Pharmacy Access to Emergency Contraception in Rural and Frontier Communities

CONTEXT: Timely access to emergency contraception (EC) has emerged as a major public health effort in the prevention of unintended pregnancies. The recent FDA decision to allow over-the-counter availability of emergency contraception for adult women presents important rural health implications. American women, especially those living in rural and frontier areas, have one of the highest rates of unintended and teen pregnancy among developed countries. PURPOSE: This study, conducted prior to the recent FDA ruling, evaluated the participation among California pharmacies in the pharmacy access program in December 2005, specifically comparing rural/frontier and urban pharmacies. METHODS: The sample consisted of 862 California pharmacies, including 50 in rural/frontier areas, which were randomly selected and surveyed by telephone. FINDINGS: The results indicated that similar proportions of rural/frontier pharmacies and urban pharmacies provided direct pharmacy access services (28% vs 22%, P = 0.32). However, of the 13 rural/frontier counties included in the survey, eight (62%) had no emergency contraception pharmacies. The rural/frontier pharmacies that provided emergency contraception services tended to be small, independent pharmacies in the most remote areas of the state. Among rural/frontier pharmacies that did not participate in the program, the primary reasons included lack of training or demand for emergency contraception. Only one rural/frontier pharmacist cited moral or religious opposition to providing emergency contraception. CONCLUSIONS: In light of the current limited over-the-counter status of emergency contraception, the role of rural and frontier pharmacies in ensuring access to emergency contraception will increase in the future.     

Developing Culturally Relevant Educational Materials About Emergency Contraception

New York City has growing numbers of Mexican and Caribbean born residents, who have been identified as underserved communities for reproductive health care. We conducted exploratory focus groups to develop and test messages about emergency contraception that would be culturally relevant to these communities. Findings reveal lack of knowledge about what emergency contraception is and how it works, concerns about safety, and health care barriers. Multiple messages were tested in Spanish and English, and participants expressed positive attitudes about using emergency contraception once they knew that is was different from an abortion pill.     

Emergency Contraception: The User Profile

Emergency contraception (EC) has recently become available, accepted and widely used in Sweden but little is known about the characteristics and background factors of women requesting EC.Methods: During a four-month period, consecutive women (n=762) visiting family planning clinics to request emergency contraception filled out a questionnaire about their current need for EC.Results: The user of emergency contraception was typically a nulligravid young woman (83%) but 13% had a previous history of at least one induced abortion and 4% had given birth in the past. One out of four had used EC before, and of these 20% more than once. Condom breakage was the major reason for the current need for EC but as many as 37% had not discussed the need for contraception prior to intercourse. Friends were the most important source of knowledge about EC.Conclusion: Women requesting emergency contraception could be anyone and emergency contraception is used to compensate for contraceptive failure in order to prevent unwanted pregnancies.     

紧急避孕方法的应用

紧急避孕是指在无避孕或觉察到避孕失误的情况下,于几小时或几天内采用的防止意外妊娠的短效补救措施。近年来,国内外研究、应用较多的有口服紧急避孕药物和放置带铜宫内节育器(IUD) ,山东省济南市历下区人民医院对要求紧急避孕的就诊妇女采用了口服左炔诺孕酮或米非司酮及IUD等3种方法,现就这3种方法的有效性、可接受性报告如下。对象与方法1 对象　选择2 0 0 2年1～1 2月来该院就诊的、要求紧急避孕的健康育龄妇女30 0人,对其进行避孕方法介绍后,由妇女进行知情选择,然后分为3组,每组1 0 0人,分别采用口服左炔诺孕酮、米非司酮及IUD …     

Assessing Sexual Assault Survivors' Access to Emergency Contraception: Results From a Mixed Methods Study in South Carolina

