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (F.L.-L.); (J.-M.P.-F.)
- University Hospital Virgen del Rocío, 41013 Seville, Spain
- Correspondence:
| | | | - Juan-Manuel Praena-Fernández
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (F.L.-L.); (J.-M.P.-F.)
- Unit Biostatistic, Department of Statistics, Faculty of Medicine, University of Granada, 18016 Granada, Spain
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Barbosa RM, Kalckmann S, Arilha M, Giacomo do Lago TD. The emergency contraceptive pill in Brazil: High usage rates but schooling differences persist. Contraception 2021; 104:401-405. [PMID: 34224695 DOI: 10.1016/j.contraception.2021.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This paper aims to analyze usage rates for the emergency contraceptive pill (ECP) among women living in the city of São Paulo and their associated factors. STUDY DESIGN A population based cross-sectional survey was conducted in 2015 with a probabilistic sample of 4,000 women aged 15 to 44 living in São Paulo, Brazil. Response rate for households was 75% and 77% for eligible women. Binary logistic regression models were used to describe the association between each outcome and selected variables. RESULTS A total of 51.4% of women living in the city of São Paulo had used ECP at least once in their lifetime. Women under 35 were more likely to use ECP, as were those with more than 9 years of schooling, having at least one live birth, not cohabiting with a partner, with more than two lifetime sexual partners and as length of sexual life decreased. Among ECP users, 32.6% used it only once, 47.5% used it 2 to 4 times, and 19.9% used it 5 or more times. CONCLUSIONS Our findings suggest that ECPs have been incorporated into the contraceptive method mix for many women as a fundamental strategy for regulating fertility. Particularly young women, unmarried women and those who have had more partners seem to take greater advantage of ECP to prevent pregnancy. IMPLICATIONS Despite the high use rate, lower levels of schooling are associated with lower levels of ECP use. There is a need for both policies to reduce schooling inequities and strategies to improve women's knowledge of reproduction and contraception.
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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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Glasier A, Baraitser P, McDaid L, Norrie J, Radley A, Stephenson JM, Battison C, Gilson R, Cameron S. Emergency contraception from the pharmacy 20 years on: a mystery shopper study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:55-60. [PMID: 32554399 PMCID: PMC7815628 DOI: 10.1136/bmjsrh-2020-200648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/07/2020] [Accepted: 05/17/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND Emergency contraception (EC) was approved in the UK as a pharmacy medicine for purchase without prescription in 2001. Twenty years later we conducted a study to characterise routine practice pharmacy provision of EC. STUDY DESIGN Mystery shopper study of 30 pharmacies in Edinburgh, Dundee and London participating in a clinical trial of contraception after EC. METHODS Mystery shoppers, aged ≥16 years, followed a standard scenario requesting EC. After the pharmacy visit, they completed a proforma recording the duration of the consultation, where it took place, and whether advice was given to them about the importance of ongoing contraception after EC. RESULTS Fifty-five mystery shopper visits were conducted. The median reported duration of the consultation with the pharmacist was 6 (range 1-18) min. Consultations took place in a private room in 34 cases (62%) and at the shop counter in the remainder. In 27 cases (49%) women received advice about ongoing contraception. Eleven women (20%) left the pharmacy without EC due to lack of supplies or of a trained pharmacist. Most women were generally positive about the consultation. CONCLUSIONS While availability of EC from UK pharmacies has undoubtedly improved access, the necessity to have a consultation, however helpful, with a pharmacist introduces delays and around one in five of our mystery shoppers left without getting EC. Consultations in private are not always possible and little advice is given about ongoing contraception. It is time to make EC available without a pharmacy consultation.
