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Washington, D.C., Meridian Development Foundation, International Consortium for Emergency Contraception, 2018. 24 p.The Consortium has produced these medical and service delivery guidelines about oral emergency contraceptive pills to assist family planning programs and providers in assuring that the women they serve can use these regimens effectively and safely. This document reflects the latest available evidence and has been reviewed by internationally recognized reproductive health experts. Local programs are welcome to adapt these guidelines as needed to comply with national or other requirements. These guidelines do not discuss the use of the copper-bearing intrauterine device for emergency contraception. This device is the most effective emergency contraceptive option and should be offered to women when appropriate. Some of the new research and data updated include: New details on the hormone UPA and new studies on the influence of BMI on effectiveness are briefly discussed, as well as how ECP regimens work, their efficacy and safety, guidelines on repeat use, and considerations for starting or resuming regular contraceptives following ECP regimens. This update includes a Clinical Summary document (https://www.cecinfo.org/wp-content/uploads/2018/12/18-209_ICEC-Clinical-Summary_121918.pdf) which highlights essential takeaways.
A cross sectional study on awareness about emergency contraception among medical students in Kannur, Kerala, India.
International Journal of Community Medicine and Public Health. 2016 Nov; 3(11):3216-3219.Background: Emergency contraception (EC) is the methods of contraception that can be used to prevent pregnancy in the first five days after sexual intercourse. Unwanted pregnancy among young adults poses a major challenge to the reproductive health in developing countries because of unsafe abortions and deaths due to the same. Since medical students are future health care providers and their awareness about EC will help in giving health education to the community. Objectives of the study were to assess the knowledge of emergency contraception among second and third year medical students in a private medical college, Kannur, Kerala, India. Methods: A cross sectional study was conducted on second and third year medical students of a private medical college, Kerala, India. A total of 200 students were interviewed using pre-validated, semi structured questionnaire. Descriptive statistics were used to analyse the data. Results: Among the study population, 58% and 42% were females and males respectively. All students were heard about EC and 78.5% were correctly aware about the correct timing of administration of EC. 52% of them felt that they can get EC directly from any pharmacy store without consultation to a doctor, 93% of the students feel that EC is not an effective routine method of contraception and only 27% said that it will result in more women suffering from STI/HIV. Conclusions: Present study showed that, students were having above average knowledge about EC. Since they are the health care providers in future, giving proper training to them in acquiring good knowledge will help in dispensing the health education to the community especially youth in future.
Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset.
British Journal of General Practice. 2018 Dec 3;BACKGROUND: Evidence of an association between exposure to domestic violence and abuse (DVA) and use of emergency contraception (EC) is lacking in the UK. AIM: To quantify the association between exposure to DVA and consultations for EC in general practice. DESIGN AND SETTING: Nested case-control study in UK general practice. METHOD: Using the Clinical Practice Research Datalink, the authors identified all women all women aged 15-49 years registered with a GP between 1 January 2011 and 31 December 2016. Cases with consultations for EC (n = 43 570) were each matched on age and GP against four controls with no consultations for EC (n = 174 280). The authors calculated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between exposure to DVA in the previous year and consultations for EC. Covariates included age, ethnicity, socioeconomic status, pregnancy, children, alcohol misuse, and depression. RESULTS: Women exposed to DVA were 2.06 times more likely to have a consultation for EC than unexposed women (95% CI = 1.64 to 2.61). Women aged 25-39 years with exposure to DVA were 2.8 times more likely to have a consultation for EC, compared with unexposed women (95% CI = 2.08 to 3.75). The authors found some evidence of an independent effect of exposure to DVA on the number of consultations for EC (OR 1.48, 95% CI = 0.99 to 2.21). CONCLUSION: A request for EC in general practice can indicate possible exposure to DVA. Primary care consultation for EC is a relevant context for identifying and responding to DVA as recommended by the World Health Organization and National Institute for Health and Care Excellence guidelines. DVA training for providers of EC should include this new evidence. (c) British Journal of General Practice 2018.
The history of universal access to emergency contraception in Peru: a case of politics deepening inequalities.
Reproductive Health Matters. 2018 Nov 26; 1-4.Add to my documents.
