Counseling about and use of emergency contraception in the United States

Messaging and access strategies for improving emergency contraceptive knowledge and uptake among Italians

OBJECTIVES

Over-the-counter emergency contraception (EC) purchase was legalised in Italy in 2015. Knowledge and access gaps, however, remain. The goal of this study was to explore women's and men's EC informational and access needs.

METHODS

As part of a larger reproductive study, researchers conducted 42 in-depth interviews (May-June 2019) with English-speaking women and men aged 18-50 years (mean ± standard deviation, 29.1 ± 7.9 years) living in or near Florence, Italy, and using the Italian health care system. Researchers completed qualitative data analysis to identify emergent themes related to EC knowledge, attitudes and access. HyperRESEARCH aided data organisation and analysis. Researchers used a comparative method to contextualise data and identify emergent themes.

RESULTS

Findings demonstrated that peer communication and experiences served as influential factors in others' EC use. This propagated misinformation, reducing participants' confidence in EC efficacy and safety. Women described the relevance of relationship type in whether to engage men in EC discussion, while men desired an active supportive role. Finally, participants described various messaging and access channels to increase EC knowledge and access.

CONCLUSION

Findings offer practical recommendations to guide social marketing and behaviour change interventions to increase EC access among women and men in Italy. The utility of pharmacists to individuals wishing to access EC is explored.

Emergency contraceptive pill use among women of reproductive age in Pathein, Myanmar

Purpose

Emergency contraceptive pills (ECPs) allow a second chance to prevent unwanted pregnancy in unplanned sexual intercourse. Therefore, it helps reduce the rate of induced or unsafe abortions. Although they are available over-the-counter in Myanmar, relevant information remains improperly known by women and its use is limited. The purpose of this paper is to identify the prevalence and associated factors of ECPs use among women of reproductive age in the delta region of Myanmar.

Design/methodology/approach

This community based cross-sectional study was conducted in Pathein Township, Ayeyarwady Division, Myanmar from March 30 to April 29, 2018. This study was conducted among 238 respondents selected using multistage sampling and face-to-face interviews employed structured questionnaires. Multiple logistic regression was used to analyze the associations among variables.

Findings

The prevalence of ECPs use among reproductive aged women was 11.3 percent. Factors significantly associated with ECPs use were high monthly family income (AOR=4.50, 95% CI=1.31–15.48), condom use (AOR=4.40, 95% CI=1.07–18.16) and never having experienced pregnancy (AOR=6.20, 95% CI=2.06–18.67).

Originality/value

To improve the use of ECPs, extension of services such as opening hours or working days is needed. The government and NGOs should implement the services to support women who have encountered unplanned sexual intercourse so that unwanted pregnancy can be prevented.

U.S. Men's Perceptions and Experiences of Emergency Contraceptives

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.

Asking for what she needs? Pregnancy testing or EC?

BACKGROUND

When used within 5 days of unprotected sex, emergency contraception (EC) can reduce the risk of pregnancy. Our objective was to explore how often women seeking clinic-based pregnancy testing who do not desire pregnancy might benefit from EC and examine variables associated with patients asking for EC when use is indicated.

STUDY DESIGN

Women seeking pregnancy testing or EC from an inner-city Title-X-funded family planning clinic between January 2011 and June 2012 were invited to complete surveys.

RESULTS

Twenty-seven percent (n=79) of respondents were seeking EC, and 73% (n=215) were seeking pregnancy testing. Of those seeking pregnancy testing, 39% might have benefited from same-day use of EC pills. Women who had never used EC and who had more than one episode of unprotected sex within the past month were less likely to request EC when use was indicated, while single women were more likely to request EC.

CONCLUSIONS

Counseling regarding EC options is particularly important for women seeking same-day pregnancy testing who do not desire pregnancy.

Emergency contraception considerations and use among college women

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Emergency contraception knowledge among nurse practitioner students

PURPOSE

The purpose of this study was to ascertain the knowledge level of nurse practitioner (NP) students about emergency contraception (EC), and to explore attitudes about EC that may intersect with willingness to prescribe EC.