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Affiliation(s)
- Anna Glasier
- Obstetrics & Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Paula Baraitser
- Department of Sexual Health, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Lisa McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Andrew Radley
- Directorate of Public Health, NHS Tayside, Dundee, UK
- Division of Cardiovascular Medicines and Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Judith M Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Claire Battison
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Richard Gilson
- Institute for Global Health, University College London (UCL), London, UK
| | - Sharon Cameron
- Obstetrics & Gynaecology, University of Edinburgh, Edinburgh, UK
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
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Berry H, Anderson E. Education and training for pharmacy professionals and their support staff to manage requests for emergency contraception within community pharmacy in England. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:1-3. [PMID: 32718984 DOI: 10.1136/bmjsrh-2020-200645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Hayley Berry
- Centre for Pharmacy Postgraduate Education (CPPE), The University of Manchester, Manchester M13 9PT, UK
| | - Emma Anderson
- Centre for Pharmacy Postgraduate Education (CPPE), The University of Manchester, Manchester M13 9PT, UK
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Radley A, Anderson C. Emergency contraception from community pharmacies: looking back and looking forward. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:4-5. [PMID: 32900794 DOI: 10.1136/bmjsrh-2020-200767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Andrew Radley
- Directorate of Public Health, NHS Tayside, Dundee, UK
- School of Medicine, University of Dundee, Dundee, UK
| | - Claire Anderson
- Division of Pharmacy Practice & Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
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Cameron ST, Glasier A, McDaid L, Radley A, Baraitser P, Stephenson J, Gilson R, Battison C, Cowle K, Forrest M, Goulao B, Johnstone A, Morelli A, Patterson S, McDonald A, Vadiveloo T, Norrie J. Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic cluster-randomised crossover trial. Lancet 2020; 396:1585-1594. [PMID: 33189179 PMCID: PMC7661838 DOI: 10.1016/s0140-6736(20)31785-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/01/2020] [Accepted: 08/13/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Unless women start effective contraception after oral emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies. We hypothesised that pharmacist provision of the progestogen-only pill as a bridging interim method of contraception with emergency contraception plus an invitation to a sexual and reproductive health clinic, in which all methods of contraception are available, would result in increased subsequent use of effective contraception. METHODS We did a pragmatic cluster-randomised crossover trial in 29 UK pharmacies among women receiving levonorgestrel emergency contraception. Women aged 16 years or older, not already using hormonal contraception, not on medication that could interfere with the progestogen-only pill, and willing to give contact details for follow-up were invited to participate. In the intervention group, women received a 3-month supply of the progestogen-only pill (75 μg desogestrel) plus a rapid access card to a participating sexual and reproductive health clinic. In the control group, pharmacists advised women to attend their usual contraceptive provider. The order in which each pharmacy provided the intervention or control was randomly assigned using a computer software algorithm. The primary outcome was the use of effective contraception (hormonal or intrauterine) at 4 months. This study is registered, ISRCTN70616901 (complete). FINDINGS Between Dec 19, 2017, and June 26, 2019, 636 women were recruited to the intervention group (316 [49·6%], mean age 22·7 years [SD 5·7]) or the control group (320 [50·3%], 22·6 years [5·1]). Three women (one in the intervention group and two in the control group) were excluded after randomisation. 4-month follow-up data were available for 406 (64%) participants, 25 were lost to follow-up, and two participants no longer wanted to participate in the study. The proportion of women using effective contraception was 20·1% greater (95% CI 5·2-35·0) in the intervention group (mean 58·4%, 48·6-68·2), than in the control group (mean 40·5%, 29·7-51·3 [adjusted for recruitment period, treatment group, and centre]; p=0·011).The difference remained significant after adjusting for age, current sexual relationship, and history of effective contraception use, and was robust to the effect of missing data (assuming missingness at random). No serious adverse events occurred. INTERPRETATION Provision of a supply of the progestogen-only pill with emergency contraception from a community pharmacist, along with an invitation to a sexual and reproductive health clinic, results in a clinically meaningful increase in subsequent use of effective contraception. Widely implemented, this practice could prevent unintended pregnancies after use of emergency contraception. FUNDING National Institute for Health Research (Health Technology Assessment Programme project 15/113/01).