BackgroundProvision of emergency contraceptive pills (ECPs) is widely recognized as the standard of care to prevent pregnancy after a sexual assault. However, previous research has shown that hospitals do not routinely counsel sexual assault patients about or provide sexual assault survivors with ECPs or accurate referrals.MethodsWe undertook a mixed methods study to assess policies and practices regarding the provision of ECPs for sexual assault survivors in South Carolina. The study includes four components: An analysis of the South Carolina Victims' Rights Amendment, in-depth interviews with rape crisis agency and state agency representatives, a survey of hospital emergency department staff, and a survey of hospital emergency department administrators.FindingsOur findings indicate that hospital policies and practices regarding ECP-related services for sexual assault patients are generally consistent with the standard of care. According to hospital staff and administrators, requiring a police report and/or undergoing a rape kit examination before providing ECPs do not seem to be significant access barriers. However, hospitals that do not conduct rape kit examinations transfer patients to other facilities, and these initial hospitals do not routinely provide patients with ECPs before transfer.ConclusionOur findings suggest that further research to document whether transfer practices and reporting requirements impede access to ECPs is warranted. Furthermore, our results support the recommendation that any woman reporting sexual assault should be immediately offered dedicated, progestin-only ECPs. Last, our results suggest that key stakeholders in the sexual assault community could be engaged to improve sexual assault and ECP-related services in South Carolina.     

米非司酮紧急避孕机制的研究

目的:探讨米非司酮(Mifepristone,孕激素受体拮抗剂)对月经不同功能时期中Ley寡糖蛋白表达的影响。方法:取34例患子宫肌瘤志愿者手术后的内膜,经病理检测,分为4组:增生期(8例)、分泌期(8例)、分泌期服用米非司酮(8例)及增生期服用米非司酮(10例),每例均重复实验。应用Western免疫印迹法,观察Ley寡糖抗原的表达。结果:①每组样品中Ley寡糖蛋白均有4种分子量68kD、60kD、52kD、27kD表达;②分析结果显示:Ley寡糖在分泌期高表达,增生期表达低,两组间差异有显著性(P<0.001);③分泌期服用米非司酮的表达较分泌期明显减少(P<0.001),较增生期无明显变化(P>0.05);④增生期服用米非司酮的表达较增生期有所增多(P<0.001),仍较分泌期明显减少(P<0.001)。结论:在分泌期Ley寡糖蛋白的含量呈高表达,在月经不同功能时期服用米非司酮后,Ley寡糖蛋白表达均较分泌期明显减少。提示人子宫内膜Ley寡糖蛋白的表达可能与胚泡着床密切相关,并且米非司酮可能是通过减少Ley寡糖蛋白的表达而达到紧急避孕的目的。     

Program Fidelity and Patient Satisfaction among Women Served by the Zika Contraception Access Network Program in Puerto Rico

BackgroundThe Zika Contraception Access Network (Z-CAN) was designed to provide women in Puerto Rico who chose to delay or avoid pregnancy during the 2016–2017 Zika virus outbreak access to high-quality client-centered contraceptive counseling and the full range of reversible contractive methods on the same day and at no cost through a network of trained providers. We evaluated the implementation of Z-CAN from the patient perspective.MethodsAn online survey, administered to a subset of women served by the Z-CAN program approximately 2 weeks after their initial Z-CAN visit, assessed patient satisfaction and receipt of services consistent with select program strategies: receipt of high-quality client-centered contraceptive counseling, same-day access to the contraceptive method they were most interested in after counseling, and no-cost contraception.ResultsOf 3,503 respondents, 85.2% reported receiving high-quality client-centered contraceptive counseling. Among women interested in a contraceptive method after counseling (n = 3,470), most reported same-day access to that method (86.8%) and most reported receiving some method of contraception at no cost (87.4%). Women who reported receiving services according to Z-CAN program strategies were more likely than those who did not to be very satisfied with services. Women who received high-quality client-centered contraceptive counseling and same-day access to the method they were most interested in after counseling were also more likely to be very satisfied with the contraceptive method received.ConclusionsA contraception access program can be rapidly implemented with high fidelity to program strategies in a fast-moving and complex public health emergency setting.     

