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Indian Journal of Medical Sciences, Vol. 61, No. 6, June, 2007, pp. 321-322 Editorial Perspectives on the adoption of emergency contraceptive pills as a new contraceptive method Larsson Margareta Department of Women's and Children's Health, Uppsala University, Uppsala Code Number: ms07050 The introduction of emergency contraceptive pill (ECP), [1] or ′the morning-after pill," was an important landmark in the history of contraception in many ways. Not only was ECP the first contraceptive method that could be used after an unprotected intercourse in order to avoid an undesired pregnancy, but also with the introduction of ECP as an over-the-counter product a new provider group, namely, pharmacists, became involved in provision of, and counseling about, hormonal contraception. The introduction has not always been easy, and the method has been referred to as ′the best-kept secret in contraception.′ Both providers and potential users had doubtful attitudes, and misunderstandings about side effects and mode of action were common. The introduction of medical abortion around the same time as when ECP was introduced created confusion, and ECP was sometimes mistaken for an abortifacient. Many experts, researchers and clinicians were optimistic and had great expectations from the method, and it was estimated that ECPs could prevent as many as 75% of unintended pregnancies. Others raised concerns that the knowledge about ECPs could deter couples from the use of more reliable contraceptive methods and contribute to more risky sexual behavior. Moreover, there was a fear that men could pressure women into nonvoluntary sexual intercourse and then give them ECPs in order to prevent an undesired pregnancy. In the light of the current experiences, when the method has been introduced and made easily available in many countries, we can conclude that none of these viewpoints have come true. ECP has not proved to be the magic bullet to solve the problem of unintended pregnancies. Even in countries where it is well known and widely used, the abortion rate has remained unchanged and most studies regarding ECP-use and contraceptive practices have concluded that ECP does not contribute to riskier behavior. A large study in the UK with advance provision of ECPs to many women in one county reported that the advance provision of ECPs did not cause any change in the abortion rates when compared to another county without intervention. [2] The main reason for not using ECP even when the women had them available at home was that the women were unaware of the pregnancy risk. According to the Theory of Diffusion, [3] a new innovation or idea typically spreads via different communication channels over a period of time, and the innovation-decision process described in the Diffusion Theory moves through different stages: 1. knowledge of an innovation, 2. forming an attitude towards the innovation, 3. decision to adopt or reject and 4. implementation. In order to reach all the sections in a community, it has been argued that programs should employ a combination of strategies. The most effective strategy may be to involve one-to-one interventions for high-risk individuals, communitywide interventions attempting to change social norms and, finally, policy-level efforts to help modify the social and political environment. In order to use ECPs properly, women and men need to be aware of the existence of this option and know enough about it so as to not have unfounded worries. They need to be able to obtain the product preferably within 24 h after an unprotected intercourse, and they also need sufficient funds for the purchase. Improving access, raising the level of knowledge and providing advance supply of ECPs are possible components in a public health strategy to reduce unwanted pregnancies. Although the effect of ECPs on unintended pregnancies and abortions may be overestimated, it is without doubt a valuable addition to other contraceptive methods. Easy access to the method is important and should be implemented all over the world. However, it must be considered as only one of many tools to prevent unwanted pregnancies. References
Copyright 2007 - Indian Journal of Medical Sciences |
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