contraceptives--postcoital and Emergencies

Topics: Contraception Behavior; Contraception, Postcoital; Contraceptives, Postcoital; Emergencies; Female; Humans; Risk Factors

A bill was introduced into the Tennessee legislature in the 2005 session that would require emergency departments to offer and dispense emergency contraception to sexual assault survivors who are at risk of pregnancy. Several advocacy groups collaborated to form the Women's Health Safety Network for the purpose of communicating as one voice. The advocacy coalition framework of policy development is applied to the political system and is used as a model to discuss issues impacting policy development for this particular bill. Key actors, proponents, and opponents to this bill are presented along with constraints to policy acceptance. The challenge for emergency contraception advocates on a state and national level is to keep the focus on public health science, the health and well-being of women, and out of the abortion debate.

Topics: Catholicism; Contraceptives, Postcoital; Cooperative Behavior; Emergencies; Emergency Service, Hospital; Female; Health Policy; Hospitals, Religious; Humans; Informed Consent; Interinstitutional Relations; Models, Organizational; Patient Advocacy; Patient Education as Topic; Patient Rights; Pregnancy; Pregnancy, Unwanted; Public Health; Rape; Tennessee; Women's Health

Women can use emergency contraception to prevent pregnancy after known or suspected failure of birth control or after unprotected intercourse. Many patients do not ask for emergency contraception because they do not know of its availability. Emergency contraception has been an off-label use of oral contraceptive pills since the 1960s. Dedicated products, the Yuzpe regimen (Preven) and levonorgestrel (Plan B), were marketed in the United States after 1998 but had been available in Europe for years before that. A third approved method of emergency contraception is the insertion of an intrauterine device. Emergency contraception is about 75 to 85 percent effective. It is most effective when initiated within 72 hours after unprotected intercourse. The mechanism of action may vary, depending on the day of the menstrual cycle on which treatment is started. Despite the large number of women who have received emergency contraception, there have been no reports of major adverse outcomes. If a woman becomes pregnant after using emergency contraception, she may be reassured about the lack of negative effects emergency contraception has on fetal development. It may be beneficial for physicians to offer an advance prescription for emergency contraception at a patient's regular gynecologic visit to help reduce unwanted pregnancies. Advance provision of emergency contraception can increase its use significantly without adversely affecting the use of routine contraception.

Topics: Contraception Behavior; Contraceptives, Postcoital; Drug Administration Schedule; Emergencies; Female; Humans

Topics: Contraceptives, Oral, Combined; Contraceptives, Postcoital; Emergencies; Estrogens; Female; Health Education; Humans; Intrauterine Devices, Copper; Patient Acceptance of Health Care; Pregnancy; Pregnancy, Unwanted; Progestins

Emergency contraception is used to prevent pregnancy after a coital act not adequately protected by a regular method of contraception. In contrast to early medical abortion, emergency contraception prevents a pregnancy from starting and does not disrupt an established pregnancy. The most commonly used approaches consist of two oral doses of contraceptive steroids. The levonorgestrel-only regimen (levonorgestrel, 0.75 mg, repeated in 12 hours) appears to be more effective and better tolerated than the Yuzpe regimen (ethinyl estradiol, 100 microg, and levonorgestrel, 0.5 mg, repeated in 12 hours). In the largest randomized, controlled trial to date, levonorgestrel prevented about 85% of pregnancies that would have occurred without its use. Hormonal emergency contraception has no known medical contraindications, although it is not indicated for suspected or confirmed pregnancy. However, if hormonal emergency contraception is inadvertently taken in early pregnancy, neither the woman nor the fetus will be harmed. Nausea and vomiting associated with the Yuzpe regimen can be reduced by prophylactic use of meclizine. A strong medical and legal case exists for making hormonal emergency contraception available over the counter, as has happened in countries other than the United States. Easier access to and wider use of emergency contraception could dramatically lower the high rates of unintended pregnancy and induced abortion in the United States.

Topics: Age Factors; Contraceptives, Postcoital; Contraceptives, Postcoital, Hormonal; Contraindications; Drug Combinations; Drug Interactions; Drug Prescriptions; Emergencies; Female; Fetus; Humans; Intrauterine Devices; Jurisprudence; Mifepristone; Nausea; Pregnancy; Pregnancy Tests; Pregnancy, Unwanted; Smoking; Time Factors; Vomiting

Topics: Attitude to Health; Contraception; Contraceptives, Postcoital; Cost Savings; Drug Prescriptions; Emergencies; Female; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Nurse Practitioners; Pregnancy; Pregnancy, Unwanted; Primary Health Care

Emergency contraception to prevent pregnancy after episodes of unprotected sexual intercourse has existed since ancient times. Modern medicine began to use hormonal methods in the 1960s, and today emergency contraception is used regularly in many countries. In the United States, providers do not routinely prescribe it, nor do they adequately inform their patients that it is available. This occurs even though sufficient information exists on the safety and efficacy of this method. Because the effectiveness of emergency contraceptive pills relies heavily on prompt administration, better access for patients is essential. Recently, proponents of emergency contraception have attempted to better inform the public of this resource. In addition, two oral contraceptive products are now available and marketed specifically for emergency contraception. The purpose of this article is to discuss the safety and efficacy of emergency contraceptive pills and the potential for them to become available without a prescription.

Topics: Contraceptives, Postcoital; Cost-Benefit Analysis; Emergencies; Female; Health Education; Health Services Accessibility; Hotlines; Humans; Information Services; Internet; Marketing of Health Services; Nonprescription Drugs; Safety; Time Factors; United States; Women's Rights

Emergency contraceptives are methods that prevent pregnancy when used shortly after unprotected sex. Three different emergency contraceptive methods are safe, simple, and widely available in the United States. These are: (1) ordinary combined oral contraceptives containing ethinyl estradiol and levonorgestrel taken in a higher dose for a short period of time and started within a few days after unprotected intercourse; (2) levonorgestrel-only tablets used similarly; and (3) copper-bearing intrauterine devices inserted within approximately 1 week after unprotected intercourse. Emergency contraceptive use is best known for women who have been raped, but the methods are also appropriate for women who have experienced condom breaks, women who did not use any method because they were not planning on having sex, or women who had unprotected intercourse for any other reason. Unfortunately, few women know about emergency contraceptives, and few clinicians think to inform their patients routinely about the option. A nationwide toll-free hotline (1-888-NOT-2-LATE) and a website (http://not-2-late.com) can help women learn about these options. Sharing "family planning's best-kept secret" widely with women could prevent as many as a million unwanted pregnancies annually in the United States.

Topics: Contraceptives, Oral, Combined; Contraceptives, Postcoital; Emergencies; Female; Health Services Accessibility; Humans; Intrauterine Devices, Copper; Pregnancy; Pregnancy, Unwanted; United States; Vomiting; Women's Health

Topics: Contraceptives, Postcoital; Emergencies; Female; Humans; Legislation, Drug; Nonprescription Drugs

Topics: Contraceptives, Oral, Combined; Contraceptives, Postcoital; Emergencies; Female; Humans; Travel

Topics: Contraceptives, Postcoital; Emergencies; Female; Humans

Emergency contraception, sometimes referred to as "morning after" or postcoital contraception, provides a second chance for women who experience contraceptive failure or do not use a method, as well as for women who experience unplanned intercourse, including coerced sex or rape. The two primary methods of emergency contraception are postcoital use of a higher dose of oral contraceptive pills and insertion of an intrauterine device (IUD). Both can significantly reduce a woman's chance of becoming pregnant (75% and 99% respectively). Knowledge of emergency contraception is crucial, since women must know they can prevent pregnancy after intercourse in order to seek out treatment. While rates of unwanted pregnancy vary in different countries and among population groups, the need for emergency contraception is critical worldwide, However, the availability of emergency contraception differs widely. It is most extensively used in Europe, but is still a new method in other countries, including the United States.

Topics: Contraceptives, Postcoital; Emergencies; Female; Global Health; Health Knowledge, Attitudes, Practice; Health Services Needs and Demand; Humans; Intrauterine Devices; Pregnancy; Pregnancy, Unwanted

Emergency contraception (EC) prevents pregnancy. Four regimens are available in different parts of the world, a combination of ethinyl estradiol and levonorgestrel, levonorgestrel alone, mifepristone, and emergency insertion of an intrauterine device. All the regimens are also used either as long-term contraception or, in the case of mifepristone, as an abortifacient, and considerable data indicate their safety when used in these ways. Data on safety when the regimens are used as EC are lacking, but theoretically, and from practical experience, all appear to be extremely safe, particularly when compared to the risks of pregnancy. There has been a tendency to over-"medicalize" EC. Prescribing EC is simple. Consideration should be given to making EC available off prescription because it is so safe.

Topics: Clinical Protocols; Contraceptives, Postcoital; Drug Prescriptions; Drug Therapy, Combination; Emergencies; Female; Humans; Intrauterine Devices; Pregnancy; Professional Autonomy; Referral and Consultation; Safety

Women should be informed that it is possible to prevent unwanted pregnancy after intercourse in most cases by effective emergency contraception (EC). The currently used hormonal method, the Yuzpe regimen, however, has unpleasant side effects. The UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research training in Human Reproduction has worked on developing improved methods of EC for the last ten years. This research has focused on levonorgestrel and mifepristone. Now that results from large clinical studies are becoming available, they suggest that both these compounds are better tolerated and appear even more effective than the Yuzpe regimen. The challenge now is to implement the research results by making better emergency contraceptives a reality for women.

Topics: Abortifacient Agents, Steroidal; Clinical Trials as Topic; Contraceptives, Postcoital; Drug Therapy, Combination; Emergencies; Estradiol Congeners; Ethinyl Estradiol; Female; Humans; Levonorgestrel; Mifepristone; Norgestrel; Pregnancy; Pregnancy, Unwanted; Progesterone Congeners; World Health Organization

Leading health agencies, including the World Health Organization and the US Food and Drug Administration, consider emergency contraceptive pills (ECPs) safe and effective and have called for better access to them. Yet debate about whether ECPs should continue to be available by prescription only has been limited. After measuring the characteristics of ECPs against criteria developed to assess the necessity for prescription status for drugs generally, we argue that ECPs can safely be marketed over the counter. Professional assistance is not necessary since the woman diagnoses her own need for the pills and takes them herself. ECPs do not need to be adjusted for the individual woman and pose no potential threat of overdose or addiction. There are no contraindications except confirmed pregnancy (in which case the therapy will not work), and monitoring is not necessary. We conclude that prescription requirements that keep ECPs from women provide little, if any, benefit.

Topics: Contraceptives, Postcoital; Drug and Narcotic Control; Drug Prescriptions; Emergencies; Female; Health Services Accessibility; Humans; Nonprescription Drugs; Pregnancy; Safety; United States; United States Food and Drug Administration; World Health Organization

Despite the proven safety and efficacy of providing concentrated doses of oral contraceptive pills as postcoital contraception, many physicians and health care providers are unclear as to this "off-label" use and thus remain reluctant to dispense it. It is critical that health care providers learn about both the medical and legal aspects of providing emergency contraception so that they can make this important method of pregnancy prevention available to their patients. While a dedicated product may soon gain US Food and Drug Administration approval and go on the market, it is still important for health care providers to be aware of the legal issues surrounding the various aspects of both on- and off-label provision of emergency contraceptive pills. This paper provides an overview of the legal issues involved and suggests that there are a number of ways that health care providers can make emergency contraceptive pills available and readily accessible to patients with no serious legal risk.

