The Visit Before the Morning After: Barriers to Preprescribing Emergency Contraception

Karasz, Alison; Kirchen, Nicole Tan; Gold, M.

doi:10.1370/afm.105

Cited by 39 publications

(27 citation statements)

References 14 publications

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“…7,18,28,[35][36][37][38] Few concerns about the safety and efficacy of taking ECP were raised by physicians. Rather, some respondents worried that use of ECP may discourage regular contraceptive use (17%) or encourage promiscuity (6%).…”

Section: Physicians' Attitudes On Ecp Provision 495mentioning

confidence: 99%

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

Vahratian

Patel

et al. 2007

Journal of Women's Health

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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

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Section: Physicians' Attitudes On Ecp Provision 495mentioning

confidence: 99%

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

Vahratian

Patel

et al. 2007

Journal of Women's Health

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“…If this is implemented in the form of an undated prescription, a woman may still encounter the difficulty of finding a willing pharmacist to fill the prescription when it is needed. Further, empirical study of primary care providers suggests that physicians' misconceptions about EC lead to reluctance to provide advance prescriptions (Karasz and Gold 2004). This underscores the point that analysis of the reasons supporting conscientious refusals -the focus of this essay -ought to remain center stage in this discussion.…”

Section: Conscientious Objection and Emergency Contraceptionmentioning

confidence: 85%

Conscientious Objection and Emergency Contraception

Card

2007

The American Journal of Bioethics

112

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This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons and concludes that they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested.

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“…[65][66][67][68][69][70] Some physicians refuse to provide emergency contraception to teenagers, regardless of the circumstance, and others may provide emergency contraception only if nonconsensual penetration has occurred. Both of these choices by physicians have important adverse consequences for adolescents in their ability to access emergency contraception.…”

Section: Ethical Dilemmas For Physicians and Pharmacistsmentioning

confidence: 99%

Emergency Contraception

Upadhya¹,

Breuner²,

Trent³

et al. 2012

Pediatrics

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Despite significant declines over the past 2 decades, the United States continues to have teen birth rates that are significantly higher than other industrialized nations. Use of emergency contraception can reduce the risk of pregnancy if used up to 120 hours after unprotected intercourse or contraceptive failure and is most effective if used in the first 24 hours. Indications for the use of emergency contraception include sexual assault, unprotected intercourse, condom breakage or slippage, and missed or late doses of hormonal contraceptives, including the oral contraceptive pill, contraceptive patch, contraceptive ring (ie, improper placement or loss/expulsion), and injectable contraception. Adolescents younger than 17 years must obtain a prescription from a physician to access emergency contraception in most states. In all states, both males and females 17 years or older can obtain emergency contraception without a prescription. Adolescents are more likely to use emergency contraception if it has been prescribed in advance of need. The aim of this updated policy statement is to (1) educate pediatricians and other physicians on available emergency contraceptive methods; (2) provide current data on safety, efficacy, and use of emergency contraception in teenagers; and (3) encourage routine counseling and advance emergency-contraception prescription as 1 part of a public health strategy to reduce teen pregnancy. This policy focuses on pharmacologic methods of emergency contraception used within 120 hours of unprotected or underprotected coitus for the prevention of unintended pregnancy. Emergency contraceptive medications include products labeled and dedicated for use as emergency contraception by the US Food and Drug Administration (levonorgestrel and ulipristal) and the “off-label” use of combination oral contraceptives.

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The Visit Before the Morning After: Barriers to Preprescribing Emergency Contraception

Cited by 39 publications

References 14 publications

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

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

Conscientious Objection and Emergency Contraception

Emergency Contraception

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