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Affiliation(s)
- Sharon T Cameron
- Department of Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK; Chalmers Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK.
| | - Anna Glasier
- Department of Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Lisa McDaid
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Andrew Radley
- Directorate of Public Health, NHS Tayside, Dundee, UK; Division of Cardiovascular Medicines and Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Paula Baraitser
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Claire Battison
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Anne Johnstone
- Department of Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Alessandra Morelli
- Department of Sexual Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Susan Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
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Heap KL, Berrington A, Ingham R. Understanding the decline in under-18 conception rates throughout England's local authorities between 1998 and 2017. Health Place 2020; 66:102467. [PMID: 33120069 DOI: 10.1016/j.healthplace.2020.102467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 11/18/2022]
Abstract
We consider England's two-decade teenage conception decline in the context of societal changes: rising educational aspirations; growing second- and third-generation teenage ethnic minority populations; increased deprivation associated with economic recession and post-2008 Government austerity; and changing housing availability. Using England's Local Authority Districts (LAD) 1998-2017, we explore the role of area characteristics in explaining spatial differences in under-18 conception rates and how changing characteristics may explain temporal changes. Urban/rural distinctions in teenage conceptions are largely minimised after considering LAD characteristics. Area characteristics continue to partly explain teenage conception rates but are better at explaining area differences than variation over time.
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Affiliation(s)
- Katie L Heap
- Department of Social Statistics and Demography, University of Southampton, Southampton, SO17 1BJ, UK; ESRC Centre for Population Change, Southampton, UK.
| | - Ann Berrington
- Department of Social Statistics and Demography, University of Southampton, Southampton, SO17 1BJ, UK; ESRC Centre for Population Change, Southampton, UK.
| | - Roger Ingham
- Centre for Sexual Health Research, School of Psychology, University of Southampton, Southampton, SO17 1BJ, UK.
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Eastham R, Milligan C, Limmer M. Qualitative findings about stigma as a barrier to contraception use: the case of Emergency Hormonal Contraception in Britain and implications for future contraceptive interventions. EUR J CONTRACEP REPR 2020; 25:334-338. [PMID: 32840425 DOI: 10.1080/13625187.2020.1806998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Emergency Hormonal Contraception (EHC) has been underused in Britain and internationally since its introduction. 'Stigmatisation' has been identified as one of the barriers to EHC. However, few, if any publications have focussed on the significance of this factor in the British context, the social meanings for women of seeking EHC and the implications for future contraceptive provision and innovation. METHOD In-depth qualitative material from 27 women across two British studies was analysed. The first, in which 11 young women were interviewed in-depth regarding EHC specifically, was supplemented by material from a multi-stage narrative study of 15 women concerning their life history experiences of using contraception more broadly. RESULTS Stigmatisation of EHC use is a key barrier and derives from associations with irresponsible behaviour. This irresponsibility exists on a continuum with some behaviours and some women more ir/responsible than others. In addition, despite not being an abortifacient, EHC may be closely aligned with abortion meaning users can be perceived as 'bad women' in a similar way to abortion seekers. This stigma can deter participants seeking EHC when they may need it. CONCLUSION Stigma is a powerful barrier to EHC use due to the social significance of responsibility and expectations pertaining to the behaviour of 'good women.' Understandings about stigmatisation in the case of EHC should be translated to other aspects of contraceptive service delivery and future innovations, to ensure effective provision of methods and safeguard their uptake.
