Access to the Emergency Contraceptive Pill and Women's Reproductive Health: Evidence From Public Reform in Chile

We examine the sharp expansion in availability of the emergency contraceptive pill in Chile following legalized access through municipal public health care centers. We study the period 2002–2016 and a broad rollout of the emergency contraceptive pill occurring between 2008 and 2011. By combining a number of administrative data sets on health outcomes and pharmaceutical use, and using event-study and difference-in-differences methods, we document that this expansion improved certain classes of women's reproductive health outcomes, notably reducing rates of abortion-related morbidity. These improvements were greater in areas of the country where the rollout of the emergency contraceptive pill was more extensive. We also document some evidence that refusal to provide the emergency contraceptive pill upon a women's request was linked with a worsening in reproductive health outcomes. These results point to the importance of contraceptive access as a determinant of women's reproductive health and well-being and relates to a growing body of work documenting the importance of women's autonomy as a determinant of health.

Kontrasepsi Darurat dan Permasalahannya

Emergency contraception is a contraceptive method that can prevent pregnancy if used immediately following unprotected sex. The use of emergency contraception could reduce the rate of unwanted pregnancy by up to 50%. There are two emergency contraceptive methods, including the emergency contraceptive pill and copper intrauterine device (IUD). Emergency contraceptive pills should be taken immediately following unprotected sex and are most effective when taken within 24 hours. IUD as an emergency contraceptive can be applied five days after unprotected sex, and it does not cause abortion. There is no absolute contraindication for emergency contraception except for known pregnancy, and simply because it is ineffective. The efficacy of emergency contraception can be defined by the proportion of women who become pregnant after using this method and the total pregnancy observed after using the method divided by the estimated number of pregnancies that would occur without using the method.Keywords: emergency contraception; sexual intercourse; pregnancy Abstrak: Kontrasepsi darurat dapat mencegah kehamilan bila digunakan segera setelah senggama. Penggunaan kontrasepsi darurat dapat menurunkan angka kehamilan yang tidak diinginkan hingga 50%. Terdapat dua metode kontrasepsi darurat, yaitu pil kontrasepsi darurat dan alat kontrasepsi dalam rahim (AKDR) yang menggunakan tembaga. Pil kontrasepsi darurat harus diberikan sesegera mungkin setelah senggama tidak terlindungi, dan paling efektif bila diberikan dalam waktu 24 jam. AKDR sebagai kontrasepsi darurat dapat dipasang hingga lima hari pasca senggama tidak terlindungi. Kontrasepsi darurat terutama bekerja dengan mencegah fertilisasi, dan tidak menggugurkan kehamilan. Tidak ada kontraindikasi absolut untuk penggunaan kontrasepsi darurat kecuali kehamilan yang diketahui, dan ini hanya karena tidak efektif. Efektivitas kontrasepsi darurat dapat didefinisikan dari proporsi wanita menjadi hamil setelah menggunakan metode ini, dan jumlah kehamilan yang diamati setelah penggunaan dibagi dengan perkiraan jumlah kehamilan yang akan terjadi tanpa penggunaan.Kata kunci: kontrasepsi darurat; senggama; kehamilan

Use of emergency contraceptive pill in India: boon or bane

It has been almost fifteen years since emergency contraceptive pills (ECPs) have been made available over the counter in India. There have been concerns about the overuse/misuse of ECPs and probability to replace regular contraceptive methods. This article presents various facets of the use of emergency contraceptive pills in India and highlights the importance of potential research to prevent its misuse.

Effect of Emergency Contraceptive Pill Use on Condom Utilization Among University Students in Nekemte Town, Western Ethiopia: A Cross-Sectional Study

