Knowledge of, beliefs about, and perceived barriers to the use of the emergency contraception pill among women aged 18-51 in Nova Scotia
Main Article Content
Keywords
Abstract
Objectives: To investigate women in Nova Scotia (NS), Canada with respect to their knowledge of, beliefs about, and perceptions of barriers to accessing emergency contraception pills (ECP).
Methods: A random digit dialing approach was used to survey a representative sample of NS women aged 18-51. Analyses described the knowledge, beliefs, and perceived barriers associated with ECP access among participants. Particular focus was given to differences between younger (age 18-31) and older (age 32-51) women.
Results: The survey response rate of 49% achieved the desired sample size of 770. Overall, women in NS appeared to be poorly informed about ECP with regards to effectiveness, proper timing of administration, how it works, as well as how to access Plan B®. Younger women (age 18-31) were significantly more likely than older women (age 32-51) to know that ECP does not always prevent pregnancy (p<0.01), that it can be taken more than 12 hours after unprotected intercourse (p<0.01), and that it is available without a prescription in pharmacies (p<0.01). Thirty percent of women agreed that ECP will cause an abortion, with older women (p<0.01) being more likely than younger women to agree. Cost and lack of privacy in pharmacies were identified as potential barriers to access.
Conclusions: Lack of knowledge and the perception that ECP causes an abortion may influence a woman’s ability to consider ECP as an option should she find herself at risk of an unplanned pregnancy. To address this, efforts should be made to educate women (including older women) about ECP and its availability in pharmacies.
Keywords: Contraception, Postcoital. Women’s Health. Health Knowledge, Attitudes, Practice. Age Factors. Canada.
References
1. Kost K, Landry DJ, Darroch JE. Predicting maternal behaviors during pregnancy: does intention status matter?. Fam Plann Perspect. 1998;30(2):79-88.
2. Sable MR, Spencer JC, Stockbauer JW, Schramm WF, Howell V, Herman AA. Pregnancy wantedness and adverse pregnancy outcomes: differences by race and Medicaid status. Fam Plann Perspect. 1997;29(2):76-81.
3. Sable MR, Wilkinson DS. Impact of perceived stress, major life events and pregnancy attitudes on low birth weight. Fam Plann Perspect. 2000;32(6):288-294.
4. CANSIM Table 106-9002 Pregnancy Outcomes, by age group, Canada, provinces and territories, annual. Available at: http://www5.statcan.gc.ca/cansim/pick-choisir?lang=eng&id=1069002&pattern=1069002&searchTypeByValue=1 (Accessed 04/29, 2011).
5. Poulin C, Graham L. The association between substance use, unplanned sexual intercourse and other sexual behaviours among adolescent students. Addiction. 2001;96(4):607-621.
6. Trussell J, Rodriguez G, Ellertson C. Updated estimates of the Yuzpe regimen of emergency contraception. Contraception. 1999;59:147-151.
7. World Health Organization [WHO]. Special Programme of Research, Development, and Research Training in Human Reproduction. Task Force on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet. 1998;352(9126):428-433.
8. Cheng L, Gulmezoglu AM, Piaggio G, Ezcurra E, Van Look PF. Interventions for emergency contraception. Cochrane Database Syst Rev. 2008;(2):CD001324.
9. Ho PC, Kwan MS. A prospective randomized comparison of levonorgestrel with the Yuzpe regimen in post-coital contraception. Hum Reprod. 1993;8(3):389-392.
10. Wanner MS, Couchenour RL. Hormonal emergency contraception. Pharmacotherapy. 2002;22(1):43-53.
11. Regulations amending the Food and Drug Regulations (1272-Levonorgestrel). Available at: http://canadagazette.gc.ca/partII/2005/20050504/html/sor105-e.html (Accessed February 22, 2007).
12. Trussell J, Ellertson C, Stewart F, Raymond EG, Shochet T. The role of emergency contraception. Am J Obstet Gynecol. 2004;190(4 Suppl):S30-38.
13. Glasier A. Availability, accessibility, and use. The provision of emergency hormonal contraception. In: Paintin D, editor. London: RCOG Press; 1995. p. 16-20.
14. Wan SF, Lo SST. Are women ready for more liberal delivery of emergency contraceptive pills?. Contraception. 2005;71:432-437.
15. Johnson R, Nshom M, Nye AM, Cohall AT. There's always Plan B: adolescent knowledge, attitudes and intention to use emergency contraception. Contraception. 2010;81(2):128-132.