Enhancing use of emergency contraceptive pills: A systematic review of women's attitudes, beliefs, knowledge, and experiences in Australia.
Health Care For Women International. 2018 Nov 26; 1-22.Over a decade after emergency contraceptive pills (ECPs) became available without a prescription, the rate of unintended pregnancies remains high in many settings. Understanding women's experiences and perceptions of ECPs may provide insights into this underutilization. We systematically searched databases to identify qualitative and quantitative primary studies about women's beliefs, knowledge, and experiences of ECPs in Australia. Findings demonstrate persistent misunderstandings around access, how ECPs work, and a moral discourse around acceptable versus unacceptable use. Addressing knowledge and the stigma around ECPs use is fundamental to increasing the use of this medically safe and effective strategy.
Intentions to use emergency contraception: The role of accurate knowledge and information source credibility.
American Journal of Health Education. 2018; 49(4):264-270.Background: Emergency contraception (EC) is a highly effective form of birth control that may lower rates of unintended pregnancy among young women. But efforts to disseminate EC to women are hampered by misinformation and inadequate information. Purpose: The purpose of this study was to determine the sources from which young women learn about EC (including health care providers, friends/interpersonal sources, media sources, or no information sources), and to examine source credibility with the accuracy of EC knowledge and intentions to use EC. Method: Using a computer-based survey, 339 college women (M age = 18.4) reported their EC information sources, knowledge about EC, and behavioral intentions to use EC. Results: In total, 97% of participants had heard of EC from at least one source and 49% indicated they were highly likely to use EC in the future if needed. Results demonstrated that EC knowledge mediated the relationship between EC information source credibility and intentions to use EC. Discussion: This study contributes important insights to a scarce literature on EC information sources and the factors that predict intentions to use EC. Translation to Health Education Practice: Future EC promotion efforts should target health education sources instead of media or interpersonal sources to promote EC knowledge and use among young, sexually at-risk populations.
Current Opinion In Obstetrics and Gynecology. 2018 Dec; 30(6):400-406.PURPOSE OF REVIEW: To evaluate the literature on repeat use of emergency contraception and pericoital approaches to contraception. RECENT FINDINGS: Women are very interested in an oral, on-demand contraceptive option, were one available. Ulipristal acetate and a combination of levonorgestrel (LNG) and meloxicam (a cyclo-oxygenase-2 inhibitor) both appear to be more effective at disrupting ovulation than LNG alone. Recent advisories from the United Kingdom regarding daily dosing of ulipristal for fibroids emphasize the need for more safety data. SUMMARY: Repeat pericoital dosing of 1.5-mg LNG is approximately as effective as other on-demand contraceptive methods and is overall very safe. The most common side effect is irregular bleeding. Repeat on-demand ulipristal acetate or meloxicam/other cyclo-oxygenase-2 inhibitors have potential as an on-demand option either alone or in combination but have not been evaluated for contraceptive efficacy in a large-scale study. Given the high unmet need for contraception, even among women with access to available options, there is a distinct need for options that address needs of women who are interested in an on-demand option. On-demand oral contraception has the potential to expand the convenience of contraceptive options and overall contraceptive use.
International Journal of Reproductive Medicine. 2018; 2018:2785839.Emergency contraceptives play a major role in preventing unwanted pregnancy. The use of emergency contraceptives is characterized by myths and lack of knowledge by both health professionals and users. The main objective of this paper is to summarize the clinical pharmacology of hormonal methods of emergency contraception. A literature review was done to describe in detail the mechanism of action, efficacy, pharmacokinetics, safety profile, and drug interactions of hormonal emergency contraceptive pills. This information is useful to healthcare professionals and users to fully understand how hormonal emergency contraceptive methods work.
Use of short acting reversible contraception in adolescents: The pill, patch, ring and emergency contraception.
Current Problems In Pediatric and Adolescent Health Care. 2018 Nov 20;Long acting reversible contraception (LARC) is the recommend form of birth control for adolescents by both the American Academy of Pediatrics and the American Congress of Obstetrics and Gynecology, but the majority of adolescents continue to use short acting reversible contraception (SARC) such as the oral contraceptive pill, vaginal ring, and transdermal patch. For this reason, it is important for medical providers to be familiar with how to prescribe and manage SARC in adolescents, paying particular attention to which patients are eligible to use them, which benefits the methods have outside of contraception, what side effects to be aware of, and special considerations for adolescents. Many adolescents will choose not to use any form of hormonal contraception-thus having a knowledge about and comfort with use of emergency contraception is of equal importance. Copyright (c) 2018. Published by Elsevier Inc.