Topics: Advertising; Contraceptives, Postcoital; Drug and Narcotic Control; Drug Packaging; Drug Prescriptions; Emergencies; Female; Humans; Liability, Legal; Pregnancy; United States; United States Food and Drug Administration

Barriers to widespread use of emergency contraception (EC) include lack of knowledge on the part of women and providers, lack of support for the method from providers, and lack of a dedicated product in many countries. This article reviews strategies to improve women's access to EC launched by national or regional health authorities, clinicians, grass-roots health organizations, and women's groups. Information campaigns have targeted women to improve their knowledge of EC and providers to improve their comfort with it. Local groups and individual providers have also provided leaflets or designed innovative service strategies in order to improve women's access to the method. Expanding the scope or number of these programs and introducing them in areas where women do not currently have adequate knowledge of or access to EC will insure that more women will be able to use this method.

Topics: Contraceptives, Postcoital; Delivery of Health Care; Drug Information Services; Emergencies; Europe; Female; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; United States; Women

Recent publications about emergency and implantable contraception focused on increasing the awareness about emergency contraceptive methods and on updating readers about the controversies surrounding Norplant. Both emergency and implantable contraception have excellent safety and efficacy profiles, yet neither has realized its potential for widespread use. This review addresses these concerns and attempts to place these issues in perspective.. Long-acting, user-independent methods such as Norplant and postcoital interventions are important contraceptive options. Despite their excellent safety and efficacy profiles, both methods have failed to achieve their potential for widespread use. This paper reviews the issues and controversies associated with these methods in the US. Norplant has suffered a recent marked reduction in demand as a result of negative publicity and litigation concerning its side effects, removal difficulties, and the Silastic content of the implants. Norplant acceptors tend to be adolescent and adult women who have experienced contraceptive failures or dissatisfaction with other methods. Satisfaction and side-effect tolerance appear to be directly related to the quality of pre-insertion counseling. Emergency contraception has been used in the US after instances of rape and contraceptive failure, but they should be made more widely available in other situations in which pregnancy is not desired after unprotected intercourse. Since almost half of unintended pregnancies occur among contraceptive users, postcoital contraception is an appropriate adjunct to more traditional contraceptive practices.

Topics: Contraception; Contraceptives, Postcoital; Emergencies; Female; Humans; Intrauterine Devices, Medicated; Levonorgestrel; Progesterone Congeners

Adolescent pregnancy challenges the United States and Europe. For most sexually active adolescents, pregnancy is unintended. Emergency contraception, also called the "morning-after treatment" or postcoital contraception is a way to prevent pregnancy after unprotected intercourse. In February 1997, the Food and Drug Administration (FDA) approved the use of certain oral contraceptive pills for emergency contraception. There are currently six brands of pills marketed in the United States that can be prescribed to, conform to the FDA-approved regimen. When emergency contraceptive pills are initiated within 72 hours of unprotected intercourse, they reduce the risk of pregnancy by 75%. Contraindications are the same as those used for ongoing contraceptive pills. The most common side effects are nausea, vomiting, menstrual disturbances, breast tenderness, abdominal cramping, dizziness, headache, and mood changes. Routinely counseling all adolescents about emergency contraceptive pills and increasing access to them can give adolescents a second chance at preventing pregnancy.. When initiated within 72 hours of unprotected intercourse, emergency contraception can reduce the risk of unintended pregnancy by 75%. The most common approach to postcoital fertility control is the Yuzpe regimen, which can be used with six brands of oral contraceptives currently available in the US. Despite the US Food and Drug Administration's 1997 approval of use of oral contraceptives for this use, postcoital fertility control is neither promoted among US adolescents nor routinely included in contraceptive counseling. This paper reviews the efficacy, mechanism of action, regimens, cost, indications, contraindications, and side effects of emergency contraception. Also presented are guidelines for counseling adolescents, answering their questions, and the initial and follow-up visits. If the goal is to prevent adolescent pregnancy, all adolescents--regardless of sexual status--should be counseled about emergency contraception at every opportunity available. Counseling can be enhanced by placing posters in bathrooms and waiting rooms and providing written information. Access can be improved further by instructing secretarial and nursing staff to ask patients when they call for an appointment if emergency contraception is needed. Among the obstacles to more widespread use of this method are concerns on the part of some health care providers that the availability of emergency contraception will discourage compliance with ongoing methods and encourage sexual risk taking.

Topics: Adolescent; Contraceptives, Postcoital; Counseling; Emergencies; Female; Humans; Pregnancy; Pregnancy in Adolescence; Pregnancy, Unwanted; Time Factors; Treatment Outcome; United States; United States Food and Drug Administration

In the US, few products are marketed for emergency contraception and drug manufacturers have been reluctant to enter this market, despite invitations from the US Food and Drug Administration to do so. When started within 72 hours after unprotected intercourse, a combination of ethinyl estradiol and levonorgestrel is at least 75% effective against pregnancy. The antiprogestin mifepristone is even more effective and has fewer side effects. Other emergency methods include progestin alone, the antigonadotropin danazol, and postcoital insertion of an IUD. This article reviews the modes of action of emergency contraception (effects on ovulation, fertilization, gamete transport, the corpus luteum, and implantation), its indications, and the efficacy of the various regimens. The lack of availability and promotion of emergency contraception in the US is, in large part, a result of opposition from anti-abortion groups. Since this method acts before implantation, it cannot be considered an abortifacient.

Topics: Contraception; Contraceptives, Postcoital; Danazol; Embryo Implantation; Emergencies; Ethinyl Estradiol; Female; Fertilization; Humans; Intrauterine Devices; Levonorgestrel; Ovulation; Pregnancy; Pregnancy, Unwanted

Topics: Contraceptives, Postcoital; Emergencies; Female; Humans; Medical History Taking; Nurse Practitioners; Nursing Assessment; Patient Education as Topic

Topics: Abortion, Induced; Condoms; Contraceptives, Postcoital; Emergencies; France; Health Knowledge, Attitudes, Practice; Humans

Topics: Contraceptives, Oral, Combined; Contraceptives, Postcoital; Danazol; Emergencies; Estrogen Antagonists; Female; Humans; Menstrual Cycle; Mifepristone; Pregnancy; Pregnancy, Unwanted; Progestins; Time Factors

An estimated 70% of induced abortions could be prevented through the use of postcoital/emergency contraception. A study has also shown that 90% of women who have had an induced abortion would have preferred to have used emergency contraception. Emergency contraception is safe, effective, and dependent upon good doctor-patient communication. Doctors need to explain to clients through leaflets and publicity in their clinics that they can provide confidential services, including emergency contraception. Practice nurses and receptionists must cooperate in the delivery of such services and the maintenance of client confidentiality. The methods available for emergency contraception are described, as well as when and when not to use them, what the patient needs to know, and how the service can be delivered in primary care. Hormonal emergency contraception, progestogen-only emergency contraception, and the IUD are discussed.

Topics: Contraceptives, Postcoital; Contraindications; Drug Administration Schedule; Emergencies; Family Practice; Female; Humans; Intrauterine Devices, Medicated; Medical Records; Professional Practice; Progestins; Time Factors

Topics: Contraceptives, Postcoital; Drug Administration Schedule; Emergencies; Female; Humans; Nurse Practitioners; Pregnancy

In the Netherlands, many women use a postcoital method of contraception in "emergency" situations. Postcoital contraception started in the 1960's with the administration of large doses of estrogens: 50 mg diethylstilbestrol for 5 days or 5 mg ethinylestradiol for 5 days. In the eighties, a double-blind study compared the original hormonal therapy of 5 mg ethinylestradiol for 5 days with a combination pill containing just 0.1 mg in combination with 1 mg d1-norgestrel, of which two doses are give, the second 12 hours after the first. This method was as effective in preventing pregnancy as the original treatment with high estrogen dosage. Moreover, it resulted in women suffering less nausea and vomiting. One study from Hong Kong indicated that levonorgestrel without ethinylestradiol was as effective as the combination. Postcoital use of an intrauterine device to prevent pregnancy can be used as an alternative to the hormonal method. A recent development is the use of an antiprogestagen pill: 600 mg Mifepristone on day 27 of the cycle; side effects are minimal and the success rate is high. Mifepristone should be registered and made available in all countries for this indication.. Many women in the Netherlands depend on a postcoital contraceptive (PCC) method in situations of unprotected intercourse. The incidence rate for abortions and for adolescent pregnancies in the Netherlands is the lowest worldwide. Dutch society matter-of-factly accepts adolescent sexuality and provides formal and informal sex education and readily accessible contraceptive services. Emergency contraception should be administered within 72 hours after unprotected intercourse (e.g., rape or incest) or mechanical contraceptive failure. Administration of 5 mg ethinyl estradiol (EE) for 5 days as a PCC first occurred in the Netherlands in 1964, and PCC usage peaked at 55,000 in 1975. Side effects of EE include, in order of frequency, nausea, vomiting, tender breasts, and menorrhagia. Possible modes of action for EE are more rapid transport of fertilized ova through the oviduct and slowed maturation of the endometrium, resulting in suppressed implantation. The Yuzpe PCC method involves 4 tablets of a combined oral contraceptive (each tablet with 50 mcg EE + 250 mcg levonorgestrel) administered within 72 hours followed by 2 tablets 12 hours later. Side effects are similar to those of EE alone, as is the effectiveness rate. A dose of 0.75 mg levonorgestrel alone is as effective at preventing pregnancy as the Yuzpe regimen. Side effects are considerably less common with the levonorgestrel regimen than the Yuzpe regimen. For women who present more than 72 hours after and less than 7 days after unprotected intercourse or for those with contraindications to estrogen, a copper-releasing IUD can serve as a PCC. A postcoital IUD can cause serious complications for women with a sexually transmitted disease, however. Taking RU-486 during the luteal phase of the menstrual cycle greatly drops plasma levels of progesterone and estradiol. Postovulatory administration of an antiprogestogen is the best PCC method because of minimal side effects and a high success rate.

Topics: Contraceptives, Oral, Combined; Contraceptives, Postcoital; Emergencies; Ethinyl Estradiol; Female; Humans; Intrauterine Devices, Copper; Levonorgestrel; Mifepristone

In 1991, around 200,000 pregnancies were terminated in the UK. In a study of 733 women undergoing pregnancy termination in Oxford, over 40% admitted that they were using no contraception at the time they conceived. 528 of the pregnancies were predictable as either no contraception was used or a recognizable contraceptive failure occurred. 80% of these pregnancies might have been prevented by postcoital contraception (PCC), which only 18 women admitted to using. In a recent study of 398 women using the standard combined estrogen-progestogen regime, only 4 conceived, yielding a failure rate of 1%. Calculating the chance of conception for each individual woman based on the timing of intercourse, 23 pregnancies would have been anticipated, and over 80% were prevented by PCC. The IUD is even more effective in women for whom combined estrogen-progestogen is relatively contra-indicated or in those who present beyond 72 hours after intercourse: only 1 pregnancy occurred in 879 postcoital insertions and that pregnancy miscarried spontaneously. Recently, the antiprogesterone mifepristone (RU-486), given as a single dose of 600 mg, proved a safe and highly effective postcoital agent compared with the standard combined estrogen-progestogen regime. No pregnancies occurred in almost 600 women treated within 71 hours of intercourse. In a study, 30% of women did not know about emergency contraception and another 10% did not know where to get it. In a survey commissioned by Schering, over 75% of 1007 women had heard of PCC, but only 10% had an accurate knowledge of its time limits. the only contraindications of PCC are pregnancy and a history of contraindications to estrogen, such as thromboembolism. It is highly unlikely that any woman would suffer severe adverse effects from taking 200 mcg of ethinyl estradiol on one occasion. There is no evidence of any change in clotting factors following the use of the standard regime.