16. Irfan F, Karim SI, Hashmi S, Ali S, Ali SA. Knowledge of emergency contraception among women of childbearing age at a teaching hospital of Karachi. J Pak Med Assoc. 2009;59(4):235-240.
17. Payakachat N, Ragland D, Houston C. Impact of emergency contraception status on unintended pregnancy: observational data from a women’s health practice. Pharm Pract (Internet) 2010;8(3):173-178.
18. Fisher W, Boroditsky R, Morris B. The 2002 Canadian Contraception Study: part 1. J Obstet Gynaecol Can. 2004;26(6):580-590.
19. Langille DB, Delaney ME. Knowledge and use of emergency postcoital contraception by female students at a high school in Nova Scotia. Can J Public Health. 2000;91(1):29-32.
20. Moreau C, Bouyer J, Goulard H, Bajos N. The remaining barriers to the use of emergency contraception: Perception of pregnancy risk by women undergoing induced abortions. Contraception. 2005;71:202-207.
21. Foster DG, Ralph LJ, Arons A, Brindis CD, Harper CC. Trends in knowledge of emergency contraception among women in California, 1999-2004. Womens Health Issues. 2007;17(1):22-28.
22. Aneblom G, Larsson M, Odlind V, Tyden T. Knowledge, use and attitudes towards emergency contraceptive pills among Swedish women presenting for induced abortion. BJOG. 2002;109:155-160.
23. Jackson R, Schwarz EB, Freedman L, Darney P. Knowledge and willingness to use emergency contraception among low-income post-partum women. Contraception. 2000;61(6):351-357.
24. Smith BH, Gurney EM, Aboulela L, Templeton A. Emergency contraception: a survey of women's knowledge and attitudes. Br J Obstet Gynaecol. 1996;103(11):1109-1116.
25. Statistics Canada. Table 106-9034 - Induced abortions in hospitals and clinics, by age group and area of residence of patient, Canada, provinces and territories, annual, CANSIM (database). Available at: http://cansim2.statcan.gc.ca/cgi-win/cnsmcgi.exe?Lang=E&CNSM-Fi=CII/CII_1-eng.htm (Accessed 11/23/2009).
26. Belisle S, Blake J, Basson R, Desindes S, Graves G, Grigoriadis S, et al. Canadian consensus conference on menopause, 2006 update. J Obstet Gynaecol Can 2006;28(2 Suppl 1):S7-S94.
27. Nunnaly J. Psychometric theory. New York: McGraw Hill; 1978.
28. Statistics Canada. 2001 Community Profiles. 2007. Available at: http://www12.statcan.ca/english/Profil01/CP01/Details/Page.cfm?Lang=E&Geo1=PR&Code1=12&Geo2=PR&Code2=01&Data=Count&SearchText=Canada&SearchType=Begins&SearchPR=01&B1=All (Accessed 03/21, 2007).
29. Statistics Canada. 2006 Community Profiles. 2010. Available at: http://www12.statcan.ca/census-recensement/2006/dp-pd/prof/92 591/details/page.cfm?Lang=E&Geo1=CSD&Code1=1209034&Geo2=PR&Code2=12&Data=Count&SearchText=halifax&SearchType=Begins&SearchPR=01&B1=All&Custom (Accessed 05/01, 2010).
30. von Hertzen H, Piaggio G, Ding J, Chen J, Song S, Bartfai G, et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial. Lancet. 2002;360(9348):1803-1810.
31. Rodrigues I, Grou J, Joly J. Effectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse. Am J Obstet Gynecol. 2001;184:531-537.
32. Shoveller J, Chabot C, Soon JA, Levine M. Identifying barriers to emergency contraception use among young women from various sociocultural groups in British Columbia, Canada. Perspect Sex Reprod Health. 2007;39(1):13-20.
33. Fisher W, Boroditsky R, Morris B. The 2002 Canadian Contraception Study: Part 2. J Obstet Gynaecol Can. 2004;26(7):646-656.
34. Sorhaindo A, Becker D, Fletcher H, Garcia SG. Emergency contraception among university students in Kingston, Jamaica: a survey of knowledge, attitudes, and practices. Contraception. 2002;66(4):261-268.