Contraception. 2018 Dec; 98(6):482-485.OBJECTIVE: To assess the accessibility of ulipristal acetate (UPA) and copper intrauterine devices (IUDs) for emergency contraception (EC) in reproductive health centers in the Kansas City metropolitan area. STUDY DESIGN: Using a secret shopper method, two female investigators called the reproductive health centers listed as EC providers on the nonprofit website bedsider.org that were located within 25 miles of the University of Kansas Medical Center. We categorized clinics as Title X providers vs. not according to the grantee list from the Office of Population Affairs. Investigators inquired about obtaining a UPA prescription by phone, the availability of the copper IUD for EC and time to first available appointment for EC. We evaluated correlates of EC access and provision with Fisher's Exact Tests. RESULTS: We identified 40 clinics as potential EC providers. Some clinics reported that UPA could be prescribed by phone to existing patients (13/40, 32%), while others reported that women must meet with a provider first (15/40, 38%). Few clinics offered copper IUDs as EC (3/40, 8%). Title X clinic status did not predict provision of UPA by phone or copper IUDs as EC. The average time to next available appointment was 9+/-9days to discuss EC and 13+/-9days for a copper IUD. CONCLUSIONS: Accessing the most efficacious forms of EC in a timely fashion presents many logistic challenges for women. IMPLICATIONS: Healthcare systems should streamline protocols, train providers and improve rapid-access referral networks to facilitate timely provision of UPA and copper IUDs for EC. Copyright (c) 2018 Elsevier Inc. All rights reserved.
Contraceptive patterns after use of emergency contraception among female undergraduate students in Brazil.
European Journal of Contraception and Reproductive Health Care. 2018 Oct; 23(5):335-343.OBJECTIVE: The aim of our study was to describe contraceptive patterns 30 days after use of emergency contraception (EC) among female undergraduate students in Sao Paulo, Brazil. METHODS: This study was part of a larger project conducted in 2015 among 1679 female students aged 18-24 enrolled at the University of Sao Paulo. Analysis was restricted to the 916 students who reported lifetime use of EC. Logistic regression models were used to examine factors related to the use of contraception within the 30 day period following the last use of EC, changes in contraceptive behaviour before and after EC use, and gaps in contraceptive use within 30 days after EC use. RESULTS: Most women (75.4%) used contraception after accessing EC; 92.9% who used contraception prior to EC exposure resumed use of contraception afterwards, compared with 40.7% who did not use contraception prior to EC exposure. Only 6.3% of women switched to a less effective contraceptive method after EC use. Few women (7.5%) reported post-EC gaps in contraception. CONCLUSIONS: The results of this study suggest that EC may serve as a potential precursor to regular contraception among undergraduates in Brazil, with few women reporting contraceptive gaps after EC use. These patterns may contribute to reducing the risk of unintended pregnancy in this population.
Knowledge, attitude and practices regarding emergency contraception among married women in Ludhiana, Punjab, India.
International Journal of Community Medicine and Public Health. 2018 Aug; 5(8):3506-3512.Background: An unwanted and unintended pregnancy is a major concern in a women’s life as it has its adverse social and health outcomes. Emergency contraception (EC) is safe and effective method that gives women a second chance to prevent unwanted pregnancy after unprotected intercourse. Methods: This is a community based cross sectional study done in field practice area under the department of Community Medicine, Christian Medical College, Ludhiana, Punjab. A total of 400 respondents were selected by stratified random sampling from the list of eligible couples residing in the area. The interview was conducted using semi structured questionnaire, after obtaining their informed consent. Results: The mean age of respondents was 31.44±5.67 years. 68.7% of respondents were using some kind of contraception. Majority (68%) of respondents had heard of emergency contraception and for majority (81.3%) source of information about EC was Media (TV). Out of 272 respondents who had heard of emergency contraception 146 (54.1%) had negative attitude towards emergency contraception and only 30 (8%) had used ECP. Practice of ECP was found to have statistically significant association with employment and history of unwanted pregnancy. Conclusions: EC has a potential to curb the menace of unintended pregnancy thereby decreasing unsafe abortion and maternal mortality. In spite of reasonable awareness of emergency contraception, as found in present study there is wide gap for its usage. Hence behavioural change strategies should be considered to bring attitudinal change on use of emergency contraception.