Background: Emergency contraceptive pill (ECP) is a type of hormonal contraceptives which prevents unplanned pregnancy, but not sexually transmitted infections (STIs). Besides, its impact on condom utilization is not known among female university students in Nekemte town. Thus, this study was aimed to assess the awareness and attitude of university students on the use of ECP and its impact on condom utilization. Methods: An institution-based cross-sectional study was conducted on 400 female students in three private universities in Nekemte town from February 1 to 29, 2016. A simple random sampling, after proportional size allocation to respective study settings, was used to select student participants. Among the 400 randomly selected participants, 381 have completed and returned the questionnaire with 95.25% response rate. Data were collected by using self-administered questionnaire and entered into EpiData 3.1, and analyzed by using SPSS version 20. Bivariate and multivariate analysis were performed to determine the effects of ECP use on condom utilization with statistical significance set at P-value < 0.05. Results: Nearly half (48.8%) of the students indicated that they had sexual intercourse before and heard of ECP. Moreover, 30% of the respondents reported that they used ECP. Majority (61.7%) showed willingness to use ECP. Furthermore, students who used ECP were 3 times less likely to use condoms when compared to those who never used ECP (AOR = 0.322, 95% CI 0.164, 0.632). Alternatively, students who believed ECP does not prevent STIs were 2 times more likely to use condoms when compared to those who believed ECP does prevent STIs (AOR= 2.217 95% CI 1.070, 4.593). Conclusions: our findings identified that most students lack knowledge of ECP while having positive attitude on its use. On the other hand, ECP use imposes negative impact on condom utilization so that female students could be exposed to risky STIs.

The Quality of Counselling for Oral Emergency Contraceptive Pills—A Simulated Patient Study in German Community Pharmacies

Background: In Germany, there are two different active substances, levonorgestrel (LNG) and ulipristal acetate (UPA), available as emergency contraception (the “morning after pill”) with UPA still effective even 72 to 120 h after unprotected sexual intercourse, unlike LNG. Emergency contraceptive pills have been available without a medical prescription since March 2015 but are still only dispensed by community pharmacies. The aim of this study was to determine the counselling and dispensing behaviour of pharmacy staff and the factors that may influence this behaviour in a scenario that intends that only the emergency contraceptive pill containing the active substance UPA is dispensed (appropriate outcome). Methods: A cross-sectional study was carried out in the form of a covert simulated patient study in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern and reported in accordance with the STROBE statement. Each pharmacy was visited once at random by one of four trained test buyers. They simulated a product-based request for an emergency contraceptive pill, stating contraceptive failure 3.5 days prior as the reason. The test scenario and the evaluation forms are based on the recommended actions, including the checklist from the Federal Chamber of Pharmacies. Results: All 199 planned pharmacy visits were carried out. The appropriate outcome (dispensing of UPA) was achieved in 78.9% of the test purchases (157/199). A significant correlation was identified between the use of the counselling room and the use of a checklist (p < 0.001). The use of a checklist led to a significantly higher questioning score (p < 0.001). In a multivariate binary logistic regression analysis, a higher questioning score (adjusted odds ratio [AOR] = 1.41; 95% CI = 1.22–1.63; p < 0.001) and a time between 12:01 and 4:00 p.m. (AOR = 2.54; 95% CI = 1.13–5.73; p = 0.024) compared to 8:00 to 12:00 a.m. were significantly associated with achieving the appropriate outcome. Conclusions: In a little over one-fifth of all test purchases, the required dispensing of UPA did not occur. The use of a counselling room and a checklist, the use of a checklist and the questioning score as well as the questioning score and achieving the appropriate outcome are all significantly correlated. A target regulation for the use of a counselling room, an explicit guideline recommendation about the use of a checklist, an obligation for keeping UPA in stock and appropriate mandatory continuing education programmes should be considered.

Use of the emergency contraceptive pill in university students from Tunja, Boyaca

Background: The objective of this study was to asses frequency of employ, as well, as the level of knowledge of post-coital contraception in young female university students, living at the municipality of Tunja, Colombia. Methods: Descriptive, observational cross-sectional study. A sample of 615 students from two universities, public one and private the other, answered a survey about knowledge, sexual practices and the use of contraceptive methods, including the emergency contraceptive pill. Results: Mean age 21.18 years; Mean age of onset of sexuality 16.5 years; 59.7% had a stable partner; 69.6% answered that they had taken emergency contraception pill at least once in their life and 36.4% reported a frequency equal or greater than twice a year, while 17.5% considered it as a contraceptive method of habitual employment. Conclusions: Although the use of mechanical barrier methods as a method of contraception is not the objective of this study, we found that the condom is still the most commonly used contraceptive method by university students, but not used permanently or regularly. There is a high percentage of employment of emergency contraception pill, even with repetitive uses in short time periods. There is a high degree of conviction among young users about the contraceptive safety of the use of emergency contraception pill.