Topics: Contraceptives, Postcoital; Emergencies; Female; Humans; Legislation, Drug; United Kingdom

To evaluate a community-based intervention regarding emergency contraceptive pills, including a mass media campaign and information to women visiting family planning clinics.. Quasi-experimental.. Two counties in Sweden.. Eight hundred randomly selected women aged 16-30 years, 400 women in the intervention group and 400 in a comparison group.. Postal questionnaires before (2002) and after (2003) the intervention.. Exposure to the intervention, knowledge, attitudes, practices and intention to use emergency contraceptive pills.. Before the intervention, the response rate was 71% (n= 564); after the intervention, the corresponding figure was 83% (n= 467); overall response rate 58%. Two-thirds (64%) of the targeted women had noticed the information campaign. One out of six who had visited a family planning clinic during the intervention year recalled being given information about emergency contraceptive pills. Specific knowledge and attitudes improved over time in both groups, but there was no difference in change between the groups. The proportion of women who had used emergency contraceptive pills increased from 27% to 31% over time. Intention to use emergency contraceptive pills in case of need was reported by 74% of the women and remained stable over time, but logistic regression showed that information during the previous year contributed to willingness to use the method in the intervention group.. Knowledge, attitudes and practices about emergency contraceptive pills increased in both groups. Emergency contraceptive pills is gradually becoming a more widely known, accepted and used contraceptive method in Sweden, a trend that may have limited the impact of the intervention.

Topics: Adolescent; Adult; Awareness; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Health Promotion; Humans; Mass Media; Pregnancy; Progestins; Program Evaluation; Sweden

To evaluate whether advance provision of emergency contraception increases its use and/or adversely affects usual contraceptive practices.. We performed a randomized controlled trial comparing advance provision of emergency contraception with usual care in 370 postpartum women from an inner-city public hospital. Participants were followed for 1 year; 85% were available for at least one follow-up session. All participants received routine contraceptive education. The intervention group received a supply of emergency contraception (eight oral contraceptive pills containing 0.15 mg of levonorgestrel and 30 microg of ethinyl estradiol) and a 5-minute educational session. We compared use of emergency contraception and changes in contraceptive behaviors between groups.. Women provided with pills were four times as likely to have used emergency contraception as women in the control group over the course of the year (17% versus 4%; relative risk [RR] 4.0; 95% confidence interval [CI] 1.8, 9.0). Women were no more likely to have changed to a less effective method of birth control (30% versus 33%; RR 0.92; 95% CI 0.63, 1.3), or to be using contraception less consistently (18% versus 25%; RR 0.74; 95% CI 0.45, 1.2). About half of each group reported at least one episode of unprotected intercourse during follow-up, but women who received emergency contraception were six times as likely to have used it (25% versus 4%; RR 5.8; 95% CI 2.1, 16.4).. Advance provision of emergency contraception significantly increased use without adversely affecting use of routine contraception. It is safe and appropriate to provide emergency contraception to all postpartum women before discharge from the hospital.

Topics: Adult; California; Confidence Intervals; Contraception; Contraceptives, Oral; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; Patient Education as Topic; Patient Satisfaction; Pregnancy; Pregnancy, Unwanted; Reference Values

A previous randomised study suggested that the progestagen, levonorgestrel, given alone in two separate doses each of 0.75 mg caused nausea and vomiting in fewer women and might be more effective than the Yuzpe regimen of combined oral contraceptives for emergency contraception, although the difference was not significant. We compared these two regimens when started within 72 h of unprotected coitus.. We enrolled in the double-blind, randomised trial 1998 women at 21 centres worldwide. Women with regular menses, not using hormonal contraception, and requesting emergency contraception after one unprotected coitus, received levonorgestrel (0.75 mg, repeated 12 h later) or the Yuzpe regimen (ethinyloestradiol 100 microg plus levonorgestrel 0.5 mg, repeated 12 h later).. Outcome was unknown for 43 women (25 assigned levonorgestrel, 18 assigned Yuzpe regimen). Among the remaining 1955 women, the crude pregnancy rate was 1.1% (11/976) in the levonorgestrel group compared with 3.2% (31/979) in the Yuzpe regimen group. The crude relative risk of pregnancy for levonorgestrel compared with the Yuzpe regimen was 0.36 (95% CI 0.18-0.70). The proportion of pregnancies prevented (compared with the expected number without treatment) was 85% (74-93) with the levonorgestrel regimen and 57% (39-71) with the Yuzpe regimen. Nausea (23.1 vs 50.5%) and vomiting (5.6 vs 18.8%) were significantly less frequent with the levonorgestrel regimen than with the Yuzpe regimen (p<0.01). The efficacy of both treatments declined with increasing time since unprotected coitus (p=0.01).. The levonorgestrel regimen was better tolerated and more effective than the current standard in hormonal emergency contraception. With either regimen, the earlier the treatment is given, the more effective it seems to be.

Topics: Adult; Contraceptives, Oral, Combined; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Double-Blind Method; Emergencies; Estradiol Congeners; Ethinyl Estradiol; Female; Humans; Levonorgestrel; Nausea; Pregnancy; Pregnancy, Unwanted; Risk; Time Factors; Vomiting

To assess the knowledge, attitudes and practices of general practitioners in New South Wales regarding the provision of emergency contraception.. Randomised group comparison of 100 rural and 100 urban general practitioners (GPs) by questionnaire.. Eighty-four rural and 76 urban GPs responded. More rural GPs were knowledgeable about emergency contraception than urban GPs (95% v. 78%), and more women knew about it than men. More urban GPs frequently prescribed emergency contraception than rural GPs (26% v. 6%) and female GPs prescribed it more readily than male GPs (22% v. 12%). There was great variation in the regimens prescribed, especially among rural GPs. Twenty-five per cent of urban GPs and 31% of rural GPs did not offer women information about emergency contraception, while 16% of both groups included such information in any discussion about contraceptive options, and 18% gave information only if requested by the woman. More than 60% of the GPs would provide information about emergency contraception as a back-up to use of barrier methods.. The sex, attitude and knowledge of the GPs influence the likelihood of women being made aware of or being given emergency contraception in NSW. There is a need to further educate both the public and practitioners about emergency contraception.. In New South Wales, Australia, 76 urban general practitioners (GPs) and 84 rural GPs completed a questionnaire designed to determine their knowledge, attitude, and prescribing practices concerning emergency contraception. Rural GPs were more likely to know about emergency contraception than urban GPs (95% vs. 78%). Yet urban GPs were more likely than rural GPs to receive many requests for emergency contraception (25% vs. 6%; p = 0.018) and to prescribe it often (26% vs. 6%; p = 0.009). Female GPs not only were more likely than male GPs to know about emergency contraception but also to prescribe it (22% vs. 12%; p = 0.009). 58% of urban GPs and 52% of rural GPs prescribed the Yuzpe regimen (100 mcg ethinyl estradiol + 500 mcg levonorgestrel within 72 hours of unprotected intercourse and repeated 12 hours later). The GPs (particularly rural GPs) varied greatly in the emergency contraception regimens prescribed. These prescribed variable regimens, other than the Yuzpe regimen, have not been adequately studied, however. 28% of urban GPs and 31% of rural GPs did not automatically provide information about emergency contraception. 16% of both groups always included emergency contraception in discussions about contraceptive options. 18% only provided this information on request. 60% of all GPs would provide information about emergency contraception as a back-up to barrier methods. These findings suggest the need for GPs and the public to become educated about emergency contraception. Pharmaceutical companies should provide a specific emergency contraceptive package so that regulators can approve it and that normal marketing can begin. Ideally, a prepackaged postcoital regimen should be available over-the-counter.

Topics: Attitude of Health Personnel; Clinical Competence; Contraceptive Devices; Contraceptives, Postcoital; Counseling; Drug Prescriptions; Drug Utilization; Emergencies; Family Practice; Female; Humans; Male; New South Wales; Patient Education as Topic; Physician-Patient Relations; Practice Patterns, Physicians'; Rural Health; Sex Factors; Urban Health

Topics: Adult; Contraceptives, Postcoital; Drug Information Services; Emergencies; Female; Humans; Terminology as Topic

Topics: Abortion, Legal; Adolescent; Adult; Awareness; Contraception; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Health Surveys; Humans; Patient Education as Topic; Pregnancy

Teachers and guardians (parents or authorized persons) are expected to collaborate in educating female students about emergency contraceptive pills (ECPs) but it is unknown whether they have similar perspectives on ECPs. This study aimed to compare their knowledge, attitudes, experience, and opinions regarding ECPs. Questionnaires were distributed to 720 female teachers and guardians of eight randomly selected high schools and vocational schools in Chiang Mai, Thailand. There were significantly more teachers who knew about the existence of ECPs than guardians. More guardians reported some accurate information regarding ECPs than did teachers. More teachers than guardians believed that the use of ECPs was not morally wrong. Both teachers and guardians had similar experience with ECP use and similar agreement in teaching female adolescents about ECPs. The teachers and guardians had some different opinions on teaching barriers. It is suggested that both teachers and guardians are suited to teach female adolescents about ECPs, but they need preparation in different aspects.

Topics: Adolescent; Adult; Aged; Attitude to Health; Contraceptives, Postcoital; Educational Status; Emergencies; Faculty; Female; Health Knowledge, Attitudes, Practice; Humans; Income; Marital Status; Middle Aged; Organizational Policy; Parents; Psychology, Adolescent; Schools; Sex Education; Shame; Surveys and Questionnaires; Teaching Materials; Thailand

Topics: Contraceptives, Oral; Contraceptives, Postcoital; Emergencies; Female; Fertilization; Humans; Male; Ovulation; Ovum Transport; Rape; Sperm Transport; United States; United States Food and Drug Administration

The purpose of this study was to examine knowledge, attitudes, and behaviors regarding emergency contraception (EC) in university men and women aged 18-21.. Data sources included responses to a 25-item questionnaire and an 8-item demographic survey completed anonymously at a public site on campus. Ninety-seven university students participated in the study. Participants were asked to respond to questions relating to knowledge, attitudes, and behaviors regarding EC, perceived worthiness, objections, sources of information about EC, preferred birth-control method and usage, and perceptions of their personal risk of unintended pregnancy.. Many respondents considered unintended pregnancy to be a major problem and considered EC a worthy option in the event of method failure or unprotected intercourse. While most participants were aware that there was a postcoital method of contraception, confusion existed between EC and RU-486 (the abortion pill). Almost half (49.5%) believed that EC was the same as RU-486. There was an association between advanced prescription for EC and its likelihood of use. Most women would be significantly more likely to use EC if they had a prescription on hand. Of the women who were less likely to choose EC, 100% indicated they would feel embarrassed or judged when asking for it. Only 34% of those women who have had a gynecological exam in the past 12 months had discussed EC with their provider.. Advanced practice nurses need to incorporate EC into preventive health counseling for both men and women. Providing women with an advanced prescription increases the likelihood that women will use EC.

