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A flow chart of patients prescribed emergency contraception.
Source publication
To assess the effectiveness of emergency single-dose levonorgestrel contraception in preventing unintended pregnancies among woman who visited the emergency department (ED) due to sexual assault (SA).
We conducted a retrospective chart review in a university hospital in South Korea. Cases from November 10, 2006 to November 9, 2009 were enrolled. In...
Context in source publication
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Objective:
To estimate the effect of increased body weight and body mass index (BMI) on pregnancy rates with Levonorgestrel (LNG) 1.5mg used as emergency contraception.
Methods:
The study reviewed data from 6873 women in four WHO-HRP randomized trials on emergency contraception (EC) conducted between 1993 and 2010. Participants took either 1.5mg...
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...
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Breast cancer, affecting one in eight American women, is a modern epidemic. The increasing frequency of breast cancer is widely recognized. However, the wealth of compelling epidemiological data on its prevention is generally not available, and as a consequence, is largely unknown to the public. The purpose of this report is to review the epidemiol...
Citations
... The morning-after pill can prevent unintended pregnancies if correctly used within few days of unprotected sex [42][43][44][45][46] . However, maybe as a result of misinformation and scarce knowledge, the morning-after pill has not proven to be effective in reducing unintended pregnancies or influencing the rates of abortions [42][43][44] . ...
... The morning-after pill can prevent unintended pregnancies if correctly used within few days of unprotected sex [42][43][44][45][46] . However, maybe as a result of misinformation and scarce knowledge, the morning-after pill has not proven to be effective in reducing unintended pregnancies or influencing the rates of abortions [42][43][44] . As shown in Table 6, the knowledge of the morning-after pill remains considerably low 29,31 . ...
Since sexual health education (SHE) is not mandatory in Italian schools, we conducted a survey on freshmen of four Italian university campuses in 2012 to investigate the respective level of sexual health knowledge (SHK) in relation to birth control, with the aim to inform public health policy makers. A convenience strategy was employed to sample 4,552 freshmen registered with various undergraduate courses at four Italian universities: Padua university (Veneto Region); university of Milan (Lombardy Region); university of Bergamo (Lombardy Region); university of Palermo (Sicily Region). We investigated the level of SHK on birth control using 6 proxy indicators: (1) the average length of a woman’s period [outcome with 3 levels: wrong (base) vs. acceptable vs. correct]; (2) the most fertile interval within a woman’s period (binary outcome: correct vs. wrong answer); (3) the event between the end of a period and the beginning of the next cycle (binary outcome: correct vs. wrong answer); (4) the average survival of spermatozoa in the womb (binary outcome: correct vs. wrong answer); (5) the concept of contraception (binary outcome: correct vs. wrong answer); (6) the efficacy of various contraceptives to prevent unintended pregnancies (linear score: 0–17). We fitted 6 separate models of multiple regression: multinomial for outcome 1; logistic for outcomes 2, 3, 4, 6; linear for outcome 6. Statistical estimates were adjusted for a number of socio-demographic factors. Results were expressed as odds ratios (OR) for the 4 multiple logistic regression models, linear coefficients (RC) for the linear regression model and relative risk ratio (RRR) for the multinomial logistic regression model. The level of significance of each risk estimate was set at 0.05. The level of SHK of freshmen sampled was rather low, as 60% interviewees did not know the average length of a woman’s period, the average survival of spermatozoa in the womb and the concept of contraception, whilst the most fertile interval within a woman’s period was known only to 55% of interviewees. The mean score of SHK on the efficacy of various contraceptive methods was only 5 (scale 0–17). Some categories of students were consistently and significantly less knowledgeable on birth control at multivariable analysis: males; students from the university of Palermo; those with vocational secondary school education and those not in a romantic relationship at the time the survey was conducted. The results of this survey clearly call for the introduction of SHE programs in Italian schools, as already done in several European countries. School SHE should start as early as possible, ideally even before secondary school. SHE should be holistic and delivered with a multiple agency coordinated approach involving the Ministry of Health, the Ministry of Education, University and Scientific Research (MIUR), families, schools, public health departments, primary health care providers, pharmacists, media, other.
... Alie-se a ele as contradições dos esquecimentos discursivos encontrados e chegamos ao contingente do enunciatório e a suas intencionalidades ocultas 24 . Uma rede eficaz de assistência à mulher em situação de violência sexual, além dos cuidados específicos, disponibiliza a contracepção de emergência 2,4 , reduzindo o número de gestações decorrentes de estupros e consequentemente a necessidade do procedimento abortivo 30 . Uma norma técnica específica padronizou o atendimento emergencial, nas primeiras 72 horas após a violência, para fins de acolhimento, administração de anticoncepção de emergência e a profilaxia para as IST, doenças virais e bacterianas 31 . ...