International Journal of Community Medicine and Public Health. 2018 Aug; 5(8):3413-3417.Background: Accredited Social Health Activist (ASHA) is one of the key components of National Rural Health Mission (NRHM).The success of national health programs on family planning depends on how well ASHAs are trained and perform. Therefore it’s essential to assess the knowledge of ASHA workers. This study intends to assess the awareness of family planning services among ASHA workers in a municipality of northern Kerala. Methods: This is a cross sectional study conducted among ASHA workers working in a municipality in Kannur District, during a study period of two weeks (July 1- July14, 2017). Data was collected using a semi structured questionnaire. Data was analyzed using SPSS version 16.0 software and the results were expressed in terms of means, frequencies and percentage. Results: Majority (42.1%) of the ASHAs belongs to the age group of 42- 45 years and none of them were below 30 years. The mean population catered by ASHA workers were 1250. All of them were experienced for at least 7 years. Conclusions: All ASHA workers had satisfactory knowledge about family planning services. Despite this some of the ASHA workers don’t have adequate knowledge about ECPs, Progesterone only pills and non-contraceptive uses of condom. Hence it is essential to ensure that they are getting proper training from qualified personnel at regular intervals.
International Journal of Community Medicine and Public Health. 2018 Sep; 5(9):3930-3935.Background: Emergency contraception has the potential to greatly reduce the number of unintended pregnancies. The level of knowledge among the medical student population about EC has not been adequately investigated. This study aims to assess the knowledge, attitude and practice of EC (Emergency Contraception) amongst the medical under graduate students in Government college of Surat. Methods: This study was carried out among 339 medical under graduate students during the month of October, 2016. A predesigned self-administered questionnaire was used to collect the data. Results: Majority of students knew about some form of contraception. Only quarter of students knew about EC pill. Varied responses were observed regarding various knowledge aspects of EC. Internet and books were the most common source of knowledge. As far as their attitudes are concerned, almost 40% believed that EC would lead more irresponsible behaviour and more STD/HIV cases, while 30% believed that it would lead to promiscuity, and be inexpensive, if they are readily available. More than half number of students opined that EC should be made available for women aged only 18 years and above. As far as practice is concerned, only one student reported using EC. However, more than 40% were willing to use it, if required and would also encourage friends and relatives to use it. Conclusions: Awareness of EC was low among students. Attitude was favorable towards EC. Study also document very low level of practice of EC among the students.
Assessment of knowledge and attitude towards emergency contraception among postnatal mothers in Bruhat Bengaluru Mahanagara Palike referral hospital.
International Journal of Community Medicine and Public Health. 2018 Sep; 5(9):3813-3819.Background: Unintended pregnancy is an important public health issue in developing countries like India. Emergency contraception (EC) is one of the method for preventing such pregnancies. Awareness regarding EC is necessary for postnatal mothers since delay in contraceptive use during postpartum period until return of menstruation might subject them to risk of unintended pregnancy. Hence, the present study was undertaken. Methods: The study was conducted at Bruhat Bengaluru Mahanagara Palike (BBMP) referral hospital, Bengaluru from March 2016 to May 2016. A total of 100 postnatal mothers, were included in the study. A pre-tested semi-structured proforma was administered and information about socio-demographic profile, knowledge and attitude towards use of emergency contraception was obtained. Results: Among the study subjects, 28% were aware of emergency contraception, friends (57%) were the major source of information about EC. Overall knowledge regarding methods, time limit and dosage was low. There was a significant association between the educational level (p=0.01) and previous planned delivery (p<0.001) with awareness about EC. 51.4% had favourable attitude towards its use as an additional contraception whenever necessary. Conclusions: There is lack of knowledge and unfavourable attitude towards EC among post natal mothers.The factors such as education and previous planned deliveries had significant association with the awareness about EC. Hence health education regarding emergency contraception is necessary.