Topics: Adolescent; Adult; Attitude to Health; Contraception Behavior; Contraceptives, Postcoital; Cross-Sectional Studies; Emergencies; Female; Health Knowledge, Attitudes, Practice; Health Services Needs and Demand; Humans; Male; Men; North Carolina; Nurse Practitioners; Racial Groups; Religion and Psychology; Sex Education; Sex Factors; Sexual Behavior; Students; Surveys and Questionnaires; Universities; Women

Topics: Adolescent; Adolescent Medicine; Contraceptives, Postcoital; Emergencies; Female; Guidelines as Topic; Humans; Pregnancy; Pregnancy in Adolescence

Emergency contraception can play an important role in reducing the rate of unintended pregnancies in Nigeria. Although it is included in the national family planning guidelines, there is limited awareness of this method among clients.. In 2003-2004, a sample of 256 health care providers within Lagos State were surveyed about their knowledge of, attitudes toward and provision of emergency contraceptives, using a 25-item, self-administered questionnaire. Frequencies were calculated for the various measures, and chi-square tests were used to determine significant differences.. Nine in 10 providers had heard of emergency contraception, but many lacked specific knowledge about the method. Only half of them knew the correct time frame for effective use of emergency contraceptive pills, and three-fourths knew that the pills prevent pregnancy; more than a third incorrectly believed that they may act as an abortifacient. Fewer than a third of respondents who had heard of the pills knew that they are legal in Nigeria. Of those who had heard about emergency contraception, 58% had provided clients with emergency contraceptive pills, yet only 10% of these providers could correctly identify the drug, dose and timing of the first pill in the regimen. Furthermore, fewer than one in 10 of those who knew of emergency contraception said they always provided information to clients, whereas a fourth said they never did so.. Nigerian health care providers urgently need education about emergency contraception; training programs should target the types of providers who are less knowledgeable about the method.

Topics: Contraception, Postcoital; Contraceptives, Postcoital; Data Collection; Developing Countries; Educational Status; Emergencies; Female; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Intrauterine Devices, Copper; Male; Nigeria

Topics: Abortion Applicants; Abortion, Induced; Adolescent; Adult; Awareness; Contraception Behavior; Contraceptives, Postcoital; Contraceptives, Postcoital, Hormonal; Cross-Sectional Studies; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; Middle Aged; Nonprescription Drugs; Pregnancy; Surveys and Questionnaires; Sweden

To evaluate a community-based intervention consisting of an information campaign and advance provision of emergency contraceptive pills (ECP) to abortion applicants.. Submission of repeated waiting room questionnaires to abortion applicants in two cities in mid-Sweden; one intervention city (IC) and one comparison city (CC) in 2002 (IC = 92, CC = 95) and 2003 (IC = 244, CC = 204).. The overall response rate was 90%. The percentage of women who had undergone an abortion within the previous year had decreased in the intervention group but not in the comparison group. Almost two-thirds (63%) of the targeted women had noticed the information campaign and one out of three (33%) who had visited a family planning clinic recalled being given information about ECP. There was a small decline in the use of combined oral contraceptives and intrauterine devices over time. After the intervention, women in the intervention city had better knowledge of ECP and had used it more than women in the comparison city did.. More than half of the targeted women had noticed the information campaign and it may have had a limited impact. Further investigations are needed to determine whether advance supply of ECP to abortion applicants can reduce repeat abortions.

Topics: Abortion, Induced; Adolescent; Adult; Contraceptives, Postcoital; Cross-Sectional Studies; Emergencies; Female; Health Knowledge, Attitudes, Practice; Health Promotion; Humans; Middle Aged; Pregnancy; Surveys and Questionnaires; Sweden; Waiting Lists

To study the level of awareness and use of emergency contraception (EC) in women attending a pregnancy termination clinic.. A questionnaire was handed to all women attending the clinic for termination of pregnancy and related advice during the month of February 2003. Completed questionnaires were collected before the women left the clinic and the data analysed.. A total of 78 women received the questionnaire and all except two were returned. Fifty-nine (78%) women were familiar with EC. Sixty percent of women felt that EC was easily accessible, but only 37% of them had ever used it. However, 90% of the women questioned would consider using EC in the future.. Despite the level of awareness of EC in Fife being quite good, EC is underused for many reasons.

Topics: Abortion Applicants; Abortion, Legal; Adolescent; Adult; Awareness; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; Pregnancy; Pregnancy, Unwanted; Surveys and Questionnaires; United Kingdom

There have been many approaches to understanding contraception use including social cognition models which have been criticised for their individualistic approach and their static nature. The present quantitative study developed and refined a contextual and dynamic model of contraception use that was derived using qualitative research. This model conceptualizes the predictors of contraception use in terms of the meaning and importance of a range of social goals, perceptions of vulnerability, and constraints on or facilitators of contraception use each of which changes over time. The present study operationalized this model in relation to emergency contraception and explored differences between users and non-users and between episodes of use and non-use. In terms of users and non-users, the results showed that the users of emergency contraception showed a more positive view of an emergency contraception user, perceived greater support from their partner for emergency contraception use, rated themselves more at risk of pregnancy, and felt more confident about asking for emergency contraception. In terms of use and non-use, use was related to an increased belief about the risk of pregnancy, increased partner support, increased concern about health care professionals and the side-effects of the drug, and a more positive identity of an emergency contraception. The study has helped to develop and refine the model and has identified some key factors that are specifically relevant to emergency contraception use in a sample of women in education in and around London.

Topics: Adult; Aspirations, Psychological; Contraceptives, Postcoital; Culture; Emergencies; England; Female; Goals; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Internal-External Control; Male; Pregnancy; Self Efficacy; Sexual Partners; Social Support

Emergency contraception is increasing in use and has become a universal standard of care in the United States. This article reviews available forms of emergency contraception, their indications, contraindications, adverse effects and efficacy at preventing pregnancy. This article describes the mechanism of action of different forms of emergency contraception and provides recommendations on when to start or restart an ongoing method of contraceptive after emergency contraception use. Literature on the impact of the advance provision of emergency contraception on contracepting behaviors is reviewed, and behavior change counseling related to emergency contraception is described.

Topics: Adolescent; Contraception; Contraceptives, Oral; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; Intrauterine Devices, Copper; Mifepristone; Pregnancy; Pregnancy in Adolescence; Progestins; Risk Factors; Treatment Outcome

Topics: Adult; Contraception; Contraceptive Agents, Female; Contraceptives, Postcoital; Emergencies; Female; Fertilization; Humans

Topics: Contraceptives, Postcoital; Drug Approval; Emergencies; Female; Humans; Nonprescription Drugs; Politics; United States; United States Food and Drug Administration

A hospital-based program simulating nonprescription access to emergency contraception (EC) is described.. A collaborative agreement between the pharmacy and therapeutics committee and the pharmacy department was initiated at a safety-net teaching hospital to provide EC to clinic patients directly from the hospital pharmacy without the need to first see a health care provider. EC was available 24 hours per day to any woman requesting it at the hospital pharmacy, with the collaborative agreement serving as the prescription. During clinic hours, patients were directed to the outpatient pharmacy to request EC. After hours, patients went to the emergency department triage desk and were directed to the inpatient pharmacy. Patients making inquiries about EC were encouraged to see their health care provider as soon as possible for counseling about contraceptive options. No specific program was initiated for publicizing the increased availability of EC, as it was assumed that health care providers and word-of-mouth would inform patients of this option.. The program was initiated in the fourth quarter of 2001. Total doses of EC dispensed increased nearly eightfold over the 1.5-year study period since the inception of this program. Most of this increase (81%) was attributable to the collaborative agreement. Twenty-eight percent of EC was dispensed outside of regular clinic hours. No patient complaints regarding this plan were received, and pharmacy staff did not believe that this program presented a significant additional burden to their workload.. A collaborative agreement simulating nonprescription availability increased the use of EC in a hospital-based clinic setting.

Topics: Administration, Oral; Adolescent; Adult; Contraceptives, Postcoital; Drug Combinations; Drug Utilization Review; Emergencies; Ethinyl Estradiol; Female; Health Services Accessibility; Hospitals, Teaching; Humans; Levonorgestrel; Nonprescription Drugs; Pharmacy Service, Hospital; Time Factors; United States

Topics: Contraceptives, Postcoital; Emergencies; Female; Humans; Research Design; Treatment Outcome; Ultrasonography; Uterus

Topics: Contraception Behavior; Contraceptives, Postcoital; Emergencies; Female; Humans

Topics: Contraceptives, Postcoital; Emergencies; Female; Humans

Topics: Canada; Conscience; Contraceptives, Postcoital; Disclosure; Emergencies; Female; Health Services Accessibility; Humans; Medical Records; Physician-Patient Relations; Pregnancy; Pregnancy, Unwanted; Referral and Consultation; Women's Health

Deregulation of emergency contraceptive pills (ECP) has led to pharmacy staff becoming a new provider group of ECP, together with nurse-midwives, who are already experienced in prescribing contraceptives. This postal questionnaire survey aimed to assess practices and attitudes towards ECP and the over-the-counter (OTC)-availability among pharmacy staff (n=237) and nurse-midwives (n=163). The overall response rate was 89%. Both study groups were positive to ECP and the OTC-availability and the vast majority agreed that sexually active women should be aware of ECP and that routine information about ECP should be included in contraceptive counseling. Verbal information on all aspects of ECP to clients was reported more often by nurse-midwives than by pharmacy staff. Both groups supported collaboration between providers. Our findings suggest that further collaboration between pharmacies and family planning clinics should be encouraged to ensure a competent and client-friendly provision of ECP.

Topics: Adult; Attitude of Health Personnel; Contraceptives, Postcoital; Cooperative Behavior; Counseling; Discriminant Analysis; Emergencies; Female; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Interdisciplinary Communication; Interprofessional Relations; Male; Middle Aged; Nonprescription Drugs; Nurse Midwives; Patient Education as Topic; Pharmacists; Practice Patterns, Physicians'; Professional Role; Social Support; Surveys and Questionnaires; Sweden

Although contraceptives, including emergency contraceptives, are widely available free at public health facilities in South Africa, rates of teenage and unintended pregnancy are high. This paper analyses awareness and utilisation of emergency contraception amongst 193 young women (aged 15-24 years) attending public sector health facilities. Structured interviews were held at 17 and 14 primary health clinics in an urban and a rural area respectively. Respondents were asked about their knowledge of contraceptive methods and use, and specifically about emergency contraceptive utilisation. More sexually active young urban women (76%) were currently using a method of contraception, compared to the young rural women (53%). Only 17% had ever heard of emergency contraception, although significantly more in the urban area (p = 0.005) had heard of it. Only one woman from each site had ever used emergency contraception, although 39% had had unprotected intercourse in the previous year when they did not wish to conceive. Young South African women should be the focus of interventions aimed at improving awareness of the availability of emergency contraception and knowledge about its correct utilisation.

