Young women described the benefits of having advance supplies of emergency contraception but emphasised its use as a “last resort” rather than an alternative form of contraception
Q What are the views and experiences of young women who have kept advance supplies of emergency contraception (EC) at home?
A postal survey and qualitative interviews, which were part of the Lothian Emergency Contraception Project (LECP). Only the methods and results of the qualitative interviews are reported here.
22 women (16–29 y) who had received advance supplies of EC (5 courses of Schering PC4) to keep at home in the context of the LECP.
Women participated in semistructured individual interviews that lasted 45–90 minutes and addressed circumstances of EC use, previous experience with EC, and views about advance supplies and deregulation of EC. Interviews were audiotaped and transcribed. Analysis used constant comparison techniques and attended to both the structure and content of the women’s talk. 2 researchers regularly discussed coding, tested the analysis in different sections of the data, and explored deviant cases.
Views of advance supplies of EC. Women were surprised that they were offered 5 packets of EC and expressed concern that this might send the wrong message about the acceptability of the method, particularly to younger women who might use it too often. All women thought that having an advance supply of EC was a good idea because of convenience; quicker use, with resultant greater efficacy; reductions in physician time; reductions in the embarrassment and stigma of obtaining EC from general practitioners or family planning clinics; the option of sharing supplies with friends; and the comfort of “knowing it’s there” if the need arises. Repeated use of EC when advance supplies were available. Despite the perceived benefits of having an advance supply of EC, none of the women suggested that EC be used regularly; reasons were based primarily on experiences of side effects (eg, “messed up” menstrual cycles and nausea). Advance supplies and use of other forms of contraception. Women went to great lengths to establish that they did not see EC as “proper” contraception or an alternative to other forms of contraception, but rather something to be used as a “last resort.” Some spoke of the potential dangers of ingesting “a large dose of hormones.” Circumstances of use of advance supplies. Reasons offered for use of advance supplies included broken condoms; missed oral contraceptive doses or use of antibiotics that could affect the efficacy of the “pill”; and unprotected sex with a regular partner, knowing that EC was available for use after the event. Giving advance supplies to friends. Women reported giving EC packs to friends, stressing that there was no alternative and that they ensured correct use. Concerns about “other women.” Some women expressed ambivalence about providing advance EC supplies to other, generally younger women, fearing that they would “abuse” EC, expose themselves to sexually transmitted infections (STIs), or forgo other methods of contraception. At the same time, these women emphasised that they did not put themselves at risk of STIs (because they only had sex, even if unprotected, with long term partners). Are advanced supplies likely to encourage women to take more risks? Again, participants felt that advance supplies might encourage risky behaviour “in other women,” but not themselves, reiterating their reluctance to overuse EC because of adverse effects and concerns about exposure to STIs. Many believed that “if you’re going to have unprotected sex you’ll do it regardless of whether you have the morning after pill or not…”; they did not feel, however, that EC would encourage someone who would otherwise use protection to take risks.
Young women described the benefits of having advance supplies of emergency contraception at home. They did not believe that advance supplies would encourage frequent use, neglect of other contraceptive methods, or sexual risk taking.
- Cicely Marston, PhD
Recent evidence suggests that non-prescription provision of EC has not increased use,1 and a substantial number of unintended pregnancies still occur that could have been prevented by EC.2 In this careful analysis, Ziebland et al uncovered some of the reasons that EC may be failing to reduce the incidence of unintended pregnancies. Their findings add to the large body of evidence that enhanced access to EC does not increase risky sexual behaviour and that women often fail to use the method because they do not realise that they are at risk of pregnancy. The study also highlights the effects of the stigma attached to use of EC, one of which is that even women aware of their risk of pregnancy would sometimes rather “take a chance” than seek EC from a clinician or pharmacist.
Some of the women in this study were able to provide EC to their friends from their advance supply. Wider distribution of EC may require use of these and other non-medical (and relatively non-stigmatising) networks. Women were also able to access the treatment at the moment it was required. Such immediate availability is important because EC should be used as soon as possible after unprotected sex for optimal effectiveness. Although providing an advance supply of EC is far from a panacea, this study reveals that overcoming some barriers to access is possible. Therefore, use might be improved if more women had easy access to EC—either on hand in their homes or available through sources other than clinics and pharmacies, such as friendship networks. Nurses can help by providing advance supplies where permitted and taking a non-judgmental approach when responding to women requesting EC.
For correspondence: MsS Ziebland, Department of Primary Health Care, University of Oxford, Headington, UK.
Source of funding: Wellcome Trust.