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Affiliation(s)
- Rachael Eastham
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Mark Limmer
- Division of Health Research, Lancaster University, Lancaster, UK
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Guleria S, Munk C, Elfström KM, Hansen BT, Sundström K, Liaw K, Nygård M, Kjaer SK. Emergency contraceptive pill use among women in Denmark, Norway and Sweden: Population‐based survey. Acta Obstet Gynecol Scand 2020; 99:1214-1221. [DOI: 10.1111/aogs.13849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/22/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sonia Guleria
- Virus, Lifestyle and Genes Danish Cancer Society Research Center Copenhagen Denmark
| | - Christian Munk
- Virus, Lifestyle and Genes Danish Cancer Society Research Center Copenhagen Denmark
| | - K. Miriam Elfström
- Department of Laboratory Medicine Karolinska Institutet Stockholm Sweden
| | - Bo T. Hansen
- Department of Research Cancer Registry of Norway Oslo Norway
| | - Karin Sundström
- Department of Laboratory Medicine Karolinska Institutet Stockholm Sweden
| | - Kai‐Li Liaw
- Epidemiology Merck Research Laboratories North Wales PA USA
| | - Mari Nygård
- Department of Research Cancer Registry of Norway Oslo Norway
| | - Susanne K. Kjaer
- Virus, Lifestyle and Genes Danish Cancer Society Research Center Copenhagen Denmark
- Department of Gynecology Rigshospitalet University Hospital University of Copenhagen Copenhagen Denmark
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13
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Given JE, Gray AM, Dolk H. Use of prescribed contraception in Northern Ireland 2010-2016. EUR J CONTRACEP REPR 2020; 25:106-113. [PMID: 32069122 DOI: 10.1080/13625187.2020.1723539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The aim of this study was to describe the use of prescribed contraceptives in Northern Ireland (NI) and how this varies with a woman's age, the deprivation in the area in which she lives and characteristics of her general practice (GP).Method: A population-based cohort study was conducted including 560,074 females, aged 12-49 registered with a GP (2010-2016) contributing 3,255,500 woman-years of follow-up. Dispensed contraceptive prescriptions were linked to demographic details.Results: A contraceptive prescription was dispensed in 26.2% of woman-years with women aged 20-24 most likely to have a contraceptive dispensed (45.7% of woman-years). After adjusting for patient and other practice characteristics, practices in the least deprived quintile prescribed 6% more contraception than those in the most deprived quintile. The combined oral contraceptives (16.6% of woman-years) and progesterone only pill (8.0% of woman-years) were the most commonly dispensed methods. Patient and practice level characteristics were found to be related to the specific contraceptive methods dispensed which also changed during the time frame of the study.Conclusions: This is the first population-based assessment of contraceptive prescription in NI. It is useful for health service planning and to inform broader reproductive policy debates. The impact of practice area-based deprivation, above that of the woman's residence, on contraceptive dispensing is a new finding that deserves more exploration.
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Affiliation(s)
- Joanne E Given
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | | | - Helen Dolk
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
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14
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Mantzourani E, Hodson K, Evans A, Alzetani S, Hayward R, Deslandes R, Hughes ML, Holyfield G, Way C. A 5-year evaluation of the emergency contraception enhanced community pharmacy service provided in Wales. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:bmjsrh-2018-200236. [PMID: 31395752 DOI: 10.1136/bmjsrh-2018-200236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 07/03/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Access to emergency contraception (EC) has been a core component of attempts to address high teenage pregnancy rates in Wales. A national service was commissioned in 2011, allowing supply of EC free of charge from community pharmacies (CPs). This study investigated 5 years of the EC service, to describe its use and investigate changes in the pattern of use over time. METHODS Secondary analyses of data from all National Health Service funded CP EC consultations in Wales between 1 August 2012 and 31 July 2017 (n=181 359). Data comprised standardised clinical and demographic information, in the form of predefined service user responses, submitted for reimbursement by CPs. RESULTS Overall service provision remained relatively consistent over the study period, with women aged between 13 and 59 years accessing the service. An association was observed between the time since unprotected sexual intercourse and the day on which the service was accessed (Χ2(18)=16 292.327, p<0.001). Almost half (47.9%) of requests were because no contraception had been used, with a strong and positive association for teenagers and women aged 40+ years. A statistically significant and increasing percentage of consultations were accompanied by further sexual health advice (r=0.7, p<0.01). CONCLUSIONS Access to EC through CPs is contributing to reducing teenage conceptions and termination rates. However, action is needed to increase contraception use in all age groups. Reduced availability of CP services on Sundays is a barrier to timely EC access. Findings support an expanded role for community pharmacists in provision of regular contraception.