Topics: Adolescent; Adult; Contraception; Contraception Behavior; Contraceptives, Postcoital; Educational Status; Emergencies; Employment; Family Planning Services; Female; Health Care Surveys; Health Knowledge, Attitudes, Practice; Humans; Marital Status; Needs Assessment; Patient Acceptance of Health Care; Public Sector; Rural Health; Sex Education; South Africa; Surveys and Questionnaires; Unsafe Sex; Urban Health; Women

Topics: Contraceptives, Postcoital; Embryo Implantation; Emergencies; Female; Humans; Pregnancy; Semantics

To determine whether transvaginal ultrasonography improves evaluation of conception time in women seeking emergency contraception.. Prospective study.. Obstetrics and Gynecology Department, Siena University, Siena, Italy.. One hundred sixty-three women seeking postcoital contraception.. Data on menstrual history and time of unprotected intercourse were recorded. Ultrasonographic variables evaluated were ovarian follicle or corpus luteum diameter, endometrial echopattern and thickness, and peritoneal fluid volume. Expected pregnancy rates were calculated according to the probability of conception as estimated from Dixon's table of data, based solely on anamnestic data, or from endometrial or ovarian findings on transvaginal ultrasonography.. According to the menstrual history (cut-off level < 0.03) we expected to find 7.6 pregnancies (7.9 in the high-risk group and 0.31 in the low-risk group). According to transvaginal ultrasonography (at the same cut-off), we expected 11.2 pregnancies (0.3 in the low-risk group and 10.9 in the high-risk group). No more than 7 pregnancies were observed, all of which occurred in the high-risk group as determined by transvaginal ultrasonography. In contrast, on the basis of anamnestic data, 4 of 7 pregnancies were in the high-risk group and 3 of 7 were in the low-risk group.. Transvaginal ultrasonography allows timely definition of the fertile period and is a reliable method of computing the day of ovulation. It improves therapeutic options by allowing treatment of only women at high risk of conception.

Topics: Adult; Contraceptives, Postcoital; Emergencies; Endometrium; Female; Humans; Menstrual Cycle; Ovary; Ovulation; Probability; Prospective Studies; Ultrasonography; Vagina

Topics: Contraception; Contraceptives, Postcoital; Emergencies; Female; Humans; Pregnancy

This paper discusses findings from an evaluation of a scheme to provide free emergency hormonal contraception (EHC) via community pharmacies in the North-West of England. Drawing on interview data with pharmacists taking part in the scheme and focus groups with users, we tentatively suggest that the scheme was largely well received. The benefits of the service, cited by both pharmacists and users, included enhanced access to EHC, at times when it was needed, and at no cost to the user. In particular, users noted a welcome absence of judgmental attitudes when accessing the service. Pharmacists too were positive about the service, not least because they believed that it conferred enhanced professional status. However, both users and pharmacists had a number of major concerns about the schemes, centring on the potential for misuse, changes in contraceptive behaviour and the impact on sexually transmitted infections. We conclude that more research is needed to explore these issues.

Topics: Adult; Attitude of Health Personnel; Community Pharmacy Services; Contraceptives, Postcoital; Emergencies; England; Female; Humans; Interviews as Topic; Male; Middle Aged; Nonprescription Drugs; Patient Acceptance of Health Care; Pharmacies; Pharmacists; Professional-Patient Relations

The merits of non-prescription distribution of levonorgestrel as emergency contraception (EC), which is effective within 72 hours of unprotected intercourse, are contentious. The advantage of promptness and convenience of access may be offset by the absence of medical counselling. Opposition to EC based on the possibility of the drug acting after fertilization but before implantation departs from standard medical criteria of pregnancy. Physicians who propose to apply non-medical criteria, and use religious objections to abortion to deny prescription of EC, must publicize their opposition in advance, so that women may seek assistance elsewhere. When objecting practitioners, or facilities, become responsible for women for whom EC is indicated, such as rape victims, they are bound ethically and legally to refer them to reasonably accessible non-objecting sources of care.

Topics: Adult; Contraception; Contraceptive Agents, Female; Contraceptives, Postcoital; Emergencies; Female; Health Services Accessibility; Humans; Levonorgestrel; Pregnancy

Topics: Contraceptives, Postcoital; Emergencies; Endometrium; Female; Humans; Menstrual Cycle; Observer Variation; Ovary; Ovulation; Probability; Ultrasonography

The Consensus Statement on Emergency Contraception recommends the collection of data within each country in order to facilitate the use of emergency contraception; this has led us to design a prospective observational study with a view to identifying the reality in Spain regarding emergency contraception. We have conducted a national observational study including 4390 cases of requests for the prescription of emergency contraception in the entire Spanish territory, collected by means of a questionnaire completed by the person prescribing the emergency contraception between April and December 2002. The mean age of the women requesting emergency contraception was 23 years, with 35.1% of these being adolescents and 71% of them under the age of 24 years. Of the applicants, 40% reported that they were students and 31.8% were working. The educational level of studies was medium or higher. Emergency contraception had previously been used by 19.8% of the women and, of these, 75% used it on a single occasion. The main reason put forward for requesting emergency contraception was condom breakage (68.7%), followed by the failure to use any contraceptive measures whatsoever (15.4%). The Spanish women requesting emergency contraception are young students and resort to this method on one occasion.

Topics: Adolescent; Adult; Age Factors; Contraceptives, Oral; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; Middle Aged; Patient Satisfaction; Population Surveillance; Pregnancy; Pregnancy, Unwanted; Prospective Studies; Risk Assessment; Spain

Topics: Adolescent; Adolescent Behavior; Adult; Age Factors; Child; Contraception Behavior; Contraceptives, Postcoital; Emergencies; Humans; Spain; Terminology as Topic; World Health Organization

The promotion and availability of emergency contraception have the possibility of reducing the number of unwanted pregnancies, leading to fewer pregnancy terminations and possibly to reduced maternal morbidity and mortality.. The aims of the study were to determine the knowledge and use of emergency contraception in two groups of women: those requesting emergency contraception after sexual misadventure and another group of women requesting termination of pregnancy. A retrospective analysis was performed on all files of patients who requested emergency contraception over a 12-month period. Telephone interviews were conducted 1 year later. Structured questionnaires regarding knowledge and usage of emergency contraception were also administered to patients requesting termination of pregnancy.. Seventy-six women requested emergency contraception over the 12-month period. Forty-one (53.9%) did not attend the follow-up visit. Only two patients used condoms. A total of 39 patients were contacted by telephone after 1 year. Of these, 18 did not use any contraception, although five were sexually active. In the group of women who requested termination of pregnancy, 44% had not previously used contraception. In all, 40% did not know about emergency contraception, 36% had not used it previously and 24% had used it previously.. Lack of knowledge concerning emergency contraception can contribute to the number of legal abortions requested. There is an urgent need to address current education for users and providers on the use of emergency contraception.

Topics: Adolescent; Adult; Age Factors; Ambulatory Care Facilities; Confidence Intervals; Contraception; Contraceptives, Postcoital; Developing Countries; Emergencies; Family Planning Services; Female; Health Behavior; Health Education; Health Knowledge, Attitudes, Practice; Hospitals, County; Humans; Middle Aged; Pregnancy; Pregnancy Rate; Pregnancy, Unwanted; Retrospective Studies; Risk Assessment; South Africa; Statistics, Nonparametric; Surveys and Questionnaires

Emergency contraception is safe and effective for preventing an unplanned pregnancy, although it is not widely used. Widespread and appropriate use of emergency contraception should be encouraged as it is a promising means to arrest the increasing abortion rate. It is therefore important for all doctors to be able to prescribe emergency contraceptive pills and to educate women of reproductive age about emergency contraception. This article provides an update on the prescription of emergency contraceptives so that doctors may become more confident at prescribing emergency contraceptives and educating women about this back-up contraceptive. The current changes in the delivery of emergency contraceptive pills from prescription-only through self administration to over-the-counter sales will be discussed.

Topics: Contraception Behavior; Contraceptives, Postcoital; Drug Prescriptions; Emergencies; Ethinyl Estradiol; Female; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Hong Kong; Humans; Intrauterine Devices; Levonorgestrel; Mifepristone; Nonprescription Drugs; Patient Education as Topic; Pregnancy; Pregnancy, Unwanted; Self Administration

To determine emergency department (ED) practitioner willingness to offer emergency contraception (EC) following sexual assault and consensual sex, and to compare responses of practitioners from states whose laws permit the refusal, discussion, counseling, and referral of patients for abortions (often called "opt-out" or "abortion-related conscience clauses") with those of practitioners from states without these laws.. Using a structured questionnaire, a convenience sample of ED practitioners attending a national emergency medicine meeting was surveyed.. The 600 respondents were: 71% male, 29% female; 34% academic, 26% community, and 33% resident physicians; and 7% nurse practitioners and physician assistants. Many respondents (88%) were inclined to offer EC to those sexually assaulted by unknown assailants. More practitioners said they were willing to offer EC if the assailant was known to be HIV-infected rather than if the assailant had low HIV risk factors (90% vs. 79%, p < 0.01). More respondents would prescribe EC after sexual assault than consensual sex (88% vs. 73%, p < 0.01). The rates of willingness to offer EC were the same for practitioners in states with "abortion-related conscience clauses" and those from other states.. Most ED practitioners said they were willing to offer EC. Although the risk of pregnancy exists after consensual sex, practitioners were less willing to prescribe EC after those exposures than for sexual assault. "Abortion-related conscience clauses" did not seem to influence willingness to offer EC.

Topics: Adolescent; Adult; Attitude of Health Personnel; Chi-Square Distribution; Contraceptives, Postcoital; Data Collection; Emergencies; Emergency Medicine; Emergency Service, Hospital; Female; Health Surveys; HIV Infections; Humans; Male; Practice Patterns, Physicians'; Pregnancy; Sex Offenses; Surveys and Questionnaires; United States

Topics: Contraceptives, Postcoital; Emergencies; Female; Humans; Legislation, Drug; Nonprescription Drugs; United Kingdom

To describe and analyze emergency contraception (EC) awareness and use among sexually active Swiss teenagers.. Anonymous computerized questionnaires were distributed to a national representative sample of 4283 in-school adolescents (aged 16 to 20 years) in high schools and professional centers. Young people who were sexually active (51.5% of the sample: 1058 girls and 1073 boys) responded to questions on EC awareness and use and on sexual perception, attitude, and behaviors. Univariate analyses and multiple regression analyses were used to describe EC awareness and use and their correlates.. Most of the sexually active girls (89.3%) and boys (75.2%) knew of the existence of EC. Of girls, 20% reported having used EC, and the majority of them used it only once (64.1%) or twice (18.5%). EC awareness was positively associated with the father's level of education (girls: odd ratio 5.18) and the scholastic curriculum of the respondent. Gender differences in the correlates of EC awareness demonstrate that girls who had a confidant or a group of friends or boys of Swiss nationality and those who have had the opportunity to discuss the issue of contraception declare greater awareness of EC. EC use was higher among girls who lived in urban areas (odds ratio 1.91) and occasionally had unprotected intercourse. We did not find any significant difference in the profile of multiple vs. one-time users.. EC awareness and use should be improved through better information and accessibility, especially among teenagers who place themselves in at-risk situations.

Topics: Adolescent; Adolescent Behavior; Adult; Awareness; Contraceptives, Postcoital; Cross-Sectional Studies; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; Logistic Models; Male; Pregnancy; Pregnancy in Adolescence; Surveys and Questionnaires; Switzerland

Requiring a physician's prescription for hormonal emergency contraceptive pills makes no sense. Unintended pregnancies remain endemic in the United States, and wider use of emergency contraceptive pills could substantially help. However, the prescription requirement poses an unnecessary barrier to prompt, effective use of this preventive therapy. According to the Durham-Humphrey Amendment of 1951, the default option for all new drugs is, in principle, over-the-counter, unless a drug is addictive or dangerous when self-administered. Clearly, hormonal emergency contraception is neither of these. Emergency contraceptive pills meet all the customary criteria for over-the-counter use: low toxicity, no potential for overdose or addiction, no teratogenicity, no need for medical screening, self-identification of the need, uniform dosage, and no important drug interactions. The Food and Drug Administration is authorized, and, by its own regulations, should be required to switch hormonal emergency contraception to over-the-counter status without delay. The current prescription requirement is not only gratuitous but also harmful to women's health because it impedes access to this important therapy.