... A vigilância e a consequente punição, todavia, não se restringem às mulheres. Os profissionais que participam efetivamente da assistência às mulheres em situação de violência sexual também são estigmatizados e sofrem diferentes formas de punição 29,30 , o que reforça os silenciamentos 49,50 . Constrói-se, assim, uma norma institucional tácita, silenciosa e não escrita, mas que vigora por coadunar com formações ideológicas correntes na sociedade. ...
Resumo: Este artigo objetivou compreender a objeção de consciência com base na análise das formações ideológicas que permeiam o acesso ao abortamento legal decorrente de violência sexual na concepção de trabalhadores e gestores que atuam em serviços de referência. Trata-se de uma pesquisa qualitativa mediante a participação de 20 trabalhadores (seis exerciam, também, a gestão) desses serviços a um roteiro de entrevista semiestruturado. O método de análise usado foi a análise do discurso. Os resultados evidenciam que a objeção de consciência emergiu como elemento discursivo central às mesmas. A análise contextualizada dos discursos evidenciou uma instrumentalização da prerrogativa por razões ideológicas, confluindo para a organização dos resultados nas seguintes categorias: a instrumentalização da objeção de consciência e a desarticulação da rede; e a instrumentalização da objeção de consciência a fim de vigiar e punir. Conclui-se que a objeção de consciência como formação discursiva foi ressignificada, a fim de compor um complexo e refinado sistema de sabotagem interna - consciente e inconsciente - dos serviços de atendimento à mulher em situação de violência sexual, apesar dos marcos e avanços legais.
... O presente estudo demonstra a relevância da contracepção de emergência na prevenção da gravidez quando aponta menor proporção (1,6%) de gravidez para as mulheres que receberam contracepção de emergência em 72hs, período de maior eficácia do medicamento, seguidas por aquelas que procuraram o serviço após esse período e ainda receberam a anticoncepção, com 4,2% de gravidez. Estes achados corroboram em relação à eficácia da anticoncepção de emergência, tendo indicação de uso em até cinco dias após a agressão, com diminuição da proteção proporcional ao tempo decorrido 24 . Importante considerar que a contracepção de emergência em 72 horas demonstrou ser o maior fator de proteção (84,0%) para a gravidez. ...
Resumo Estudo da violência sexual contra a mulher em Santa Catarina, notificada no Sistema de Informações de Agravos de Notificação entre 2008 e 2013. O objetivo foi estimar a ocorrência de gravidez e infecção sexualmente transmissível (IST) decorrente da violência sexual e testar associação entre gravidez, IST e o atendimento nos serviços de saúde. Para a gravidez foram analisadas 1.230 notificações e para IST 1.316 notificações. As variáveis foram idade, escolaridade, tempo de atendimento, profilaxias para IST, contracepção de emergência, número de agressores e violência de repetição. As variáveis foram analisadas por meio de proporções e intervalos de confiança de 95%. As associações foram testadas por regressão logística não ajustada e ajustada com os valores expressos em razão de chance. A ocorrência de gravidez foi de 7,6%. Ser atendida em 72 horas e receber a contracepção de emergência foram fatores de proteção. A ocorrência de IST foi de 3,5%. Ser atendida em 72 horas e receber profilaxias não resultou em menor proporção de IST, são necessários estudos que aprofundem esta questão.
... Emergency contraception is a method that can prevent pregnancy if used correctly a few days after unprotected sexual intercourse or due to contraceptive failure [12][13][14][15][16]. However, EC has not been demonstrated to lead to a population-level reduction in unintended pregnancy and induced abortion [12,14]. ...
Background
The vulnerabilities of young women of low socio-economic status and those with little or no formal education tend to dominate the discourse on unplanned pregnancy, unsafe abortion and emergency contraception (EC) in sub-Saharan Africa. This article draws on a survey conducted among female undergraduate students to shed light on sexual behaviour and the dynamics of emergency contraceptive use among this cohort.
Methods
The survey involved 420 female undergraduate students drawn using a multistage sampling technique, while a self-administered questionnaire was used for data collection. Univariate and bivariate analyses were applied to examine the factors associated with the use of emergency contraception.
Results
Of the 176 female students who reported being sexually active in the year preceding the survey, only 38.6% reported the use of condom during the entire year. Of those who reported unplanned pregnancy anxiety n = 94, about 30.1% used EC, 20.4% used non-EC pills as EC, while others reported having used no EC. A few respondents (n = 3) had terminated a pregnancy under unsafe conditions. Awareness of EC (p < 0.001), knowledge of timing of EC (p = 0.001), perceived risk of unplanned pregnancy (p < 0.001), and level of study (p = 0.013), were significantly correlated with the use of EC.
Conclusion
The study revealed that educated youths engaged in high-risk sexual activities and also, sought recourse to unproven and unsafe contraceptive methods. Poor knowledge of EC methods and timing of use, as well as wrong perception about EC side effects, are barriers to the utilisation of EC for the prevention of unplanned pregnancy among the study participants.
