Emergency contraception: a qualitative study of young women's experiences

Emergency contraception has the potential to greatly reduce the number of unintended pregnancies. Experiences in the use of emergency contraception have rarely been reported in the literature. Thirteen young women (a subset of a larger study cohort), were individually interviewed in a variety of settings about their personal experiences in relation to the use of emergency contraception. A thematic analysis of the transcribed data was undertaken. Barriers and facilitators to its use are explicated using excerpts from individual interviews with participants. Some young women had positive experiences, however many experiences were negative and reflected difficulties with access and availability of emergency contraception, as well as poor provider attitudes. Positive experiences generally occurred where services were responsive to the needs of young people or when a provider was well known to the young woman. Their experiences underscore the need to understand the situational stress and sometimes difficult arrangements needed to obtain this method of contraception. To optimise young women's experiences of emergency contraceptive use, a number of strategies need to be implemented. These include improvement of information about emergency contraception for young women and their partners; for health professionals; and for the broader community. Of critical importance is the need to include strategies to improve access to emergency contraception. A number of recommendations to achieve this within current health care delivery sectors in Australia, as well as suggestion forfuture access are provided.     

Sexual health: meeting adolescents' needs

BACKGROUND: The UK has the highest rate of sexually transmitted infections (STIs), especially among young people, in western Europe. Knowledge of what influences young people's sexual behaviour is limited which highlights a need to understand adolescent development and recognise that they are at increased risk of acquiring an STI compared with other groups. This article examines the risks of acquiring STIs in adolescence and discusses how nurses feel about treating young people with sexual health needs. CONCLUSION: Postgraduate training needs to incorporate specific modules relating to young people within sexual health. Sexual health providers go some way to providing an adolescent-friendly service, but more creative approaches to service delivery such as flexible opening hours and contraception outreach services would make them more accessible to young people.     

Emergency contraception: a pilot study by school nurses

Tackling unintended teenage pregnancy and reducing sexually transmitted infection is a priority for school nurses in Selby and York NHS Trust. Research from the NHS Centre for Reviews and Dissemination in 1997 suggested that school-based sex education could be effective in reducing teenage pregnancy when it was linked to contraceptive services. With this in mind a pilot study was devised whereby an emergency contraception service was introduced to two secondary schools: one rural and one inner city. Results of the pilot, conducted for a complete school year from September 2001 to July 2002, revealed a significant difference in the numbers of teenagers accessing advice and requesting condoms in the two schools. Reasons for the findings are discussed, as well as the vital role of the school nurse in addressing the sexual health needs of young people.     

Improving young people's access to emergency contraception

A lack of knowledge about contraception, poor access to contraceptive services and alcohol use are all contributory factors to the UK's high teenage pregnancy rate. Improving young people's access to emergency contraception is one intervention that could have a positive impact on reducing this statistic.     

You and the law: teenagers, birth control and the nurse.

Today's teen-agers do need access to contraceptive information. 8 years ago in Canada, there were 14,801 illegitimate births among mothers between the ages of 15 and 19. Changes in Canadian abortion laws have resulted in a decrease in the number of illegitimate births since then, but the need for contraception continues as indicated by the 12,481 therapeutic abortions performed on adolescents in this age group in 1974. Teen-age male as well as female adolescents need counseling in the area of sexual conduct regarding the prevention of pregnancy and venereal disease. Despite school-sponsored classes in sexual development, teen-agers continue to have misconceptions concerning pregnancy and birth control. Effective teaching and counseling as preventive measures are critical, and the nurse has a key role for often she provides the counseling. Sensitive listening and open communication are important elements in dealing with young people. It is important for nurses to be aware of their own personal attitudes and biases regarding human sexual conduct, and these personal views should not be imposed on patients. A sensitive, open, and non-judgmental approach is necessary with adolescents. The minor's capacity to give consent to treatment is of major relevance, for without consent a physician or nurse may incur liability. While some provinces allow teen-agers under the age of majority to give a valid consent to treatment, most provinces restrict capacity to give such consent to those who have attained the age of majority. Physicians and nurses frequently do deal directly with minors without parental consent, yet the number of reported legal cases in Canada remains miniscule, possibly because parents eventually recognize the need for contraception in their sexually active teen-agers. Once parental involvement is refused by the teen-agers, the teen-agers should become the primary patient and confidentiality should be respected.     