35. Dunn S, Brown TE, Cohen MM, Cockerill R, Wichman K, Weir N, et al. Pharmacy provision of emergency contraception: the Ontario emergency contraception pilot project. J Obstet Gynaecol Can. 2003;25(11):923-930.
36. Eggertson L, Sibbald B. Privacy issues raised over Plan B: women asked for names, addresses, sexual history. CMAJ. 2005;173(12):1435-1436.
37. Emergency contraception moves behind the counter. CMAJ. 2005;172(7):845.
38. Cooper J, Crandall L. Media cites privacy concerns in delivery of ECP. Can Pharm J. 2006;139(1):37.
39. Novikova N, Weisberg E, Fraser IS. Does readily available emergency contraception increase women's awareness and use?. Eur J Contracept Reprod Health Care. 2009;14(1):39-45.
40. Campbell JW3rd, Busby SC, Steyer TE. Attitudes and beliefs about emergency contraception among patients at academic family medicine clinics. Ann Fam Med. 2008;6(Suppl 1):S23-27.
2. Sable MR, Spencer JC, Stockbauer JW, Schramm WF, Howell V, Herman AA. Pregnancy wantedness and adverse pregnancy outcomes: differences by race and Medicaid status. Fam Plann Perspect. 1997;29(2):76-81.
3. Sable MR, Wilkinson DS. Impact of perceived stress, major life events and pregnancy attitudes on low birth weight. Fam Plann Perspect. 2000;32(6):288-294.
4. CANSIM Table 106-9002 Pregnancy Outcomes, by age group, Canada, provinces and territories, annual. Available at: http://www5.statcan.gc.ca/cansim/pick-choisir?lang=eng&id=1069002&pattern=1069002&searchTypeByValue=1 (Accessed 04/29, 2011).
5. Poulin C, Graham L. The association between substance use, unplanned sexual intercourse and other sexual behaviours among adolescent students. Addiction. 2001;96(4):607-621.
6. Trussell J, Rodriguez G, Ellertson C. Updated estimates of the Yuzpe regimen of emergency contraception. Contraception. 1999;59:147-151.
7. World Health Organization [WHO]. Special Programme of Research, Development, and Research Training in Human Reproduction. Task Force on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet. 1998;352(9126):428-433.
8. Cheng L, Gulmezoglu AM, Piaggio G, Ezcurra E, Van Look PF. Interventions for emergency contraception. Cochrane Database Syst Rev. 2008;(2):CD001324.
9. Ho PC, Kwan MS. A prospective randomized comparison of levonorgestrel with the Yuzpe regimen in post-coital contraception. Hum Reprod. 1993;8(3):389-392.
10. Wanner MS, Couchenour RL. Hormonal emergency contraception. Pharmacotherapy. 2002;22(1):43-53.
11. Regulations amending the Food and Drug Regulations (1272-Levonorgestrel). Available at: http://canadagazette.gc.ca/partII/2005/20050504/html/sor105-e.html (Accessed February 22, 2007).
12. Trussell J, Ellertson C, Stewart F, Raymond EG, Shochet T. The role of emergency contraception. Am J Obstet Gynecol. 2004;190(4 Suppl):S30-38.
13. Glasier A. Availability, accessibility, and use. The provision of emergency hormonal contraception. In: Paintin D, editor. London: RCOG Press; 1995. p. 16-20.
14. Wan SF, Lo SST. Are women ready for more liberal delivery of emergency contraceptive pills?. Contraception. 2005;71:432-437.
15. Johnson R, Nshom M, Nye AM, Cohall AT. There's always Plan B: adolescent knowledge, attitudes and intention to use emergency contraception. Contraception. 2010;81(2):128-132.
16. Irfan F, Karim SI, Hashmi S, Ali S, Ali SA. Knowledge of emergency contraception among women of childbearing age at a teaching hospital of Karachi. J Pak Med Assoc. 2009;59(4):235-240.
17. Payakachat N, Ragland D, Houston C. Impact of emergency contraception status on unintended pregnancy: observational data from a women’s health practice. Pharm Pract (Internet) 2010;8(3):173-178.
18. Fisher W, Boroditsky R, Morris B. The 2002 Canadian Contraception Study: part 1. J Obstet Gynaecol Can. 2004;26(6):580-590.
19. Langille DB, Delaney ME. Knowledge and use of emergency postcoital contraception by female students at a high school in Nova Scotia. Can J Public Health. 2000;91(1):29-32.