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Affiliation(s)
- Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | | | - Sarah Alzetani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Hayward
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Rhian Deslandes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Mary Louise Hughes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | | | - Cheryl Way
- National Health Service Wales Informatics Service, Cardiff, UK
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15
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Michie L, Cameron ST. Emergency contraception and impact on abortion rates. Best Pract Res Clin Obstet Gynaecol 2019; 63:111-119. [PMID: 31362908 DOI: 10.1016/j.bpobgyn.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022]
Abstract
Emergency contraception (EC) is a drug or a device that is taken after sexual intercourse to prevent unintended pregnancy. The most effective EC is the copper-bearing intrauterine device (Cu-IUD), but oral EC methods are more commonly used and include a single dose of either levonorgestrel (1.5 mg) or ulipristal acetate (30 mg). Although all EC methods are extremely safe, access to EC is often limited due to prevailing misconceptions over how EC works. Although EC can prevent unintended pregnancy for an individual woman, it has failed to make an impact on abortion rates at a population level. This may be because it is not used after every episode of unprotected sex and because existing oral EC methods are only effective if used before ovulation. Future strategies around EC should focus on maximising uptake of Cu-IUD, facilitating initiation of effective regular contraception after EC and developing a more effective oral EC.
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Affiliation(s)
- L Michie
- The Gatehouse, NHS Ayrshire and Arran, Ayrshire Central Hospital, United Kingdom.
| | - S T Cameron
- Chalmers Sexual and Reproductive Health Centre, NHS Lothian, 2 A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom; Obstetrics and Gynaecology, University of Edinburgh, United Kingdom.
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16
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Kilander H, Brynhildsen J, Alehagen S, Fagerkrantz A, Thor J. Collaboratively seeking to improve contraceptive counselling at the time of an abortion: a case study of quality improvement efforts in Sweden. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:190-199. [PMID: 31289100 DOI: 10.1136/bmjsrh-2018-200299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/15/2019] [Accepted: 05/16/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND Many women find it difficult to choose and initiate a contraceptive method at the time of an abortion. There is a gap between regular clinical practice and existing evidence on motivational and person-centred counselling, as well as on use of long-acting reversible contraception (LARC). This study aims to describe and evaluate a Quality Improvement Collaborative (QIC) designed to enhance contraceptive services, with regard to changes in healthcare professionals' (HCPs') counselling in clinical practice, and in women's subsequent choice of, and access to, contraception. METHODS Three multiprofessional teams working in abortion services from three hospitals in Sweden, and two women contributing with user experience, participated in a QIC during the period March-November 2017. Using a case study design, we collected and analysed both quantitative and qualitative data. RESULTS Teams agreed on QIC goals, including that ≥50% of women would start LARC within 30 days post-abortion, and tested multiple evidence-based changes, aided by the two women's feedback. During the QIC, participating HCPs reported that they gained new knowledge and developed skills in contraceptive counselling at the time of an abortion. The teams welcomed the development of a performance feedback system regarding women's post-abortion contraception. While the majority of women counselled during the QIC chose LARC, only 20%-40% received it within 30 days post-abortion. CONCLUSION The QIC, incorporating user feedback, helped HCPs to develop capability in providing contraceptive services at the time of an abortion. Timely access to LARC remains a challenge in the present setting.
