Emergency Contraception Provision: A Survey of Michigan Physicians from Five Medical Specialties

Abstract

Objective: Despite the controversy over expanding delivery options for emergency contraceptive pills (ECP), little is known about physicians' attitudes toward over-the-counter (OTC) provision of ECP, and prior research on physicians' practices often has focused on a single specialty. This study examined the attitudes and practices regarding advance provision and OTC status of ECP among physicians in five medical specialties likely to encounter patients in need of ECP.Methods: A mail survey of a random sample of 850 Michigan physicians in family/general medicine, internal medicine, obstetrics/gynecology, pediatrics, and emergency medicine was conducted. Respondents' ECP-related attitudes and practices were assessed, and differences by physician characteristics were examined using chi-square tests and multivariable logistic regression analyses.Results: Two hundred seventy-one physicians responded to the survey (response rate ‫؍‬ 32%), with 42% of them favoring OTC provision of ECP and 40% opposing it. Half of respondents never routinely initiated discussions about ECP with their sexually active, female patients, and 77% of respondents did not routinely offer advance prescriptions. After adjusting for other factors, including medical specialty, older physicians (Ն50 years) were significantly more likely than their younger counterparts to support OTC provision of ECP (OR ‫؍‬ 2.9, 95% CI 1.7-4.9) or offer advance prescriptions (OR ‫؍‬ 2.5, 95% CI 1.1-5.8). Physicians with a specialty in obstetrics/gynecology were 3.5 times (95% CI 1.3-9.8) as likely as physicians in family/general medicine to offer advance prescriptions for ECP, and female physicians were 2.5 (95% CI 1.05-6.0) times as likely as male physicians to offer advance prescriptions. Graduation from a medical school within the United States and practicing in a private practice were marginally associated with a lower likelihood of supporting OTC status of ECP (OR ‫؍‬ 0.5, 95% CI: 0.2-1.0; and OR ‫؍‬ 0.6, 95% CI 0.3-1.1, respectively).Conclusions: Certain physician characteristics were significantly associated with their ECPrelated attitudes and practices. The majority of physicians surveyed in this study did not offer advance prescriptions for ECP, and few had initiated discussions on ECP with patients, which may pose critical barriers to patients' timely access. 489

Obstetrician–gynecologist physicians' beliefs about emergency contraception: a national survey

“…Our results largely agree with earlier opinion surveys on the topic of whether increased access to EC will increase sexual risk-taking (less use of other contraceptives, initiating sex at a younger age, having more sexual partners) [8, 14, 15, 20]. …”

“…This is reminiscent of earlier data showing that EC provision is non-uniform, even for sexual assault victims [8, 20, 25,26,32]. While non-prescription availability makes adult women less dependent on a physician’s prescription than in years past, studies repeatedly show that some women do not know about ECs [15, 33,34], and even well-informed patients still rely on their physician’s advice.…”

“…The focus on Ob/Gyns limits our ability to generalize our findings to other kinds of physicians. Differences among specialties are known to exist – for instance Ob/Gyn physicians are more likely to promote EC access than are family and general medicine physicians [20]. The survey questions were fairly nonspecific, providing a sketch of physicians’ tendencies but leaving unanswered questions about how physicians would respond to specific (more detailed) situations.…”

“…Minors (under 17 years) still require a prescription, and patients rely on physicians for medical information and advice. In the past decade, several studies have assessed physicians’ beliefs and practices regarding EC [8, 14–16, 20, 21], but to our knowledge all were initiated prior to the 2006 FDA decision making levonorgestrel available without a prescription, and none provided in-depth characterization of which physicians favor or oppose EC. Here we surveyed obstetrician-gynecologist (Ob/Gyn) physicians to determine what demographic, clinical, and personal characteristics (including religious characteristics) correlate with various beliefs and practices regarding EC.…”

Emergency Contraception: Knowledge and Attitudes of Family Physicians of a Teaching Hospital, Karachi, Pakistan

“…More than half (63%) of the participants felt that emergency contraception was not an appropriate topic to discuss at routine consultation. The majority (69%) of the physicians were uncomfortable because of religious reason which is similar to the findings of previous research (19,30) and, therefore, seldom inform or prescribe emergency contraception. Forty-eight percent of the respondents did not had an opportunity to learn about it.…”