20. Moreau C, Bouyer J, Goulard H, Bajos N. The remaining barriers to the use of emergency contraception: Perception of pregnancy risk by women undergoing induced abortions. Contraception. 2005;71:202-207.
21. Foster DG, Ralph LJ, Arons A, Brindis CD, Harper CC. Trends in knowledge of emergency contraception among women in California, 1999-2004. Womens Health Issues. 2007;17(1):22-28.
22. Aneblom G, Larsson M, Odlind V, Tyden T. Knowledge, use and attitudes towards emergency contraceptive pills among Swedish women presenting for induced abortion. BJOG. 2002;109:155-160.
23. Jackson R, Schwarz EB, Freedman L, Darney P. Knowledge and willingness to use emergency contraception among low-income post-partum women. Contraception. 2000;61(6):351-357.
24. Smith BH, Gurney EM, Aboulela L, Templeton A. Emergency contraception: a survey of women's knowledge and attitudes. Br J Obstet Gynaecol. 1996;103(11):1109-1116.
25. Statistics Canada. Table 106-9034 - Induced abortions in hospitals and clinics, by age group and area of residence of patient, Canada, provinces and territories, annual, CANSIM (database). Available at: http://cansim2.statcan.gc.ca/cgi-win/cnsmcgi.exe?Lang=E&CNSM-Fi=CII/CII_1-eng.htm (Accessed 11/23/2009).
26. Belisle S, Blake J, Basson R, Desindes S, Graves G, Grigoriadis S, et al. Canadian consensus conference on menopause, 2006 update. J Obstet Gynaecol Can 2006;28(2 Suppl 1):S7-S94.
27. Nunnaly J. Psychometric theory. New York: McGraw Hill; 1978.
28. Statistics Canada. 2001 Community Profiles. 2007. Available at: http://www12.statcan.ca/english/Profil01/CP01/Details/Page.cfm?Lang=E&Geo1=PR&Code1=12&Geo2=PR&Code2=01&Data=Count&SearchText=Canada&SearchType=Begins&SearchPR=01&B1=All (Accessed 03/21, 2007).
29. Statistics Canada. 2006 Community Profiles. 2010. Available at: http://www12.statcan.ca/census-recensement/2006/dp-pd/prof/92 591/details/page.cfm?Lang=E&Geo1=CSD&Code1=1209034&Geo2=PR&Code2=12&Data=Count&SearchText=halifax&SearchType=Begins&SearchPR=01&B1=All&Custom (Accessed 05/01, 2010).
30. von Hertzen H, Piaggio G, Ding J, Chen J, Song S, Bartfai G, et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial. Lancet. 2002;360(9348):1803-1810.
31. Rodrigues I, Grou J, Joly J. Effectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse. Am J Obstet Gynecol. 2001;184:531-537.
32. Shoveller J, Chabot C, Soon JA, Levine M. Identifying barriers to emergency contraception use among young women from various sociocultural groups in British Columbia, Canada. Perspect Sex Reprod Health. 2007;39(1):13-20.
33. Fisher W, Boroditsky R, Morris B. The 2002 Canadian Contraception Study: Part 2. J Obstet Gynaecol Can. 2004;26(7):646-656.
34. Sorhaindo A, Becker D, Fletcher H, Garcia SG. Emergency contraception among university students in Kingston, Jamaica: a survey of knowledge, attitudes, and practices. Contraception. 2002;66(4):261-268.
35. Dunn S, Brown TE, Cohen MM, Cockerill R, Wichman K, Weir N, et al. Pharmacy provision of emergency contraception: the Ontario emergency contraception pilot project. J Obstet Gynaecol Can. 2003;25(11):923-930.
36. Eggertson L, Sibbald B. Privacy issues raised over Plan B: women asked for names, addresses, sexual history. CMAJ. 2005;173(12):1435-1436.
37. Emergency contraception moves behind the counter. CMAJ. 2005;172(7):845.
38. Cooper J, Crandall L. Media cites privacy concerns in delivery of ECP. Can Pharm J. 2006;139(1):37.
39. Novikova N, Weisberg E, Fraser IS. Does readily available emergency contraception increase women's awareness and use?. Eur J Contracept Reprod Health Care. 2009;14(1):39-45.
40. Campbell JW3rd, Busby SC, Steyer TE. Attitudes and beliefs about emergency contraception among patients at academic family medicine clinics. Ann Fam Med. 2008;6(Suppl 1):S23-27.