DATA SOURCES

Four hundred and sixty-seven NP students completed a 30-item web-based survey using Vovici survey software.

CONCLUSIONS

Students who reported formal content on EC in their program of study showed significantly better mean knowledge scores (t= 5.279, df = 459, p < .001). Gaps in NP students' knowledge of EC mechanisms of action, understanding of indications and contraindications were apparent. Younger students (F(3,457) = 4.994, p < .002), those newer to nursing (F(4,456) = 6.641, p < .0005), and women's health NP students (F(4,445) = 3.488, p < .008), demonstrated significantly better knowledge. Attitudes regarding EC appeared to be tied to the respondent's knowledge about EC.

IMPLICATIONS FOR PRACTICE

Knowledge is an important factor in informing NP practice decisions. Clinicians need accurate, evidence-based knowledge to provide health education and counseling to reproductive age women if unintended pregnancies are to be reduced.

Knowledge-attitude-practice survey among Portuguese gynaecologists regarding combined hormonal contraceptives methods

ABSTRACT Objectives To evaluate knowledge, attitude and practices of Portuguese gynaecologists regarding combined hormonal contraceptives. Methods A cross-sectional survey was conducted among 303 gynaecologists. Results Ninety percent of the gynaecologists considered that deciding on contraceptive methods is a process wherein the woman has her say. Efficacy, safety and the woman's preference were the major factors influencing gynaecologists, while efficacy, tolerability and ease of use were the major factors perceived by the specialists to influence the women's choice. Gynaecologists believed that only 2% of women taking the pill were 100% compliant compared to 48% of those using the patch and 75% of those using the ring. The lower risk of omission was the strong point for the latter methods. Side effects were the main reason to change to another method. Vaginal manipulation was the most difficult topic to discuss. Conclusions Most gynaecologists decided with the woman on the contraceptive method. The main reasons for the gynaecologist's recommendation of a given contraceptive method and the women's choice were different. Counselling implies an open discussion and topics related to sexuality were considered difficult to discuss. Improving communication skills and understanding women's requirements are critical for contraceptive counselling.

Obstetrician-gynecologist physicians' beliefs about emergency contraception: a national survey

BACKGROUND

Although emergency contraception (EC) is available without a prescription, women still rely on doctors' advice about its safety and effectiveness. Yet little is known about doctors' beliefs and practices in this area.

STUDY DESIGN

We surveyed 1800 US obstetrician-gynecologists. Criterion variables were doctors' beliefs about EC's effects on pregnancy rates, and patients' sexual practices. We also asked which women are offered EC. Predictors were demographic, clinical and religious characteristics.

RESULTS

Response rate was 66% (1154/1760). Most (89%) believe EC access lowers unintended pregnancy rates. Some believe women use other contraceptives less (27%), initiate sex at younger ages (12%) and have more sexual partners (15%). Half of physicians offer EC to all women (51%), while others offer it never (6%) or only after sexual assault (6%). Physicians critical of EC, males and religious physicians were more likely to offer it never or only after sexual assault (odds ratios 2.1-12).

CONCLUSION

Gender, religion and divergent beliefs about EC's effects shape physicians' beliefs and practices.

Pharmacy access to the emergency contraceptive pill: a national survey of a random sample of Australian women

BACKGROUND

The emergency contraceptive pill (ECP) has the potential to assist in reducing unintended pregnancy and abortion rates. Since its rescheduling to pharmacy availability without prescription in Australia in January 2004, there is little information about Australian women's knowledge, attitudes and use of the ECP. The aim of this study was to measure the knowledge about the ECP and sociodemographic patterns of and barriers to use of the ECP.

STUDY DESIGN

A cross-sectional study, using a computer-assisted telephone interview (CATI) survey conducted with a national random sample of 632 Australian women aged 16-35 years.