The impact of education and media on contraceptive use in Bangladesh: A multivariate analysis

In this paper, an attempt is made to show the impact of education and media on contraceptive use and also to identify the factors that associated with the current use of contraception and continuing of contraception. To reach our goal, Bangladesh Demographic and Health Survey (BDHS 2007) data were used. Findings of this study reveal that education, age of the respondents, religion, media exposure, area of residence and if they belong to any of the non‐governmental organizations (Grameen Bank, Bangladesh Rural Advancement Committee, ASA, Mother's club, etc.) have significant contribution to current use of contraception and continuing of contraception. Media, particularly TV, and education play the leading role regarding this issue, whereas the others have an indirect relationship. Multivariate analyses showed that contraceptive use were higher among educated women and those women who watch TV at least once a week as compared with their respective counterpart. The results indicate urgent need to give emphasis on education, ensuring electronic media exposure, head‐to‐head communication programme, institutional‐based family planning education and necessary information to learn about the impact of overpopulation for the people all over the country.     

Emergency contraception for prevention of adolescent pregnancy

Adolescent pregnancy remains a significant problem in the United States today, despite availability of effective contraceptive methods. Not all sexually active adolescents use contraception, and even those who do use contraception sometimes use it incorrectly. Emergency contraception, which refers to methods of pregnancy prevention used after unprotected intercourse, has the potential to prevent most unplanned adolescent pregnancies. Emergency contraceptive pills (ECP) containing estrogen and progestin or progestin alone are more than 75% effective when the first dose is taken within 72 hours after unprotected sex and the second dose is taken 12 hours later. However, barriers to accessing ECPs include lack of knowledge of the method, fear of loss of privacy, difficulties in finding a provider, and cost. Another barrier is that controversy exists about the mechanisms of action of emergency contraception about its role in pregnancy prevention. As a result, some nurses are not comfortable with suggesting emergency contraception to their patients.Nurses can play a critical role in providing ECPs to adolescents by developing programs to streamline distribution of ECPs, while maintaining adolescent privacy. Other essential roles for nurses include providing education about ECPs to parents, other healthcare providers and community members, and advocating for political and legal changes that will ease restrictions on ECP distribution. Nurses who are personally uncomfortable discussing emergency contraception can refer their patients to other providers for information and access to this method.     

Nurses' discourse in contraceptive prescribing: an analysis using Foucault's 'procedures of exclusion'

AIM: This paper is a report of an analysis of the discourse about contraceptive efficacy and side effects used by nurses when prescribing contraception. BACKGROUND: All women seeking contraception should be informed of the efficacy and potential adverse effects of the particular method they are considering. This information facilitates an informed choice. Women also require this information in order to monitor for any side effects. Paradoxically, side effects are also a key factor in reducing adherence with contraceptive regimens. However, there is no literature that explores specifically how this issue is addressed in clinical consultations, or places these practices in a theoretical context. METHOD: Forty-nine consultations between nurses and women in sexual health clinics were audio-recorded during 2002. Data were subject to a discourse analysis using Foucault's 'procedures of exclusion' to explore the discursive construction of contraceptive efficacy and side effects FINDINGS: The nurses employed specific discursive strategies when discussing contraception. When addressing efficacy, discourse centred on medico-statistical facts, but side effects were described in lay terms that minimized their severity. Nurses contextualized contraceptive side effects within potential problems that women might experience in pregnancy, and also attempted to 'normalize' contraceptive-related problems. CONCLUSION: Discourse and its deployment play a key role in practitioner-client relationships that sexual health nurses need to become more aware of how they discuss clinical issues about contraception with women. Clinical data on contraceptive side-effects are present in the literature, and it is important that sexual health nurses use this to help women make truly informed decisions.     

A causal model of contraceptive intention and its gender comparison among Taiwanese sexually inexperienced adolescents

