Evaluation of an emergency contraception introduction project in Kenya

The Consortium for Emergency Contraception introduced Postinor-2, a progestin-only EC product, into Kenya as part of its work to expand access to EC in developing countries. Introduction activities included registering Postinor-2, training providers, and developing provider and client materials. We surveyed family planning clients and providers to assess the impact of these activities. Knowledge of EC among clients and providers improved between the baseline and evaluation surveys. More women and providers had heard of EC and more providers were distributing it. Support for access to EC in Kenya also improved. The results indicate, though, that further information is needed. Only one-fifth of women at the evaluation had heard of EC and almost half of the women expressed concerns about EC at baseline and evaluation. More research and experience using novel ways of informing women about EC in Africa is needed, and information needs to address women's concerns.     

Pharmacy-based interventions for initiating effective contraception following the use of emergency contraception: a pilot study

Objectives

In Scotland most women get emergency contraception (EC) from pharmacies. Pharmacists currently cannot provide effective ongoing contraception after EC. In this pilot study, we aimed to determine the feasibility of a larger study designed to ascertain if pharmacy-based interventions can increase the uptake of effective contraception after EC.

Study design

This is a pilot study of women presenting for levonorgestrel EC to community pharmacies in Edinburgh, UK, in 2012. Pharmacies were cluster randomized to provide either standard care or one of two interventions: (a) one packet of progestogen-only pills (POPs), giving women 1 month to arrange ongoing contraception; (b) invitation to present the empty EC packet to a family planning clinic (FPC) for contraceptive advice (rapid access).

Results

One hundred sixty-eight women were recruited from 11 pharmacies to POP (n=56), rapid access (n=58) and standard care (N=54) groups, respectively. Telephone follow-up was conducted successfully in 102 women (61%) 6–8 weeks later to determine current contraceptive use. In the POP arm, 35/39 (90%) women used the pills provided, and 9/28 women (32%) in the rapid access arm attended the FPC. The proportion of women using effective contraception at follow-up was significantly greater in both POP [56% (22/39), p=<0.001] and rapid access [52% (13/25), p=0.006] groups compared to standard care [16% (5/31)]. The relative probability of a woman using an effective method of contraception versus barrier/no method, after use of EC, was 3.13 [95% confidence interval (CI), 1.90–5.13] in the POP group and 2.57 (95% CI, 1.55–4.27) in the rapid access group.

Conclusions

This promising pilot study suggests that simple pharmacy-based interventions may increase the uptake of effective contraception after EC. A larger study is required to provide further validation of these findings.

Implications statement

For women obtaining EC from a pharmacy, simple interventions such as supplying 1 month of a POP, or offering rapid access to a FPC, hold promise as strategies to increase the uptake of effective contraception after EC.     

Ongoing contraception after use of emergency contraception from a specialist contraceptive service

Background

A consultation for emergency contraception (EC) gives way to an opportunity to provide women with an ongoing effective method of contraception.

Study Design

A review of the case notes of women seeking EC from a large family planning clinic in Edinburgh, Scotland, was conducted to determine what percentage of women were provided with an effective method of ongoing contraception.

Results

Case notes of 460 women presenting for EC over a 2-year period were reviewed. Women were of mean age 26 years (range 15–49 years) and presented because they had used no contraception (47%), experienced condom failure (42%) or missed oral contraceptive pills (9%). Only 2% (n=11) were given an intrauterine device for EC. All women who had missed contraceptive pills prior to taking EC opted to continue this method. Only 23% (n=89) of women using no method or condoms at EC received supplies of an effective contraceptive method (pills, patch, injectable). Two thirds (n=263) of the women chose condoms for ongoing contraception.

Conclusion

Research is required to develop strategies to improve the uptake of effective contraception after EC.     

Barriers to the use of IUDs as emergency contraception.

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.