Topics: Contraceptives, Postcoital; Emergencies; Female; Humans; Legislation, Drug; Nonprescription Drugs; Public Health; United States

Topics: Abortion, Legal; Attitude to Health; Contraceptives, Postcoital; Emergencies; Health Knowledge, Attitudes, Practice; Humans; Sex Education; Surveys and Questionnaires; United States; Women

Topics: Adolescent; Adult; Attitude to Health; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; Sex Education; Surveys and Questionnaires; Women

Topics: Contraception; Contraception Behavior; Contraceptives, Postcoital; Emergencies; Family Planning Services; Female; Health Promotion; Humans; Maternal-Child Nursing; Nursing Assessment; Sex Education; Sexual Behavior

To evaluate access to emergency contraception among women seeking help from clinicians who registered to be listed on the Emergency Contraception Hotline (1-888-NOT-2-LATE, ie, 1-888-668-2528) and the Emergency Contraception Website (not-2-late.com).. Two college-educated investigators posing as women who had a condom break the previous night called 200 providers to seek help.. Only 76% of attempts resulted in an appointment or telephone prescription from a hotline provider within 72 hours, 14% were failures, and 11% resulted in referrals to other providers not listed on the hotline or website.. Even under ideal conditions, access to emergency contraception is currently constrained. Although emergency contraception could reduce significantly the incidence of unintended pregnancy and the consequent need for abortion, its potential will not be realized unless women have better access to clinicians who can prescribe emergency contraceptive pills.

Topics: Contraceptives, Oral, Combined; Contraceptives, Postcoital; Emergencies; Female; Health Services Accessibility; Hotlines; Humans; Internet; Pregnancy; Pregnancy, Unwanted; Quality Assurance, Health Care; United States; Women's Health

To evaluate the quality of patient information about emergency contraception on the Internet.. We performed an on-line search of the Internet and found relevant World Wide Web sites by combining the key phrases 'emergency contraception' and 'patient information' in two Web subject guides and two search engines. We defined quality as the extent to which the characteristics of a Web site satisfied its stated and implied objectives. Our assessment focused on credibility and content of each Web site. Credibility was assessed by source, currency and editorial review process and content of Web site was assessed by hierarchy and accuracy of evidence.. Our search revealed 32 relevant Web sites, none of which complied with all of the criteria for quality of credibility and content. Twenty-eight Web sites displayed the source clearly, 17 Web sites showed currency, and none of the Web sites had an editorial review process. Only six of the 32 sites mentioned hierarchy of evidence. None of the Web sites depicted all the criteria for accuracy of contents.. None of the Web sites provided complete information to patients about emergency contraception according to the quality criteria used in this study. As previous studies have shown, people need to be wary about the quality of information on the Internet.

Topics: Contraceptives, Postcoital; Emergencies; Evidence-Based Medicine; Health Education; Humans; Information Services; Internet; Patient Education as Topic; Publishing

Topics: Abortion, Legal; Canada; Contraceptives, Postcoital; Emergencies; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Patient Advocacy

Topics: Contraceptives, Postcoital; Emergencies; Humans; Information Services; Internet

To compare the knowledge of emergency contraception in women attending hospital for termination of pregnancy in 1984 and 1996.. A questionnaire survey.. Ninewells Hospital, Dundee.. Cohorts of 100 consecutive women undergoing termination of pregnancy in 1984 and 1996.. Over this 12 year period, there has been a significant improvement in the knowledge of emergency contraception. Seventy three per cent had a good knowledge of the postcoital pill in 1996 compared to 12 per cent in 1984 (p=

Topics: Abortion, Induced; Adolescent; Adult; Condoms; Contraceptives, Postcoital; Educational Status; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; Pregnancy; Pregnancy, Unwanted; Scotland; Surveys and Questionnaires; Women

The intrauterine contraceptive device (IUD) is a very effective form of emergency contraception (EC). This author hypothesised that IUDs are an underused method and determined to evaluate potential barriers to IUD use. A postal survey of 100 family planning doctors and 100 general practitioners was conducted in Trent Region during March 1998 with a 70 per cent response rate. Lack of time was the most important factor that influenced doctor's decisions not to offer IUDs to the majority of women requesting emergency contraception. Most doctors registered concern about the risk of pelvic inflammatory disease. Misconceptions and a lack of accurate information contributed to participants reluctance to discuss IUDs as emergency contraception. Lack of time in consultations is a well-recognised issue in general practice. The risk of sexually transmitted infections is a nationwide concern, but is difficult to address without accurate data on the prevalence of the most common pathogens. Considerable effort would be required to increase doctors' knowledge and willingness to offer IUDs routinely to women requesting emergency contraception.

Topics: Adult; Aged; Attitude of Health Personnel; Contraception; Contraceptives, Postcoital; Emergencies; Family Planning Services; Family Practice; Female; Gynecology; Health Knowledge, Attitudes, Practice; Humans; Intrauterine Devices; Male; Middle Aged; Practice Patterns, Physicians'; Surveys and Questionnaires; United Kingdom

Topics: Adolescent; Contraception; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Counseling; Emergencies; Estradiol Congeners; Ethinyl Estradiol; Female; Humans; Norgestrel; Pregnancy; Progesterone Congeners; Time Factors

Topics: Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; Intrauterine Devices; Patient Education as Topic

Topics: Contraception Behavior; Contraceptives, Postcoital; Emergencies; Female; Humans; Intrauterine Devices; Sri Lanka

Topics: Contraception Behavior; Contraceptives, Postcoital; Emergencies; Female; Humans

Emergency contraception (EC) has been available since 1984 but has been labelled the 'best kept secret' (Winfield, 1995). Because EC was originally termed 'the morning after pill', many people interpreted this literally and missed an opportunity to use the method. More recent publicity has dropped this term and emphasized that the method is effective up to 72 h after unprotected intercourse or contraceptive failure (Burton & Salvage, 1990). Uptake of EC has steadily increased since 1985 but there is still evidence that younger women in particular are least aware of its existence.

Topics: Adolescent; Adult; Attitude to Health; Contraceptives, Postcoital; Emergencies; England; Female; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Needs Assessment; Nursing Methodology Research; Sex Education; Surveys and Questionnaires; Women; Women's Health

The high number of unintended pregnancies and terminations in Britain indicates that women who could use emergency contraception do not. Knowledge of access to sources of emergency contraception is limited. Oral administration of combined oestrogen-progestogen is safe and does not require routine physical administration, and there are proposals to re-regulate this from a prescription-only medicine to a pharmacy medicine, available over the counter in community pharmacies under the supervision of a pharmacist.. We aimed to demonstrate that the availability of combined, oral oestrogen-progestogen under the supervision of the community pharmacist would be safe and effective.. Guidelines were developed by a multidisciplinary group incorporating pharmacists, GPs, a pharmacologist and a consultant in family planning. The guidelines were based on published evidence, where possible.. Guidelines have been developed to accompany the provision of combined, oral oestrogen-progestogen which demonstrate that over-the-counter availability could be a safe and effective method of reducing the number of unwanted pregnancies in Britain.

Topics: Contraceptives, Oral; Contraceptives, Postcoital; Decision Trees; Emergencies; Female; Humans; Intrauterine Devices; Nonprescription Drugs; Pharmacists; Practice Guidelines as Topic

The World Health Organization (WHO) multicenter, randomized trial reported in this issue of "The Lancet" confirms that levonorgestrel-only (two 750-mcg doses) is significantly more effective in preventing pregnancy after unprotected intercourse than the standard Yuzpe regimen (two doses of 500 mcg levonorgestrel and 100 mcg ethinyl estradiol) and is further associated with significantly less nausea and vomiting. When initiated within 24 hours of coitus, the failure rate was only 0.4% for levonorgestrel compared with 2.0% for the combined hormonal method. A further advantage of a progestogen-only emergency contraceptive method is avoidance of contraindications in women with past proven arterial or venous thrombosis or a current attack of migraine with focal aura. Although only one pharmaceutical company (Gedeon Richter in Budapest, Hungary) currently manufactures 750 mcg of levonorgestrel in a single tablet, others are likely to follow this example given the findings of the WHO study. Strong pressure exists to increase availability of postcoital contraception through trained nurses and retail pharmacists. However, potential users will still require counseling on the importance of selecting a long-term method of contraception and a family planning provider.

Topics: Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Emergencies; Humans; Levonorgestrel; Time Factors

To identify bottlenecks in the delivery of comprehensive reproductive health care in Bulawayo, Zimbabwe's second city, a study was performed utilising volunteers pretending to be in need of emergency contraception. A total of 55 private, Zimbabwe National Family Planning Council, municipal and government health facilities were visited. These consultations resulted in 9 (16%) correct, 1 possibly correct and 15 wrong prescriptions for the morning-after pill (MAP); no treatment was prescribed in 30 instances. Public sector health personnel were very judgemental in their attitude toward sexually active teenagers. Although the Essential Drug List of Zimbabwe is quite clear about the MAP, many health providers are not aware of this, and others do not even have/use this book.

Topics: Adolescent; Adult; Attitude of Health Personnel; Contraceptives, Postcoital; Data Collection; Emergencies; Female; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Zimbabwe

Emergency contraceptive pill dispensation was estimated in Michigan Title X family planning programs.. Logistic regression and tobit estimation models were used to predict whether and to what extent emergency contraceptive pills are dispensed.. Of the 53 programs studies, 32 dispensed emergency contraceptive pills, averaging fewer than one client per month. Total dispensation was skewed toward a few programs, and the contribution of health departments to this total was small. Emergency contraceptive pill services appeared to be randomly distributed across programs, although most dispenser reported having provided the pills for less than 12 months.. Recent policy advances should lead to more consistent emergency contraceptive pill dispensation in Title X programs.

Topics: Contraceptives, Postcoital; Emergencies; Family Planning Services; Female; Humans; Logistic Models; Michigan; Public Health; Surveys and Questionnaires

Topics: Abortion, Induced; Contraceptives, Postcoital; Emergencies; Ethics, Medical; Female; Humans; Intrauterine Devices; Pregnancy; United States

Topics: Contraceptives, Postcoital; Drug Approval; Emergencies; Female; Humans; United States

Topics: Contraceptives, Postcoital; Emergencies; Estradiol Congeners; Ethinyl Estradiol; Humans; Levonorgestrel; United States; United States Food and Drug Administration

Topics: Contraceptives, Postcoital; Emergencies; Female; Humans; Pharmacists; Self Administration

Topics: Contraceptives, Postcoital; Drug Prescriptions; Emergencies; Family Planning Services; Health Policy; Humans; Pharmacists; Professional Autonomy; United Kingdom; Washington

Topics: Contraceptives, Postcoital; Emergencies; Female; Health Services Needs and Demand; Humans; Pregnancy; Pregnancy, Unwanted; Time Factors; United States

Emergency contraception (EC) will not become a standard reproductive choice in the absence of dedicated products. Emergency contraception products based on the Yuzpe regimen have been available in Western Europe for a number of years. Levonorgestrel-only products are registered in 29 countries. Dedicated products of both types are being introduced into many developing countries and the United States.

