Young People's Use and Perceptions of Emergency Contraceptives in Sub‐Saharan Africa: Existing Insights and Knowledge Gaps

Abstract

Despite growing international attention to the sexual and reproductive health and rights of young people, their uptake of modern contraceptive methods remains low, especially in Sub-Saharan Africa. This article focuses on young people's use of a relatively new contraceptive method, emergency contraceptives (ECs). Emergency contraceptives can be used after intercourse and have been marketed to be used when other contraceptives fail or after unplanned, unprotected intercourse. This article reviews qualitative evidence from seven studies on young people's experiences with this contraceptive method. Many users of ECs were in their twenties, well-educated, and either single or in a relationship. Repeated use was found in four of the studies, and ECs may fit within an existing range of post-coital methods used to prevent pregnancies. While concerns about side effects were reported frequently among non-users of ECs, other women preferred ECs above other hormonal contraceptive methods. Men were actively involved, for example, as providers of information to their partners, and as purchasers of ECs. Young people's understandings of ECs hence differ from the meanings inscribed to these pills at an international level. Further research on this topic is needed to ensure that young people's (emergency) contraceptive needs are well understood and responded to.

Access to sexual and reproductive health commodities in East and Southern Africa: a cross-country comparison of availability, affordability and stock-outs in Kenya, Tanzania, Uganda and Zambia

“…Other health system challenges beyond the price and availability of the commodities at the health facility, which were not measured in this research, also influence accessibility. These challenges include policy and regulatory issues, infrastructural issues, lack of knowledge amongst the population and healthcare workers, cultural beliefs, and lack of skilled healthcare workers [25,[58][59][60][61][62][63][64][65][66][67]. The physical availability of an ultrasound scan, for example, does not mean it is routinely used or functional; lack of healthcare workers trained in its use, lack of electricity or high user costs are also barriers [61].…”

“…Despite the clear need for access to sexual and reproductive health commodities (SRHC) in Kenya, Tanzania, Uganda and Zambia, access has not been fully achieved and unavailability, unaffordability, regulatory provisions and supply chain issues persist [20]. Previous research in these countries has focused on identifying the barriers to access on both the supply and demand side [21][22][23][24][25][26], but detailed research on availability and affordability of these medicines at the health system level is lacking. In Uganda research on availability of medicines for SRH has been conducted previously, showing that access remains suboptimal [27,28].…”

Emergency contraceptive use in Addis Ababa, Ethiopia: Challenging common assumptions about young people’s contraceptive practices

“…Repeat users claim that ECs fit their everyday lives because they are convenient in situations where they have infrequent sex, the number of pills is small and they do not experience disturbing side effects. [1][2][3][4] In contrast, reproductive health experts, while acknowledging that ECs can be taken safely as often as needed, do not recommend them for regular use because they are less effective than other contraceptive methods and frequent use can result in menstrual irregularities. 5 ECs are intended and marketed as a "back-up" method to be used after unprotected intercourse, when other contraceptives have failed (for example, after breakage or slippage of condoms), after incorrect use of contraceptives (for example, after having missed one or more regular contraceptive pills), or after being forced or coerced into having unprotected intercourse.…”

Sexual and reproductive self care among women and girls: insights from ethnographic studies

“…Designed to be used in exceptional cases, such as contraceptive failure or sexual assault, 23 emergency hormonal contraceptives are also used by women to manage their fertility. In sub-Saharan Africa, women using emergency contraception describe it as the method most aligned with their contraceptive needs and report repeated, regular, or frequent (even weekly) use.…”

“…In sub-Saharan Africa, women using emergency contraception describe it as the method most aligned with their contraceptive needs and report repeated, regular, or frequent (even weekly) use. 23 Some sex workers use emergency contraception in combination with condoms as their regular form of protection in case condoms burst. Other women report using it in combination with the rhythm method during the fertile window.…”