Journal of Obstetrics and Gynaecology Research. 2018 Sep 23;Levonorgestrel is used worldwide as an emergency oral contraceptive. There have been occasional reports of ectopic pregnancy after oral levonorgestrel use. We present a case of ectopic tubal pregnancy after the use of oral levonorgestrel as an emergency contraceptive in a 37-year-old woman with a history of treatment for Chlamydia trachomatis infection. She conceived after sexual intercourse on menstrual day 14 of the first menstrual cycle following a normal delivery. After salpingectomy for this right tubal pregnancy, her following pregnancy was an ectopic pregnancy in the contralateral tube, which was treated with laparoscopic salpingectomy. Histopathological examination revealed endometriosis. We should be aware of ectopic pregnancy even after emergency contraceptive use, especially in patients with risk factors, such as Chlamydia infection and endometriosis. Because the efficacy of levonorgestrel decreases after ovulation, we should check the stage of the cycle before prescription. (c) 2018 Japan Society of Obstetrics and Gynecology.
Use of emergency contraception among women with experience of domestic violence and abuse: a systematic review.
BMC Women's Health. 2018 Sep 25; 18(1):156.BACKGROUND: Exposure to domestic violence and abuse (DVA) results in a reduction of women's use of regular contraceptives. This evidence suggests that women exposed to DVA are more likely to have unprotected sexual intercourse and therefore may use more emergency contraception (EC) than those women who are not exposed to DVA. We aimed to test this hypothesis through evaluating the evidence for an association between exposure to DVA and use of EC. METHODS: We systematically searched eight electronic databases from inception until December 2017, checked references and citations, and contacted corresponding authors. Primary studies that evaluated the association between exposure to DVA and use of EC were included. Two reviewers were involved in screening, data extraction, quality assessment and analysis. We evaluated the quality of included studies with the adapted Newcastle-Ottawa Scale. We used tables and descriptive text to summarise and synthesise the data. Odds ratios (ORs) and 95% confidence intervals (CIs) for each estimate of the association between DVA and use of EC were plotted on a forest plot. RESULTS: Our search retrieved 1216 records of which six studies with 15,297 women were included. Five studies were observational; one study included intervention on the outcome (advance supply of EC). All studies were at high risk of bias. Four studies provided evidence of an association between DVA and EC use - ORs from 1.51 (95% CI 1.13, 2.02) to 6.50 (95% CI 4.15, 10.17). Two studies found no evidence of a such association - ORs 0.46 (95% CI 0.11, 1.96) and 0.76 (95% CI 0.29, 1.98). The latter differed by how the authors recruited participants, measured EC use and adjusted for confounders. CONCLUSIONS: This systematic review provides some evidence of increased use of EC among women exposed to DVA. Request for EC can indicate possible exposure to DVA. Therefore, each consultation for EC could be an appropriate context for clinical enquiry about DVA and signposting/referral to specialist DVA services. PROTOCOL REGISTRATION: PROSPERO CRD42017058221 .
Acta Clinica Croatica. 2018 Mar; 57(1):134-140.The aim of the study was to assess the level of knowledge of midwives working in different clinical settings about oral emergency contraception. The study included 225 midwives; during the period from December 2015 to February 2016, they completed a 16-item web-based survey using the SurveyMonkey software available on the Croatian Midwives Chamber site. In total 277 participants started to fill out the survey and 225 participants responded to all 16 questions. Demographic, educational and professional characteristics of the participants in this survey are provided. Distri-bution of participant responses to questions regarding basic reproductive endocrinology, unplanned pregnancies and emergency contraception clearly revealed important gaps in the group knowledge. There was evident gap in the knowledge about emergency contraception in the study group of Croa-tian midwives. Having in mind the study group grounds in gynecology and obstetrics, and their public health relevance, targeted educational activities both during midwife formal education and on-job are required to improve the group knowledge about emergency contraception. National guidelines on oral emergency contraception are an at hand learning tool and the most appropriate local source of information on emergency contraception. Various initiatives should be considered for this document to become an integral part of formal midwife education and regular part of their on-job trainings.