Topics: Choice Behavior; Contraception Behavior; Contraceptives, Postcoital; Developing Countries; Emergencies; Europe; Female; Humans; United States

Pharmacists are well positioned to play a major role in increasing access to emergency contraceptive pills (ECPs). A pilot project in Washington State is testing direct pharmacist prescribing. Through a collaborative drug therapy agreement, a licensed prescriber, such as a physician, delegates to a pharmacist the authority to prescribe ECPs directly to women who meet the assessment criteria. Currently pharmacists at 111 Washington State pharmacies have collaborative agreements in place, and the number of participating pharmacies continues to increase. The response to this initiative has been extremely positive. Women who have received ECPs directly from pharmacists rate their interactions with the pharmacists positively and overwhelmingly cite convenience as the primary reason for going directly to the pharmacy. Physicians and other providers with independent prescribing authority can play a pivotal role by working with pharmacists to replicate the Washington State initiative in the states that allow it.

Topics: Contraceptives, Postcoital; Drug and Narcotic Control; Drug Prescriptions; Emergencies; Female; Humans; Licensure, Pharmacy; Pharmacists; Pilot Projects; Professional Autonomy; Washington

In 1997, the nonprofit Reproductive Health Technologies Project and the Office of Population Research at Princeton University, together with the communications firm Elgin DDB, planned and executed a mass media campaign to advertise the Emergency Contraception Hotline and more generally to further awareness of emergency contraception as a last chance means of pregnancy prevention in the United State. We produced a variety of public service announcements (PSAs) including television and radio spots in English and Spanish and several print versions adaptable for newspapers and magazines as well as outdoor settings such as billboards, transit shelters, and the sides of buses. Working with local coalitions, we succeeded in placing the PSAs free of charge in six pilot cities. We also generated coverage about the campaign in local and national news outlets. We chronicle the development of the media campaign, discuss the challenges and obstacles faced, and conclude with a review of the principal lessons learned.

Topics: Advertising; Contraceptives, Postcoital; Drug Information Services; Emergencies; Female; Health Promotion; Hotlines; Humans; Mass Media; Pregnancy; United States

Kaiser Permanente Southern California and the Pacific Institute for Women's Health began a demonstration and evaluation project on emergency contraceptive pills (ECPs) in the summer of 1996 with the goal of evaluating the feasibility and acceptability of ECPs in a large health maintenance organization and developing institutional templates, provider training and patient education materials that could be used to replicate the project. The ECP program had six components: repackaging of oral contraceptives in an ECP "kit," development of provider education materials, development of patient education materials, in-service training, making ECPs kits available in convenient locations, and development of materials to support replication of the project inside and outside Kaiser Permanente. Although data are still being analyzed, preliminary results are promising. The success of the project within this relatively conservative, but well-established medical care organization provides a model for others. The development of a standard set of educational materials and approaches to implementation should facilitate dispensing ECPs in other settings.

Topics: Adult; California; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Health Maintenance Organizations; Health Personnel; Humans; Inservice Training; Male; Middle Aged; Needs Assessment; Patient Education as Topic; Pilot Projects; Program Evaluation

To determine how awareness of and practices and attitudes toward emergency contraceptive pills (ECPs) have progressed among the American public and US health professionals.. In 1997, we conducted two nationally representative telephone surveys of Americans and health professionals of their knowledge, attitudes, and practices on ECPs and compared the findings to previous surveys.. 66% of women and 51% of men 18 to 44 years old had heard of ECPs, up from 61% of women and 45% of men the same age in 1994. Only 1% of women surveyed reported having ever used this method, reflecting no change from 1994. Only 11% of women knew enough about ECPs to be able to use them. Americans named media as the primary source of information about ECPs. The proportion of physicians who had prescribed ECPs at least once in the preceding year increased significantly in 1997: 85% of obstetrician/gynecologists and 50% of family physicians compared to 69% and 34% in 1995. Almost all health professionals considered ECPs to be safe (99%) and effective (100%), yet relatively few discussed this option with their patients, and even fewer commonly prescribed it.. Ongoing efforts are needed to improve awareness among the general public and to encourage health professionals to discuss and offer ECPs more widely.

Topics: Adolescent; Adult; Attitude of Health Personnel; Attitude to Health; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Male; Mass Media; Practice Patterns, Physicians'; Surveys and Questionnaires; United States

This article reports on a study of 119 women who sought and used emergency contraceptive pills (ECPs) at Planned Parenthood of New York City (PPNYC) clinics between June 1996 and May 1997. It focuses on their satisfaction with the method, their attitudes toward ECPs, their reactions to the service, and the impact their perceptions had on changing the provision of care.. The PPNYC clinical protocol employed the Yuzpe method and fairly conservative procedures, including restrictive screening, a pelvic examination for all new patients, and limited appointment slots. A two-part survey captured information on patient experience with ECPs.. The largest group of respondents (40%) found out about ECPs from friends. Almost 90% of the women were using contraception before their visit to the clinic. Sixty-eight percent reported that they sought ECPs because the condom failed. In the follow-up, a majority (57%) reported that they intended to change or had changed their method of contraception--more than three-quarters to a hormonal contraceptive. While generally satisfied with the service, many respondents were cautious of more extensive distribution of ECPs.. The survey results had a profound impact on services: PPNYC revised the ECP protocol, developed a staff training package, expanded its service, and planned a multidimensional public media campaign. Further research, including a closer examination of participants' cautious attitude toward unrestricted distribution of ECPs, will be needed as PPNYC expands access to ECP.

Topics: Adolescent; Adult; Contraceptives, Postcoital; Emergencies; Family Planning Services; Female; Health Knowledge, Attitudes, Practice; Humans; Middle Aged; New York City; Patient Satisfaction; Program Evaluation; Surveys and Questionnaires; Urban Health Services

To assess the awareness of emergency contraception (EC) among inner-city adolescents attending a general primary health care clinic.. 197 patients filled out an anonymous 28-item survey on sexual activity, experience with contraceptives, attitude toward pregnancy, experience with pregnancy, awareness of and intent to use EC.. 71% of the sample was sexually experienced; 90% had been active within six months of the clinic visit. While 81% of the sexually experienced segment of the sample had ever used contraceptives, 53% reported having had sex at least once during the past six months without using contraception. Fifty-seven percent "worried" following unprotected intercourse about a potential pregnancy; 32% of the sample had been involved in a pregnancy. Only 30% of the sexually experienced had heard of EC, but more than 87% stated they would use it if the need arose in the future.. Urban adolescents are at high risk for unintended pregnancy due to inconsistent contraceptive use and/or method failure. Level of awareness of EC was low in our sample, particularly as compared to adult women in the United States, and to women of all ages (including teenagers) in European countries. Intent to use EC was high, however, indicating a strong desire to avoid unintended pregnancy. Attention should be focused on increasing both adolescent awareness of and access to EC.

Topics: Adolescent; Adult; Awareness; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; Male; New York City; Pregnancy; Pregnancy in Adolescence; Psychology, Adolescent; Risk Factors; Sexual Behavior; Surveys and Questionnaires; Urban Population

A focus group study was conducted to explore what Mexican women from both sides of the US-Mexican border do to prevent pregnancy after unprotected intercourse, including their use of emergency contraceptive pills (ECPs); to examine their knowledge and perceptions of ECPs; and to explore what might influence Mexican women's use of ECPs. Eight focus groups (four in Mexico and four in California) were conducted with 55 sexually active Mexican women age 18 to 34. The women discussed a variety of postcoital methods intended to prevent pregnancy including herbs and injections. Although a third of the women had heard of ECPs, their knowledge was very limited. After being informed about the characteristics of ECPs, participants had many positive comments, preferring them to unplanned pregnancies and abortions. A major topic was whether or not ECPs are abortifacients. Having information about ECPs, a woman's personal circumstances, interpersonal factors, and the role of culture and religion were factors they thought would influence a woman's use of ECPs. After the focus group discussions, 95% of the women said they would use ECPs. Mexican women's acceptance and use of ECPs will likely depend on a host of factors within the broader context of their lives.

Topics: Acculturation; Adolescent; Adult; Attitude to Health; California; Contraceptives, Postcoital; Cross-Cultural Comparison; Emergencies; Emigration and Immigration; Female; Focus Groups; Health Knowledge, Attitudes, Practice; Humans; Medicine, Traditional; Mexican Americans; Mexico; Pregnancy

In 1994, the international relief community began to recognize and address the reproductive health needs of refugees and displaced populations. A minimum initial service package of reproductive health services for refugees and the displaced, which includes emergency contraception (EC), was developed and recommended for use in refugee settings. This paper describes the experience of one international relief organization, the International Rescue Committee (IRC), in introducing EC into its worldwide reproductive health program. A recent IRC survey found that EC is available in 4 out of 14 settings where it provides reproductive health services. A case study from Tanzania demonstrates the modes of delivery, the demand for EC by women who have experienced sexual violence, and the community responses to this method of contraception. More information, education, and communication directed at refugee communities; more donor support for supplies; and institutional commitment to train staff are needed to expand refugee access to EC.

Topics: Contraceptives, Postcoital; Emergencies; Family Planning Services; Female; Health Knowledge, Attitudes, Practice; Humans; Needs Assessment; Rape; Refugees; Relief Work; Tanzania

A study supported by the World Health Organization's Task Force on Postovulatory Methods of Fertility Control compared the efficacy of the Yuzpe and levonorgestrel-only methods of emergency contraception (EC). Enrolled in this double-blind, randomized trial were 1998 women from 21 centers around the world who requested EC within 72 hours of unprotected intercourse. The pregnancy rate was 1.1% for levonorgestrel alone and 3.2% for the combined ethinyl estradiol-levonorgestrel regimen. The crude relative risk of pregnancy was 0.36 (95% confidence interval, 0.18-0.70) for levonorgestrel compared with the Yuzpe regimen. The former method prevented 85% of expected pregnancies, while the latter prevented only 57%. Finally, side effects such as nausea, vomiting, dizziness, and fatigue were significantly less common in the levonorgestrel group. Although these findings document the superiority of the levonorgestrel regimen for EC, the 0.75 mg tablets are not currently manufactured in the US.

Topics: Contraceptives, Oral, Combined; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Emergencies; Female; Humans; Levonorgestrel; Pregnancy; Research Design

Topics: Adolescent; Adult; Contraceptives, Postcoital; Emergencies; Female; Humans; Infant, Newborn; Intrauterine Devices, Copper; Pregnancy; Pregnancy, Unwanted; United States

This study examined the cost-effectiveness of emergency contraceptive pills, minipills, and the copper-T intrauterine device (IUD) as emergency contraception.. Cost savings were modeled for both (1) a single contraceptive treatment following unprotected intercourse and (2) emergency contraceptive pills provided in advance.. In a managed care (public payer) setting, a single treatment of emergency contraception after unprotected intercourse saves $142 ($54) with emergency contraceptive pills and $119 ($29) with minipills. The copper-T IUD is not cost-effective as an emergency contraceptive alone, but savings quickly accrue as use continues. Advance provision of emergency contraceptive pills to women using barrier contraceptives, spermicides, withdrawal, or periodic abstinence saves from $263 to $498 ($99 to $205) annually.. Emergency contraception is cost-effective whether provided when the emergency arises or in advance to be used as needed. Greater use of emergency contraception could reduce the considerable medical and social costs of unintended pregnancies.

Topics: Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Cost-Benefit Analysis; Emergencies; Female; Humans; Male; Managed Care Programs; Pregnancy; Pregnancy, Unwanted; Public Sector; United States

Topics: Contraception; Contraceptives, Postcoital; Emergencies; Female; Humans; Male; Pregnancy; Pregnancy, Unwanted; Sexually Transmitted Diseases; United States

British teenagers who become pregnant commonly express ignorance about emergency contraception. A case-note survey was conducted in a general practice serving about 14,200 people in a Devon market town. Of the 373 registered girls aged 15-19 years, 59 (16%) had consulted for emergency contraception, 19 of them more than once. The oral method (Yuzpe regimen) was prescribed eighty times and 2 girls became pregnant. 4 of the 59 girls who used emergency contraception had subsequent unwanted pregnancies. A consultation for emergency contraception presents an opportunity to discuss more reliable and acceptable methods of contraception.