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Affiliation(s)
- Helena Kilander
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynaecology, Region Jönköping County, Eksjö, Sweden
| | - Jan Brynhildsen
- Obstetrics and Gynecology, Clinical and Experimental Medicine, Linköping, Sweden
| | - Siw Alehagen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Amanda Fagerkrantz
- Department of Obstetrics and Gyneacology, Norrköping, Region Ostergotland, Linköping, Sweden
| | - Johan Thor
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
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17
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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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18
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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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19
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Kilander H, Berterö C, Thor J, Brynhildsen J, Alehagen S. Women’s experiences of contraceptive counselling in the context of an abortion – An interview study. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 17:103-107. [DOI: 10.1016/j.srhc.2018.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/19/2018] [Accepted: 07/22/2018] [Indexed: 10/28/2022]
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20
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Wayal S, Hughes G, Sonnenberg P, Mohammed H, Copas AJ, Gerressu M, Tanton C, Furegato M, Mercer CH. Ethnic variations in sexual behaviours and sexual health markers: findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet Public Health 2017; 2:e458-e472. [PMID: 29057382 PMCID: PMC5639148 DOI: 10.1016/s2468-2667(17)30159-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sexual health entails the absence of disease and the ability to lead a pleasurable and safe sex life. In Britain, ethnic inequalities in diagnoses of sexually transmitted infections (STI) persist; however, the reasons for these inequalities, and ethnic variations in other markers of sexual health, remain poorly understood. We investigated ethnic differences in hypothesised explanatory factors such as socioeconomic factors, substance use, depression, and sexual behaviours, and whether they explained ethnic variations in sexual health markers (reported STI diagnoses, attendance at sexual health clinics, use of emergency contraception, and sexual function). METHODS We analysed probability survey data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3; n=15 162, conducted in 2010-12). Reflecting Britain's current ethnic composition, we included in our analysis participants who identified in 2011 as belonging to one of the following seven largest ethnic groups: white British, black Caribbean, black African, Indian, Pakistani, white other, and mixed ethnicity. We calculated age-standardised estimates and age-adjusted odds ratios for all explanatory factors and sexual health markers for all these ethnic groups with white British as the reference category. We used multivariable regression to examine the extent to which adjusting for explanatory factors explained ethnic variations in sexual health markers. FINDINGS We included 14 563 (96·0%) of the 15 162 participants surveyed in Natsal-3. Greater proportions of black Caribbean, black African, and Pakistani people lived in deprived areas than those of other ethnic groups (36·9-55·3% vs 16·4-29·4%). Recreational drug use was highest among white other and mixed ethnicity groups (25·6-27·7% in men and 10·3-12·9% in women in the white other and mixed ethnicity groups vs 4·1-15·6% in men and 1·0-11·2% in women of other ethnicities). Compared with white British men, the proportions of black Caribbean and black African men reporting being sexually competent at sexual debut were lower (32·9% for black Caribbean and 21·9% for black African vs 47·4% for white British) and the number of partners in the past 5 years was greater (median 2 [IQR 1-4] for black Caribbean and 2 [1-5] for black African vs 1 [1-2] for white British), and although black Caribbean and black African men reported greater proportions of concurrent partnerships (26·5% for black Caribbean and 38·9% for black African vs 14·8% for white British), these differences were not significant after adjusting for age. Compared with white British women, the proportions of black African and mixed ethnicity women reporting being sexually competent were lower (18·0% for black African and 35·3% for mixed ethnicity vs 47·9% for white British), and mixed ethnicity women reported larger numbers of partners in the past 5 years (median 1 [IQR 1-4] vs 1 [1-2]) and greater concurrency (14·3% vs 8·0%). Reporting STI diagnoses was higher in black Caribbean men (8·7%) and mixed ethnicity women (6·7%) than white British participants (3·6% in men and 3·2% in women). Use of emergency contraception was most commonly reported among black Caribbean women (30·7%). Low sexual function was most common among women of white other ethnicity (30·1%). Adjustment for explanatory factors only partly explained inequalities among some ethnic groups relative to white British ethnicity but did not eliminate ethnic differences in these markers. INTERPRETATION Ethnic inequalities in sexual health markers exist, and they were not fully explained by differences in their broader determinants. Holistic interventions addressing modifiable risk factors and targeting ethnic groups at risk of poor sexual health are needed. FUNDING Medical Research Council, the Wellcome Trust, the Economic and Social Research Council, UK Department of Health, and The National Institute for Health Research.