Emergency contraceptive knowledge, attitudes and practices among female students at the University of Botswana: A descriptive survey.
African Journal of Primary Health Care and Family Medicine. 2018 Sep 6; 10(1):e1-e6.BACKGROUND: Unintended pregnancies are associated with unsafe abortions and maternal deaths, particularly in countries such as Botswana, where abortion is illegal. Many of these unwanted pregnancies could be avoided by using emergency contraception, which is widely available in Botswana. AIM: To assess the level of knowledge, attitudes and practices of female students with regard to emergency contraception at the University of Botswana. SETTING: Students from University of Botswana, Gaborone, Botswana. METHODS: A descriptive survey among 371 students selected from all eight faculties at the university. Data were collected using a self-administered questionnaire and analysed using the Statistical Package for Social Sciences. RESULTS: The mean age was 20.6 years (SD 1.62), 58% were sexually active, 22% had used emergency contraception and 52% of pregnancies were unintended. Of the total respondents, 95% replied that they had heard of emergency contraception; however, only 53% were considered to have good knowledge, and 55% had negative attitudes towards its use. Students from urban areas had better knowledge than their rural counterparts (p = 0.020). Better knowledge of emergency contraception was associated with more positive attitudes towards actual use (p < 0.001). Older students (p < 0.001) and those in higher years of study (p = 0.001) were more likely to have used emergency contraception. CONCLUSION: Although awareness of emergency contraception was high, level of knowledge and intention to use were low. There is a need for a targeted health education programme to provide accurate information about emergency contraception.
Contraception and Reproductive Medicine. 2018; 3:20.Emergency contraception is indicated in instances of unprotected sexual intercourse, including reproductive coercion, sexual assault, and contraceptive failure. It plays a role in averting unintended pregnancies due to inconsistent use or non-use of contraception. Options for emergency contraception vary by efficacy as well as accessibility within the U.S. This paper provides an overview of levonorgestrel (Plan B One-Step and generic counterparts), ulipristal acetate (sold as ella), and the copper intrauterine device (IUD, sold as ParaGard), including the mechanisms of action, administration, efficacy, drug interactions, safety, side effects, advantages, and drawbacks. It will also review current misconceptions about emergency contraception and access for subpopulations, including adolescents, immigrants, survivors of sexual assault, rural populations, and military/veteran women. This paper will address barriers such as gaps in knowledge, and financial, health systems, and practice barriers. Continuing areas of research, including the impact of body weight on the efficacy of emergency contraceptive pills and potential interactions between ulipristal acetate and ongoing hormonal contraceptives, are also addressed.
The knowledge and perceptions of the first year medical students of an International University on family planning and emergency contraception in Nicosia (TRNC).
BMC Women's Health. 2018 Sep 15; 18(1):149.BACKGROUND: Informing the individuals on family planning including emergency contraception is a significant step for preventing unintended pregnancies. Although there is a number of studies on family planning and emergency contraception globally and in Turkey, no such data are available in the Turkish Republic of Northern Cyprus. The objective of this study was to evaluate the knowledge and perceptions on family planning and emergency contraception of the first year students of an international medical school in Nicosia, Northern Cyprus and to increase awareness for developing new policies on the issue. METHODS: The data of this cross-sectional study were collected in February 2016 by a questionnaire of 36 questions. Of the 229 students, 189 (82.5%) completed the questionnaire. The data were evaluated by SPSS 18.0 statistical program. The differences of variables were evaluated by Chi square test, p < 0.05 being accepted as significant. RESULTS: The distribution of participants from 23 countries according to nationality revealed three leading countries: Nigeria, Turkey and Syria. Of the students, 53.6% knew the definition of family planning. The sources of information were mainly school, the internet and media, with a total of 60.9% of the participants who stated having prior information on the subject. Awareness of contraceptive methods was indicated by more than 90% and emergency contraception by 66.1% of the participants. However, the students were unable to differentiate between modern and traditional family planning methods; 85.6% did not have knowledge of the most effective period for emergency contraception and 63.1%, of the definition of emergency contraceptive pills. CONCLUSIONS: In conclusion, the knowledge and awareness level of the first year medical students on family planning and emergency contraception was insufficient. Family planning and emergency contraception education should be provided for the students at the first year of all faculties as well as medical schools and relevant programs should be included in the curricula of medical education.