Aims and objectives. To test latent constructs of social influences, contraceptive attitude and self‐efficacy for contraception as a causal model of contraceptive intention among adolescents and to search for possible gender differences in the causal model of contraceptive intention. Background. A greater understanding of the causal model of contraceptive intention among sexually inexperienced adolescents will help nurses design contraceptive programmes to improve adolescent contraceptive use when they have sex. Design. This was a cross‐sectional study; 770 boys and 685 girls that self‐reported not being sexually experienced were selected for this study. Methods. An anonymous questionnaire was used to collect data. By structural equation modelling using the eqs 6.1 software, a hypothesized structural model of contraceptive intention was tested. Findings. For both genders, social influences affected contraceptive intention indirectly through the contraceptive attitude and self‐efficacy for contraception. Contraceptive attitude and self‐efficacy for contraception affected contraceptive intention directly. Contraceptive attitude also affected contraceptive intention indirectly through the mediation of self‐efficacy for contraception. There were gender differences in the variances of contraceptive intention explained by contraceptive attitude, self‐efficacy for contraception and social influences. Nevertheless, the data explain only a low proportion of the variability in contraceptive intention. More causal constructs influencing contraceptive intention should be explored in future. Conclusions. Personal factors and social influences operate interdependently to influence contraceptive intention among sexually inexperienced adolescents. Gender is a moderator that can modify the influential level of social influences, contraceptive attitude and self‐efficacy for contraception on contraceptive intention. Relevance to clinical practice. Nurses should operate personal factors and social influences interdependently when they are designing intervention programmes for sexually inexperienced adolescents. To make intervention more effective, nurses also need to provide gender‐specific intervention programmes for sexually inexperienced adolescents.     

Emergency contraception given via a patient group direction

The aim of this audit was to evaluate the effectiveness of a patient group direction (PGD) for nurses issuing the emergency contraceptive Levonelle-2 within a sexual health clinic. The PGD was designed to increase the accessibility of emergency contraception for women, not only minimising the time they needed to spend in the clinic, but also reducing the time at which the emergency contraception was taken after unprotected intercourse, which is an important factor in efficacy rates.     

Working women and contraception: History, health, and choices.

Contraception is not a new concept. Historically, various contraceptive methods and practices have been used throughout the world. Contraception is often a topic of great interest to working women because family planning helps them balance work and home more effectively. Occupational health nurses can play a vital role in supporting these women by providing education regarding health, contraception, and contraceptive choices.     

How contraception nurses can improve teenage sexual health

The rising incidence of unwanted pregnancies and sexually transmitted infections among teenagers has made teenage sexual health a government priority. Contraceptive nurses can play a key role in advising young people about sexual health issues and contraception. This article discusses the factors affecting teenage sexual activity and how nurses can help young people take responsibility for their sexuality.     

A request for the 'morning-after' pill

A request for post-coital contraception may be the first consultation by a young girl for contraceptive advice. The problem may be used as an opportunity to discuss other relevant issues such as AIDS. The case will need sympathetic and sensitive handling and demands consideration of confidentiality, especially in Samantha's case as she is only 15.     

Family planning and sexual counselling

This paper discusses the role of the nurse in family planning and the special sensitivity that performance of this role requires. The specialist family planning nurse should be able to undertake the total contraceptive care of the well man and woman. She should be trained to take a comprehensive history, discuss alternate methods of contraception, fit a diaphragm, issue condoms, teach other methods, and evaluate and reappraise on future visits. Family planning also involves advice on fertility, pregnancy testing, the menopause, premenstrual tension, counseling for unplanned pregnancy, and sexual counseling. It involves health screening, breast examination, and advice on diet and smoking. An understanding of the emotional component and an ability to listen are essential. Nurses must have the knowledge base and the self-awareness to help people to express their concerns about sexuality. They should further be familiar with the effects of drugs, especially antihypertensives and psychotropic medications, on sexual functioning. Teaching human sexuality to nurses, health visitors, midwives, family planning nurses, and doctors is an important role for the nurse specialist in sexual counselling. Several programs in the UK now train nurses as sexual counsellors or sex therapists.     

Teenage pregnancy -- its causes, costs and consequences

Various aspects of teenage pregnancies are discussed. Adolescent girls who become pregnant have hardly established their own identity before they have to cope with motherhood. Discussion concentrates on current increased and earlier sexual activity, the role parents play in the sexual activity of their adolescents, the role and personality of the putative father, special risks to pregnant teenagers, alternatives open to the young girl who becomes pregnant, and the continued need for greater contraceptive availability.     

Contraception and young people: the condom club.

This article explores contraception among the young people. A genitourinary medicine clinic (GUM) was developed for the purpose of providing information and contraception, particularly condoms, for young people. Among those who visited was a large proportion of teens aged 16 years and under. On the first visit, youngsters were advised on confidentiality and were asked of their previous experiences. Those who have not engaged in sex ever since, were advised celibacy until they are older. Other matters they needed to know were also provided. Reasons for attending the clinic varied: girls primarily were afraid to get pregnant, while the boys were concerned about AIDS and sexually transmitted diseases (STDs). Boys often times brought their partners for emergency contraception when need arose, while girls using the service often brought their friends. Lastly, the GUM not only provided free selection of condoms and information to youngsters but also information on the impact of chlamydia infections.