Topics: Adolescent; Adolescent Behavior; Adolescent Health Services; Adult; Contraceptives, Postcoital; Emergencies; England; Family Practice; Female; Humans; Patient Acceptance of Health Care

Topics: Contraceptives, Postcoital; Drug Labeling; Drug Utilization; Emergencies; Female; Humans; Pregnancy; Pregnancy, Unwanted; United States; United States Food and Drug Administration

In recent years, there has been a marked increase in the demand for postcoital contraception in both primary care centers and hospital emergency wards. This article proposes to assure professional nurses acquire adequate basic knowledge regarding this emergency contraceptive method. Due to the fact that nurses play a major role in providing women who seek this method a health education, we believe it is of importance to deal with this aspect carefully while discussing this topic.

Topics: Contraceptives, Postcoital; Emergencies; Family Planning Services; Female; Humans; Sex Education

Topics: Administration, Oral; Adult; Computer Communication Networks; Contraceptives, Postcoital; Emergencies; Female; Health Education; Hotlines; Humans; United States; United States Food and Drug Administration

Topics: Adolescent; Adult; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; Patient Advocacy; Pregnancy; Pregnancy, Unwanted; United States

Although the Yuzpe regimen of emergency contraception is the one most commonly used, there are alternatives. Copper-containing intrauterine devices are very effective and can be inserted for at least 5 days after unprotected intercourse and sometimes longer. They may, however, transmit pre-existing infection into the upper genital tract and cause discomfort when being fitted. Progestogen-only emergency contraception appears, from WHO studies, to be a useful adjunct to current therapies. Mifepristone has been studied in various doses and has been shown to be very effective but is not yet commercially available. Health services should provide a full range of methods including emergency contraception by appropriately trained people in an acceptable environment.

Topics: Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Danazol; Emergencies; Estrogen Antagonists; Family Planning Services; Female; Health Services Accessibility; Humans; Intrauterine Devices, Copper; Levonorgestrel; Mifepristone; Patient Selection; Progestins; Time Factors

Our purpose was to measure and analyze knowledge and attitudes about emergency contraceptive pills. The hypothesis we tested was that more accurate knowledge about the regimen would be associated with favorable attitudes towards its use.. We conducted a random sample telephone survey and a series of focus group discussions at Princeton University (results for 11 focus groups are presented elsewhere) A total of 550 undergraduate and graduate students were selected randomly for participation in the survey, and the response rate was 82%. The study's primary outcome measure was attitudes toward the emergency contraceptive pill as a method of fertility control. We used multivariate regression analysis with ordered logit models to test the hypothesized association between knowledge and attitudes.. Basic awareness and approval of the emergency contraceptive pill were widespread, yet students lacked detailed knowledge, which did contribute to health and ethical misgivings about the regimen. Students with accurate information, especially those students who knew that the therapy is a large dose of regular oral contraceptives and that side effects are generally minor, were significantly more likely than others to report favorable attitudes. Many students confused the pills dispensed by the university health services (Oral, Wyeth-Ayerst, Philadelphia) with the abortifacient RU 486. Students noted discussion of the method is rare, and many wanted to know more about it. Statistical results are reported with a 95% confidence level.. Educational efforts should offer specific information about the composition of emergency contraceptive pills, the side effects, and how the regimen works.. A random survey was conducted using the campus voice mail system among 550 students of Princeton University to determine their knowledge of and attitudes about postcoital contraception (which has been available at the university health center for more than 15 years). The survey elicited a response rate of 82% and included demographic information in the data collected. The results showed that 95% (98% of the undergraduates) of the sample knew about emergency oral contraception (EOC), but 52% of the respondents could not distinguish EOC from RU-486, only 38% knew that the correct time of use was within 72 hours, only 26% knew that EOC was a regimen which used a large dose of combined oral contraceptives, and 25% knew that the effectiveness of EOC is 75%. 54% of the students believed that EOC is associated with unpleasant side effects, and 7% thought there would be serious side effects (this attitude was significantly related to nonendorsement). Only 12% of the students correctly identified the fertile period in the menstrual cycle and understood the timing factors associated with EOC. 80% of the students approved of EOC, and 91% approved in cases of rape. Those who identified themselves as Democrats were significantly more likely to approve, and those who were highly religious were significantly less likely. Ethical concerns were cited by 32% of the respondents, and 57% had health concerns. 84% felt that EOC was readily accessible, but only 43% knew it was available throughout the week. 30% of the students had experience with a situation in which more information about EOC would have been helpful. Regression analysis of these findings revealed that approval was higher among students who knew the ingredients and side effects of EOC, knew of a situation where it would have been helpful, were not religious, and/or were Democrats. Ethical concerns were associated with health concerns, strong religious feeling, Republican affiliation, and a lack of knowledge about ingredients.

Topics: Abortifacient Agents, Steroidal; Adult; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; Interviews as Topic; Male; Mifepristone; New Jersey; Random Allocation; Regression Analysis; Socioeconomic Factors; Students; Telephone; Universities

The aim of the study was to examine knowledge of and perceived availability of the emergency contraceptive pill as well as reasons for its non use.. One hundred women each attending Epsom day unit or the Auckland medical aid clinic in Auckland seeking termination of pregnancy, and 100 women seeking contraceptive advice from the Alice Bush centre in Auckland, were asked to take part in the study.. At Alice Bush centre 57% of women had previously used the emergency contraceptive pill compared with 43% women at Epsom day unit and 32% women at Auckland medical aid clinic. Only 7% of women attending Epsom day unit or Auckland medical aid clinic had used the emergency contraceptive pill in the month they conceived. When asked why they had not used the emergency contraceptive pill 38% of respondents said they had not heard of it and 41% did not know where to obtain it. Pacific Island women were least likely to have heard of it. Approximately 50% knew the correct time interval for using the emergency contraceptive pill. Sixty two percent attending the abortion clinics would have used the emergency contraceptive pill if they had a supply at home and 57% stated they would have used it if it was available over the counter through pharmacies.. The discrepancy between the numbers of women who knew of the emergency contraceptive pill (72%) and the numbers who used it to try to prevent pregnancy (7%) indicates that there are barriers to obtaining and using the emergency contraceptive pill. This study demonstrated a lack of knowledge of the emergency contraceptive pill in women attending the abortion clinics. The majority of women seeking termination of pregnancy would have used the emergency contraceptive pill if they had it available at home or over the counter through a pharmacy. Doctors prescribing the pill and barrier methods of contraception should consider providing a supply of emergency contraceptive pill at the same time and consideration should be given to over the counter prescribing of the emergency contraceptive pill in New Zealand.

Topics: Adult; Attitude; Contraception; Contraceptives, Postcoital; Emergencies; Female; Health Knowledge, Attitudes, Practice; Humans; New Zealand; Socioeconomic Factors

Emergency contraception is an effective way to prevent pregnancy from occurring after unprotected sexual intercourse. The authors report a descriptive study of pregnant teens in Devon, England, which examined the awareness and use of emergency contraception, and its potential for preventing unwanted teenage pregnancy. Findings are based upon interviews conducted with 167 pregnant women aged 13-19 years between August 1992 and January 1994. 57% were attending for a National Health Service termination 8-12 weeks pregnant, while 43% were attending booking appointments at hospital antenatal clinics 16-17 weeks pregnant. 12% of pregnancies were planned, 73% were unplanned, and in 25 pregnancies the teen was equivocal at the time of conception about preventing pregnancy. 81% of teenagers had heard of emergency contraception, although 88% did not obtain it. Of the 16 teens who did obtain postcoital contraception, the approach failed in 11 cases, one woman took the pills incorrectly, and four failed to take the pills.

Topics: Abortion Applicants; Adolescent; Contraception; Contraceptives, Postcoital; Emergencies; England; Female; Health Knowledge, Attitudes, Practice; Humans; Pregnancy; Pregnancy in Adolescence; Pregnancy, Unwanted

Topics: Contraception; Contraceptives, Postcoital; Emergencies; England; Family Practice; Female; Humans

Although emergency postcoital contraception has been available since 1974, there has been no demonstrable impact on the rate of induced abortion. This reflects both a lack of awareness of this form of pregnancy prevention, on the part of patients and physicians, and misconceptions that postcoital contraception must be administered "the morning after" to be effective. At present, 2 such types of contraception are available. A pill containing 100 mcg of ethinyl estradiol and 500 mcg of levonorgestrel is administered in 2 doses, the 1st of which must occur within 72 hours of unprotected intercourse or condom failure. The overall reported pregnancy rate associated with this method is about 1%/woman-cycle. There is no evidence that the emergency pill affects organogenesis or increases the risk of ectopic pregnancy; however, most women who seek postcoital contraception are highly motivated to avoid pregnancy and abort in cases of pill failure. The 2nd method, an emergency IUD, must be inserted within 5 days of unprotected intercourse. The failure rate of this method is only 0.04%/woman-cycle. Since both these agents prevent implantation, they are not considered abortifacients. RU-486, which can terminate a pregnancy of under 63 days' gestation, may in the future gain approval for use as an emergency contraceptive. Physicians are urged to talk to patients about steps to take if contraception is forgotten or fails (as in the event of a broken condom) well in advance of an emergency. In addition, reception staff should be alerted that women seeking emergency appointments may be in need of postcoital contraception and may not be able to wait several days to be seen.

Topics: Contraceptives, Postcoital; Emergencies; Ethinyl Estradiol; Female; Humans; Intrauterine Devices; Levonorgestrel; Menstrual Cycle; Pregnancy; Referral and Consultation

We describe a prospective study of 1,200 patients using the Yuzpe regimen of hormonal postcoital contraception. There was an 85% follow-up rate, and of the 1,015 patients followed there were 13 pregnancies, giving a pregnancy rate of 1.3%. The number of expected pregnancies at mid-cycle was reduced by 83%; 12 of the 13 pregnancies went on to abortion. The patients were young: 86% were under 25, and 10% were under 15. The most frequent reason for presentation was that no contraception had been used (57%). All patients received an antiemetic; 57% experienced no side-effects, 28% had some nausea and 9.6% some vomiting. It is concluded that this is a safe form of emergency contraception, which is an effective way of reducing the number of unwanted pregnancies, especially in the very young.. This prospective study comprised 1200 patients who were using the Yuzpe regimen of postcoital hormonal contraception. There was an 85% follow-up rate, and of the 1015 patients followed, there were 13 pregnancies for a pregnancy rate of 1.3%. The number of expected pregnancies at midcycle was reduced by 83%; 12 of the 13 pregnancies went on to abortion. The patients were young--86% were under age 25 and 10% were under age 15. The most frequent reason for presentation was that there had been no contraception used (57%). All patients received an antiemetic and 57% experienced no side effects while 28% had some nausea, and 9.6% had vomiting. It is concluded that this is a safe form of emergency contraception, which is thus an effective way to reduce the number of unwanted pregnancies, especially in the very young.

Topics: Adolescent; Adult; Ambulatory Care Facilities; Contraceptives, Postcoital; Contraceptives, Postcoital, Hormonal; Drug Administration Schedule; Emergencies; Ethinyl Estradiol; Family Planning Services; Female; Humans; Nausea; Norgestrel; Prospective Studies; Vomiting