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