Who is Using Emergency Contraception? Awareness and Use of Emergency Contraception Among California Women and Teens

INTRODUCTION: Emergency contraception (EC) reduces women's risk for pregnancy after unprotected intercourse, and women's awareness of the method is increasingly important for expanding access. However, knowledge of EC alone does not predict use, and few population data exist to describe EC use among those aware of the method. METHODS: Using data from the 2003 California Health Interview Survey, we measured EC awareness among 11,392 women ages 15-44, and EC use among 7,178 respondents who were aware of EC and at risk for pregnancy. Using chi(2) analyses and multivariable logistic regression, we examined population characteristics that epidemiologically predict EC awareness and use, including age, race/ethnicity, income, health insurance status, usual source of health care, immigration status, languages spoken at home, and urban versus rural residence. RESULTS: Nearly 76% of respondents had heard of EC, but awareness was lower among teens, women of color, poor women, women with publicly funded health insurance, those without a usual source of care, immigrants, non-English-language speakers, and rural residents. Among women aware of EC, about 4% reported having used the method in the previous year; young age, low income, attending a community/government clinic for care or not having a source of care, and living in an urban area significantly increased the odds for using EC. CONCLUSIONS: Among California women in 2003, awareness and use of EC remained low. However, similar rates of use were reported among racial, ethnic, and linguistic subgroups. Those most likely to report use of the method included population groups at high risk for unintended pregnancy.     

开展紧急避孕服务保护妇女身心健康

紧急避孕是避孕失败的一种有效补救措施,可有效降低人工流产率,对保护妇女身心健康有积极意义。我国紧急避孕服务尚不普遍,服务提供者和使用者的信息不足及缺乏可行的措施是目前存在的主要问题。通过以报纸为主要媒介的科普宣传后要求紧急避孕咨询和服务的人数明显增加,提示加强宣传是开展紧急避孕的基本措施。据统计,在加强宣传的四个月中,咨询电话的数目多达6000余次,1995年9月～1996年8月共为1000例妇女提供了紧急避孕服务,反映出群众对紧急避孕服务的迫切需求。建立热线电话也是便利群众和加强宣传的有效措施。在提供紧急避孕服务时根据紧急避孕服务使用者的特点,尊重其隐私权。对紧急避孕服务的咨询要点是,应说明所提供的紧急避孕服务方案的效果(失败率),可能的副反应及对下次月经的影响,对采用药物紧急避孕的妇女要强调本周期内用药后的避孕,并对今后常规避孕给予切实的指导。对进一步开展紧急避孕的建议包括:加强临床研究、筛选优选方案及促进紧急避孕获得性;以引入性试验方式推广紧急避孕服务及呼吁媒介加强对紧急避孕服务宣传等。     

Expanded Access to Postabortion Contraception under Oregon's Reproductive Health Equity Act

ObjectiveWe describe the first 24 months of expanded family planning services for low-income immigrants under Oregon's Reproductive Health Equity Act. We examined postabortion contraceptive use in rural versus urban locations.Study DesignWe conducted a historical cohort study of abortion services reimbursed under the Reproductive Health Equity Act in the first 2 years after its implementation (2018 and 2019). Our primary outcome was shift in contraceptive tier from a less effective method before an abortion to a more effective contraceptive method after an abortion. Our key independent variable was residence in a metropolitan or nonmetropolitan area. We tested the association of nonmetropolitan residence and shift to a tier 1 or tier 2 method after the abortion, controlling for other factors, using logistic regression.ResultsOur analysis included 625 abortions from across the state. After an abortion, 68% of women transitioned to a more effective form of contraception. Nonmetropolitan residence was not significantly associated with a shift from no method or a tier 3 method to tier 1 or tier 2 method (adjusted odds ratio, 1.28; 95% confidence interval, 0.81–2.02) compared with metropolitan residence.ConclusionsThe program was successful in helping women not wishing pregnancy to transition to a more effective contraceptive method postabortion, regardless of metropolitan location of residence.     

Providing Access to Multilingual Patient Education Materials

Access to reliable yet readable health information is key for consumers making health decisions and participating in the management of their care. This presents a particular challenge for patients whose first language is not English. The language barrier makes it difficult for them to understand the counsel and direction of care providers or educational materials only available in English. Online reliable sources in their own language may be difficult to locate, particularly for those with additional literacy or technological barriers. This article will highlight a pilot project to collate online patient education materials in languages other than English for use by providers in primary care.