Missing opportunities for preventing unwanted pregnancy: a qualitative study of emergency contraception

Abstract

Background and methodology High levels of unplanned pregnancy among young people are a huge public health problem in South Africa. However, use of emergency contraception (EC) remains low. Studies suggest that providers constitute an important link to increasing access to EC use. The aim of the study was to provide greater insights into the attitudes of providers towards EC in order to better understand factors infl uencing uptake. The study drew upon 30 indepth interviews with providers at private and public health facilities in Durban, South Africa. Results The results of the study highlight several barriers to the provision of EC in both public and private health facilities. The cost of EC products in commercial pharmacies is likely to be a major barrier to use for many women. In addition, providers in both public and private facilities are often reluctant to provide EC over the counter because they feel that the use of EC is likely to discourage regular use of contraception and increase the risk of unprotected sexual intercourse and, as a result, contribute to the spread of HIV/AIDS in South Africa. In addition, they reported that they do not have an opportunity to counsel women about EC because of time constraints. Providers in both the public and private sectors also demonstrated a level of uncertainty about the clinical effects of EC pills and on the regulations surrounding their provision. Discussion and conclusions Despite relatively progressive legislation on EC provision and the widespread availability of EC products in South Africa, providers in pharmacies, family planning clinics and public health clinics need more training on EC provision. Interventions should aim to educate health providers on both the clinical and social aspects of EC provision.

Pharmacy provision of sexual and reproductive health commodities to young people: a systematic literature review and synthesis of the evidence

“…As detailed above, lowering barriers to SRH commodity access does not translate to increases in sexually risky behavior. Yet, a persistent reservation expressed by both pharmacy personnel and clients was that increased access was unsafe for young people and would result in poor decision-making [19,22,[42][43][44][45][46][47][48][49][50]. In two US studies, for example, adolescent girl participants voiced concerns that increased commodity availability might lead to teenagers having sex at an earlier age [22] and engaging in unprotected sex [22,46].…”

“…Similarly, reservations by pharmacy personnel and other health care providers (including general practitioners and nurses) could be largely categorized in two ways. First, they believed that increasing availability of SRH commodities (ECPs, in particular) could result in "risky and promiscuous" behavior among youth [42,43,45,49]. This notion that ECP availability condones or even encourages promiscuity among younger people persisted for some time after deregulation [45,49].…”

“…First, they believed that increasing availability of SRH commodities (ECPs, in particular) could result in "risky and promiscuous" behavior among youth [42,43,45,49]. This notion that ECP availability condones or even encourages promiscuity among younger people persisted for some time after deregulation [45,49]. A second key reservation of pharma cists and other health care providers centered around a general concern that SRH commodities (ECPs, in particular) were not safe for youth [19,47] or that youth would not be able to take them as directed [48,50].…”

“…Finally, in settings where SRH commodities are not subsidized or covered by insurance, commodity cost may serve as yet another barrier for youth. One South African study found that many pharmacists opted to only stock dedicated ECP products because they were significantly more expensive than cut-up combined oral contraceptives, and would therefore discourage overuse by young people [49].…”

“…Pharmacists themselves could be an insurmountable obstacle for young people [15,26,40,44,45,49,58,[60][61][62]. Six studies using mystery clients found that, anywhere between 20% and 65% of the time, youth clients could not obtain the selected SRH commodity (ECPs or oral contraception) despite regulations allowing access [15,26,56,58,[60][61][62].…”