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Affiliation(s)
- Sonali Wayal
- Institute for Global Health, University College London (UCL), London, UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Gwenda Hughes
- Institute for Global Health, University College London (UCL), London, UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London (UCL), London, UK
| | - Hamish Mohammed
- Institute for Global Health, University College London (UCL), London, UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
| | - Andrew J Copas
- Institute for Global Health, University College London (UCL), London, UK
| | - Makeda Gerressu
- Institute for Global Health, University College London (UCL), London, UK
| | - Clare Tanton
- Institute for Global Health, University College London (UCL), London, UK
| | - Martina Furegato
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
| | - Catherine H Mercer
- Institute for Global Health, University College London (UCL), London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
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21
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Black KI, Geary R, French R, Leefe N, Mercer CH, Glasier A, Macdowall W, Gibson L, Datta J, Palmer M, Wellings K. Trends in the use of emergency contraception in Britain: evidence from the second and third National Surveys of Sexual Attitudes and Lifestyles. BJOG 2016; 123:1600-7. [PMID: 27245637 PMCID: PMC4995725 DOI: 10.1111/1471-0528.14131] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the changes in the prevalence of, and the factors associated with, the use of emergency contraception (EC) in Britain between 2000 and 2010, spanning the period of deregulation and increase in pharmacy supply. DESIGN Cross-sectional probability sample surveys. SETTING AND POPULATION British general population. METHODS Data were analysed from the second and third British National Surveys of Sexual Attitudes and Lifestyles (Natsal), undertaken in 1999-2001 and 2010-12. Univariate and logistic regression analyses were used to measure change in EC use amongst sexually active women aged 16-44 years not intending pregnancy. MAIN OUTCOME MEASURES Prevalence of EC use and factors associated with use. RESULTS Of the 5430 women surveyed in 1999-2001 and the 4825 women surveyed in 2010-12, 2.3 and 3.6%, respectively, reported using EC in the year prior to interview (P = 0.0019 for change over time). The prevalence of EC use increased amongst single women and those with higher educational attainment (adjusted odds ratio, aOR 1.51; 95% confidence interval, 95% CI 1.04-2.20; P = 0.0308). Increases in EC use were generally greater among women without behavioural risk factors, such as those with no history of abortion within 5 years (aOR 1.57; 95% CI 1.17-2.12; P = 0.0029), or those whose first heterosexual intercourse occurred after the age of 16 years (aOR 1.68; 95% CI 1.21-2.35; P = 0.0021). The increase in EC use was also more marked among women usually accessing contraception from retail sources than among those doing so from healthcare sources, which may reflect a use of condoms amongst EC users. CONCLUSION The increase in EC use among women in Britain in the first decade of the 21st century was associated with some, but not all, risk factors for unplanned pregnancy. Advice and provision may need to be targeted at those at highest risk of unplanned pregnancy. TWEETABLE ABSTRACT Despite pharmacy access, only a small rise in emergency contraception use has been seen in Britain over 10 years.
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Affiliation(s)
- KI Black
- University of SydneySydneyNSWAustralia
| | - R Geary
- London School of Hygiene and Tropical MedicineLondonUK
| | - R French
- London School of Hygiene and Tropical MedicineLondonUK
| | - N Leefe
- University College LondonLondonUK
| | | | - A Glasier
- London School of Hygiene and Tropical MedicineLondonUK
| | - W Macdowall
- London School of Hygiene and Tropical MedicineLondonUK
| | - L Gibson
- London School of Hygiene and Tropical MedicineLondonUK
| | - J Datta
- London School of Hygiene and Tropical MedicineLondonUK
- University of EdinburghEdinburghUK
| | - M Palmer
- London School of Hygiene and Tropical MedicineLondonUK
| | - K Wellings
- London School of Hygiene and Tropical MedicineLondonUK
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