... O atendimento emergencial, nas primeiras 72 horas após a violência, tem por objetivo acolhimento e administração de anticoncepção de emergência e a profilaxia para as DST, doenças virais e bacterianas. A maior parte das mulheres que recorre aos serviços de saúde para atendimento de emergência nas primeiras horas após a violência não engravida, dada a alta taxa de eficácia da anticoncepção de emergência 6 . Entretanto, para as falhas da anticoncepção de emergência e para mulheres que não procuram o atendimento emergencial, a gestação indesejada pode ocorrer. ...
In Brazil, abortion is permitted by law in cases of rape-related pregnancy. This study reports on various aspects in the experience of women that have been sexually assaulted: diagnosis of the pregnancy, seeking legal abortion, and hospitalization in a university hospital. This was a qualitative study that interviewed ten women 18 to 38 years of age, with at least eight years of schooling, one to five years after legal abortion. The women had been previously unaware of their right to a legal abortion, were ashamed about the sexual assault, kept it secret, and had not sought immediate care. The diagnosis of pregnancy provoked anxiety and the wish to undergo an abortion. Women treated through private health plans received either insufficient orientation or none at all. Respectful treatment by the healthcare staff proved relevant for the women to cope with the abortion. The study highlights the need to publicize the right to abortion in cases of rape-related pregnancy and the healthcare services that perform legal abortion, in addition to training healthcare and law enforcement teams to handle such cases.
... O atendimento emergencial, nas primeiras 72 horas após a violência, tem por objetivo acolhimento e administração de anticoncepção de emergência e a profilaxia para as DST, doenças virais e bacterianas. A maior parte das mulheres que recorre aos serviços de saúde para atendimento de emergência nas primeiras horas após a violência não engravida, dada a alta taxa de eficácia da anticoncepção de emergência 6 . Entretanto, para as falhas da anticoncepção de emergência e para mulheres que não procuram o atendimento emergencial, a gestação indesejada pode ocorrer. ...
No Brasil, a realização de interrupção legal de gestação consequente à violência sexual é permitida por lei. O objetivo deste estudo foi relatar vivências de mulheres após a violência sexual, no diagnóstico de gravidez, na busca pelo serviço de interrupção legal da gestação e durante a internação em um hospital universitário. Foi realizada pesquisa qualitativa com entrevistas semiestruturadas em dez mulheres de 18-38 anos e escolaridade ≥ 8 anos, após 1-5 anos da interrupção legal da gestação. As mulheres desconheciam o direito à interrupção legal da gestação, sentiram a violência sexual como experiência vergonhosa, mantiveram segredo e não procuraram qualquer atendimento imediato. O diagnóstico de gravidez provocou sentimentos de angústia e desejo de abortar. Para as mulheres que procuraram o setor de saúde suplementar as orientações foram precárias ou não aconteceram. O atendimento dos profissionais mostrou-se relevante para assimilação da experiência do aborto. É necessário divulgar o direito à interrupção legal da gestação e a existência de serviços que a realizam, e capacitar profissionais de saúde e segurança pública para atender esses casos.
Background:
The UN Commission on Life-Saving Commodities for Women's and Children's Health identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation.
Areas of uncertainty:
Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access.
Data sources:
PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetrician and Gynecologists, the World Health Organization, The United Nations.
Therapeutic advances:
A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device.
Conclusions:
EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts, threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.
Study objective:
The objective of the study was to examine the association of state specific emergency contraception (EC) legislation and adolescent births.
Design, setting, participants:
This was an observational cohort study of adolescents aged 15-19 years in the United States from 2000 through 2014 to determine the association of adolescent birth estimates with EC legislation.
Main outcome measures:
State-specific birth and abortion estimate data was obtained from the Centers for Disease Control and Prevention's National Vital Statistics and Abortion Surveillance for the years 2000 through 2014.
Results:
After controlling for year, abortion estimates, and oral contraception pill utilization, estimated adolescent births for states with an expansive EC policy was 14% lower as compared to states without expansive policy. Estimated adolescent births were 43% higher in states with restrictive EC policy as compared to states without restrictive policy.
Conclusion:
Restrictive EC policies are associated with increased adolescent birth estimates, while expansive EC policies are associated with decreased adolescent birth estimates. Targeted advocacy strategies to reduce legislation that aims to restrict access to contraception may prove to be most beneficial to reducing unintended pregnancies.
Numerous policy changes have expanded access to emergency contraception, such as Plan B®, in recent years. Plan B® is a progesterone-based medication that prevents pregnancy from occurring up to 120 hours after unprotected intercourse by preventing ovulation and tubal transport. Increased access to Plan B® allows women to make independent decisions regarding reproductive health. Nurses play an important role in providing education as well as comprehensive, compassionate and holistic care.
© 2015 AWHONN.