RESULTS

Most women had heard of the ECP (95%) and 26% had used it. The majority of women agreed with pharmacy availability of the ECP (72%); however, only 48% were aware that it was available from pharmacies without a prescription. About a third (32%) believed the ECP to be an abortion pill. The most common reason for not using the ECP was that women did not think they were at risk of getting pregnant (57%). Logistic regression showed that women aged 20-29 years (OR 2.58; CI: 1.29-5.19) and 30-35 years (OR 3.16; CI: 1.47-6.80) were more likely to have used the ECP than those aged 16-19 years. Women with poor knowledge of the ECP were significantly less likely to have used it than those with very good knowledge (OR 0.28; CI: 0.09-0.77). Those in a de facto relationship (OR 2.21; CI: 1.27-3.85), in a relationship but not living with the partner (OR 2.46; 95% CI 1.31-4.63) or single women (OR 2.40; CI: 1.33-4.34) were more likely to have used the ECP than married women.

CONCLUSIONS

Women in Australia have a high level of awareness of the ECP, but more information and education about how to use it and where to obtain it are still needed.

Cultural adaptation among Hispanic women as related to awareness and acquisition of emergency contraception

BACKGROUND

The study was conducted to examine the relationship between cultural adaptation (acculturation), contraceptive use, personal history of induced abortion, and emergency contraceptive (EC) awareness and acquisition among a sample of young sexually active Hispanic women.

STUDY DESIGN

A total of 959 Hispanic women between 16 and 24 years of age (mean±SD 20.71±2.42 years) completed a survey containing questions on EC acquisition and awareness, acculturation, contraceptive used at last intercourse and history of induced abortion. Data were analyzed using logistic regression analyses.

RESULTS

Acculturation (p=.017), income (p=.024) and education (p<.001) were positively associated with awareness of EC. Additionally, acculturation (p=.003) and a history of an induced abortion (p=.026) were positively associated with acquisition of EC.

CONCLUSIONS

Educational programs should make an effort to include Hispanic women with lower acculturation levels as increasing their knowledge about EC use and its mechanism of action may greatly reduce the number of unplanned pregnancies in this population.

Contraceptive needs of women seeking care from a publicly funded sexually transmitted infection clinic

OBJECTIVES

To determine the contraceptive needs [including emergency contraception (EC)] of women seeking care from a publicly funded sexually transmitted infection (STI) clinic and to better understand women's knowledge of and attitudes towards EC.

METHODS

An anonymous survey was administered to 197 women seeking services at one Chicago Department of Public Health STI clinic.

RESULTS

After excluding women unlikely to become pregnant within the next year because of age, sexual orientation, hysterectomy and those who desired pregnancy (n=47), data from 150 women were available for analysis. Thirteen percent were using "very effective" contraception (intrauterine contraception, implant or sterilization) and 26% were using "effective" contraception (contraceptive pill, patch, ring or injectable). Approximately 23% (95% CI 16.5-30.0%) may have benefited from immediate use of EC as they reported at least one act of unprotected intercourse within the past 5 days.

CONCLUSION

Many women seeking care from public STI clinics are at high risk of unintended pregnancy. A substantial number of women have an immediate need of EC at the time of their clinical visit. Efforts are needed to improve provision of EC as well as effective ongoing contraception for this population.

Young women's perceptions of pregnancy risk and use of emergency contraception: findings from a qualitative study

BACKGROUND

Advance provision of emergency contraception (EC) has increased use but not impacted on pregnancy or abortion rates. Here we describe young women's EC use and experiences of unprotected sex to explore why this difference occurs.

METHODS

In-depth interviews with twenty 20-year-old women from eastern Scotland.

RESULTS

The majority (16) had used EC; 10 reported some experience of unprotected sex. EC use followed contraceptive failure and unexpected or unplanned, but not frequent, unprotected sex. Acknowledging the need for EC requires recognition of pregnancy risk. Those reporting frequent unprotected sex misperceived their pregnancy risk and did not use EC. This group was from socially disadvantaged backgrounds, and all became pregnant.

CONCLUSIONS

EC remains an important "backup" contraceptive and should continue to be widely available. With high levels of unprotected sex, nonuse of EC and unintended pregnancies, further efforts are required to improve the sexual and reproductive health outcomes of disadvantaged young women.