Enhancing the use of emergency contraceptive pills

Over a decade after emergency contraceptive pills (ECPs) / the morning after pill became available without a prescription, the rate of unintended pregnancies remains high in many countries. Understanding women’s experiences and perceptions of ECPs may provide insights into this underutilisation. So we analysed qualitative and quantitative primary studies about women’s beliefs, knowledge, and experiences of ECPs in Australia.

KEY FINDING 1: While there was very high awareness of ECPs/the morning after pill we also found high levels of confusion and misinformation that may reduce the window of opportunity for ECP-use:

Women were unsure how to obtain ECPs and unaware it was available without a prescription

> anyone (no legal lower age limit/ you can buy for someone else) can walk in to an Australian pharmacy and access ECPs over the counter

There was widespread misunderstanding about how ECPs prevent pregnancy

> ECPs prevent fertilization so they are not an abortifacient

There was considerable confusion about the effective time frame for ECPs

> they are much more than a morning after pill! LNG is licensed for use 72 hours post-intercourse, UPA is effective for up to 5 days

Women worried about safety

> ECPs are safe for repeated use and do not increase the risk of cancer or ectopic pregnancy, or affect future fertility, nor can they harm an existing pregnancy

KEY FINDING 2: Despite broad support for ECPs and for access without a prescription among women, stigma associated with ECPs persisted. There was a clear moral discourse: ECPs should not be used as a preferred contraceptive strategy nor as a license to behave “irresponsibly” (women should take responsibility for successful contraception). We see the same moral discourse in international studies with women, GPs and pharmacists. A worry that they should not “misuse” use ECPs may be contributing to the underutilisation of ECPs internationally.

> These worries contrast with our evidence: single use of ECPs was the majority experience and overwhelmingly a response to a contraceptive mishap within an established relationship, after an occurrence of intercourse in a woman’s or her partner’s home. Women do not report having a supply of ECPs at home in case of contraception nonuse or mishap (termed “advance provision” in Australia). International studies fail to find any evidence of an increase in unprotected sex (or in STIs) after ECPs became available over the counter from a pharmacist.

TAKE HOME MESSAGE: Enhancing women’s knowledge about ECPs and directly engaging with moral prohibitions may be important if ECPs are to reduce the rate of unintended pregnancy.

Check out our paper in Health Care for Women International: Julie Mooney-Somers, Amber Lau, Deborah Bateson, Juliet Richters, Mary Stewart, Kirsten Black & Melissa Nothnagle (2018) Enhancing use of emergency contraceptive pills: A systematic review of women’s attitudes, beliefs, knowledge, and experiences in Australia, Health Care for Women International, DOI: 10.1080/07399332.2018.1526286

GET A FREE COPY OF THE ARTICLE HERE (the publisher is making 50 available, ask me for a copy when this runs out)

If you want to know more about emergency contraception, here’s a fact sheet from Family Planning NSW.

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