Elsevier

Contraception

Volume 68, Issue 2, August 2003, Pages 117-124
Contraception

Original research article
Bringing emergency contraception over the counter: experiences of nonprescription users in France, Norway, Sweden and Portugal

https://doi.org/10.1016/S0010-7824(03)00114-8Get rights and content

Abstract

Emergency contraceptive pills are now available on a nonprescription basis in over 25 countries worldwide. In an effort to learn about women's experiences with this new means of emergency contraception (EC) service delivery, we conducted focus-group discussions with nonprescription EC users from France, Norway, Portugal and Sweden. Participants from these countries overwhelming supported pharmacy access to EC, explaining that pharmacy delivery facilitated rapid access to the method. Despite expressing mixed reviews of the counseling given by the providing pharmacists, participants reported that they knew how use the method safely and properly. Most indicated that the package insert was easy to understand and adequately answered the majority of their questions. Participants described the EC experience as a motivating factor that, in many cases, has led to more consistent use of regular contraceptive methods. These data are valuable to policy-makers and institutions interested in learning more about the safety and acceptability of nonprescription access to emergency contraceptive pills.

Introduction

Emergency contraception (EC) has long been used by women around the world as a postcoital means of preventing unwanted pregnancies. Until recently, women seeking EC needed to obtain a physician's prescription, a constraint to optimal use of the method since studies demonstrate that EC is most effective when taken immediately following unprotected intercourse [1], [2]. In an effort to increase access to emergency contraceptives, several pharmaceutical companies have begun to produce progestin-only (levonorgestrel 750 μg) products, such as Norlevo and Plan B. Unlike earlier combined estrogen/progestin methods, progestin-only EC products have no medical contraindications and can therefore be safely delivered without a prescription. Over the past few years, progestin-only EC products have been registered as a nonprescription method in over 25 countries [3]. Given the novelty of this nonprescription service delivery, we felt that it was critical to document the experience of nonprescription EC users. We expect that data gathered in this study will inform EC policy, educational campaigns and service delivery guidelines.

Section snippets

Materials and methods

We conducted a series of focus-group discussions with women who had obtained and used EC without a medical prescription in large, urban centers in France, Norway, Portugal and Sweden in 2001 and 2002 (Table 1). Focus groups were used to facilitate open debates about the method. Study teams in each country led four to five focus groups, each lasting from 60 to 90 min. Informed consent was given prior to participation in the discussions. Inclusion criteria and research instruments were common to

Participant characteristics

Background information from the questionnaire is presented in Table 3. Overall, participants in the four sites were similar in age, pregnancy history and marital status.

Perceptions and misconceptions of EC prior to use

While all of the participants said they knew of the “morning-after pill,” concrete knowledge about how to use and obtain EC was limited. When probed about her knowledge of the method, a Norwegian participant summed up the view of many of her counterparts, stating, “I really think I have always known that a morning after pill

Discussion and conclusions

This study presents data on users' experiences with non-prescription access to EC in France, Norway, Portugal and Sweden. While these data are not representative of the experience of all nonprescription EC users, they do provide an important glimpse into the experiences of women in these countries. Our results demonstrate that EC users in these four countries consistently find nonprescription access to be an acceptable service delivery mechanism for this method. The women interviewed were able

Acknowledgements

This study was funded by the Robert H. Ebert Program in Critical Issues in Reproductive Health and HRA Pharma.

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