Sexual violence against women and care in the health sector in Santa Catarina - Brazil. Violencia sexual contra a mulher e o atendimento no setor saude em Santa Catarina - Brasil.
Ciencia and Saude Coletiva. 2018 May; 23(5):1687-1696.This is a study on sexual violence against women in the Brazilian State of Santa Catarina notified to the Notifiable Diseases Information System (SINAN) in the period 20082013. It aimed to estimate pregnancy and sexually transmitted infections (STIs) resulting from sexual violence and to test the association between pregnancy, STIs and care provided in health services. In total, 1,230 pregnancy notifications and 1.316 STI notifications were analyzed. Variables were age, schooling, time to receive care, STI prophylaxis, emergency contraception, number of perpetrators and recurrent violence, which were analyzed using proportions and 95% confidence intervals. Associations were tested by adjusted and non-adjusted logistic regression with values expressed in odds ratio. The occurrence of pregnancy was 7.6%. Receiving care within 72 hours and emergency contraception were protective factors. The occurrence of STIs was 3.5%. Care within 72 hours and prophylaxis did not result in lower proportions of STIs. Further studies are required regarding this issue.
Cochrane Database of Systematic Reviews. 2007 Apr 18; (2):CD005497.BACKGROUND: Emergency contraception can prevent pregnancy when taken after unprotected intercourse. Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision, in which women receive a supply of emergency contraception before unprotected sex, could circumvent some obstacles to timely use. OBJECTIVES: To summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. SEARCH STRATEGY: In August 2006, we searched CENTRAL, EMBASE, POPLINE, MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials. SELECTION CRITERIA: We included randomized controlled trials comparing advance provision and standard access, which was defined as any of the following: counseling which may or may not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy. DATA COLLECTION AND ANALYSIS: We evaluated all identified titles and abstracts found for potential inclusion. Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 4.2.8. We calculated odds ratios with 95% confidence intervals for dichotomous data and weighted mean differences with 95% confidence intervals for continuous data. MAIN RESULTS: Eight randomized controlled trials met our criteria for inclusion, representing 6389 patients in the United States, China and India. Advance provision did not decrease pregnancy rates (OR 1.0; 95% CI: 0.78 to 1.29 in studies for which we included twelve month follow-up data; OR 0.91; 95% CI: 0.69 to 1.19 in studies for which we included six month follow-up data; OR 0.49; 95% CI: 0.09 to 2.74 in a study with three month follow up data), despite increased use (single use: OR 2.52; 95% CI 1.72 to 3.70; multiple use: OR 4.13; 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -14.6 hours; 95% CI -16.77 to -12.4 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 0.99; 95% CI 0.73 to 1.34), increased frequency of unprotected intercourse, nor changes in contraceptive methods. Women who received emergency contraception in advance were equally as likely to use condoms as other women. AUTHORS' CONCLUSIONS: Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy. However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.
Women and Health. 2018 Jun 19; 1-11.Federal regulations governing access to levonorgestrel (LNG) emergency contraception (EC) have evolved since its introduction in the 1990s. LNG EC was initially available by prescription only, but is now available over-the-counter to consumers of all ages. Nonetheless, consumers seeking EC in their communities may face ongoing barriers to access, including low stock and inaccurate information provided by pharmacy staff. We conducted a review of LNG EC secret shopper studies to describe changes in EC access and barriers over time. EC access was compared across all applicable studies, which were published during 2003-2016. When possible, reasons for EC unavailability, helpfulness of pharmacy staff when EC was not in stock, and accuracy of EC information provided by pharmacy staff were described. Overall, access to EC appeared to be improving. However, EC was unavailable during 31 percent of encounters. Pharmacy staff attributed this to "low demand" (30 percent) or EC being "out of stock" (21 percent). Personal objections (9 percent) and store policy (10 percent) were also cited in studies from earlier years. Inaccurate information provided by pharmacy staff persists regarding federal EC regulations, mechanism of action, and drug administration. Pharmacy staff should remain informed about EC and its regulations in order to reduce remaining access barriers.
Fertility and Sterility. 2018 Jun; 109(6):1016-1017.Add to my documents.