Why are pediatricians uncomfortable with prescribing emergency contraception for adolescents?

Abstract

Objective: Emergency contraception (EC) is an effective and safe method for preventing unplanned pregnancy after unprotected sexual intercourse among adolescents but is infrequently prescribed by pediatricians. Because of the scarcity of data on the discomfort with EC prescription among physicians in Brazil, this study aimed to identify associated factors with discomfort with EC prescription among pediatricians in the state of Amazonas. Methods: A web-based, cross-sectional study including sociodemographic data, knowledge, attitudes, and discomfort with EC prescription was used. Multivariate logistic regression and artificial intelligence methods such as decision tree and random forest analysis were used to identify factors associated with discomfort with EC prescriptions. Results: Among 151 physicians who responded to the survey, 53.0% were uncomfortable with prescribing EC, whereas only 33.1% had already prescribed it. Inexperience was significantly associated with discomfort with EC prescription (odds ratio 4.47, 95% confidence interval 1.71–11.66). Previous EC prescription was protective against discomfort with EC prescription in the three models. Conclusions: EC is still infrequently prescribed by pediatricians because of inexperience and misconceptions. Training these professionals needs to be implemented as part of public health policies to reduce unplanned adolescent pregnancy.

Acceptability of an on-demand pericoital oral contraceptive pill: a systematic scoping review

“…Papers reported on research conducted in 16 countries across five WHO regions: nine countries in Africa, including Benin [ 29 ], the Democratic Republic of Congo (DRC) [ 35 ], Ethiopia [ 26 , 31 ], Ghana [ 11 , 33 , 36 , 38 , 39 ], Kenya [ 12 , 27 , 28 , 30 ], Nigeria [ 27 , 28 , 30 , 32 ], Somalia [ 34 ], Uganda [ 37 ] and Zambia [ 39 ]; three countries in the Americas, including the US [ 42 , 44 ], Brazil [ 40 , 43 , 45 ] and Argentina [ 41 ]; two countries in South East Asia, including India [ 46 , 48 , 49 ] and Nepal [ 47 ]; one country in Eastern Mediterranean, in Iran [ 50 ]; and two countries in Europe, in Spain [ 52 ] and Serbia [ 51 ]. One paper reported on data from multiple international settings [ 10 ]; no research was identified from the Western Pacific.…”

“…Overall, 27 papers reported on data from urban settings [ 10 – 12 , 26 – 44 , 46 – 50 ], one paper on data from rural areas [ 35 ], and one on peri-urban areas [ 12 ]. Three papers did not specify urban or rural location [ 45 , 51 , 52 ].…”

“…The reviewed papers used qualitative ( n = 12) [ 26 , 31 , 32 , 34 – 37 , 39 , 40 , 42 , 44 , 49 ], quantitative survey ( n = 14) [ 27 – 30 , 33 , 38 , 41 , 43 , 45 – 48 , 50 , 51 ], intervention or trial ( n = 3) [ 10 – 12 ] and surveillance ( n = 1) [ 52 ] approaches. Twenty four papers reported on the perspectives of end users (e.g., younger women, women of reproductive age, university students, male sexual partners) [ 10 – 12 , 26 – 39 , 41 – 44 , 49 , 52 ], nine papers on service providers (e.g., pharmacists, GPs, clinicians, midwives, community health workers) [ 26 , 34 , 40 , 45 – 48 , 50 , 51 ], and four on other stakeholders (e.g., donors, policy makers, NGO workers) [ 26 , 34 , 37 , 46 ].…”

“…Repeat use of ECPs, or use of ECPs as a primary contraceptive method, by end-users was documented in 16 papers [ 26 , 28 – 33 , 36 , 38 , 39 , 41 – 44 , 49 , 52 ], use of pericoital pills in 3 papers [ 10 – 12 ], and hypothetical use of ECPs or pericoital pills in 4 papers [ 27 , 34 , 35 , 37 ]. Seven papers reported provider perspectives of repeat use of ECPs [ 40 , 45 – 48 , 50 , 51 ]. Six papers from the African region reported use of other postcoital prevention strategies – five on non-contraceptive drugs [ 32 , 34 – 37 ], and three on other non-medical strategies [ 32 , 34 , 38 ].…”

“…Senior gynaecologists in north India expressed concerns regarding the possibility of ectopic pregnancy and infertility, as well as excessive bleeding during menstruation, vomiting or nausea [ 46 ]. The need to educate ECP providers was highlighted as a key requirement to enhance women’s access to ECPs in a range of settings [ 36 , 39 , 45 – 47 , 50 ].…”