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Indian Journal of Medical Sciences, Vol. 61, No. 6, June, 2007, pp. 323-324 Editorial Hormonal emergency contraception: Increasing awareness and access Ball Douglas Faculty of Pharmacy, Kuwait University, PO Box 24923 Safat 13110 Code Number: ms07051 In this issue of the journal, Puri et al.[1] reports on the awareness of hormonal emergency contraception among female college students at Punjab University, Chandigarh. Only around 7% had heard about emergency contraceptive pills before, let alone ′knew the details about their appropriate use.′ This result is similar to the findings of a previous study amongst educated working women at a teaching hospital, also in Chandigarh, in which 11% reported awareness of hormonal emergency contraception and most of them were nursing staff. [2] These two studies provide a valuable insight into how well women in India are aware of this contraceptive option. One can only assume that less educated women, and women in rural areas in particular, have even less knowledge. Putting these results in context, studies among university students in some African countries have reported awareness rates of around 50%; while most surveys in developed countries report awareness greater than 70%, except in certain disadvantaged communities. In fact, these figures are most comparable to results from two Muslim countries, Iran [3] and Kuwait, [4] where emergency contraception and even contraception itself are often frowned upon and awareness of less than 10% has been reported. Wider access to hormonal emergency contraception can be a difficult issue in some cultures, as has been observed in the USA over the availability of Plan-B ® both with and without prescription. However, the same arguments are used against emergency contraception that were used in the past against oral contraceptive pills and other forms of what are now accepted methods of contraception. There is no reason why emergency contraception should not be accepted in the same light as a means of enhancing the efficacy of other methods, e.g., when condoms break or when oral contraceptives are forgotten. Studies from Western countries and Asia suggest that having emergency contraception readily available does not increase sexual risk-taking behavior, incidents of unprotected sexual intercourse or interruption of normal contraceptive measures, even when supplies to keep at home are provided in advance. [5] And contrary to expectations, abortion rates appear unaffected. [6] While these results may not transfer directly into other cultures, they suggest that the availability of hormone or emergency contraception does not influence patterns of sexual behavior and moral arguments should not be an obstacle to allowing emergency contraception to be available. So what is the way forward? Increasing awareness of emergency contraceptive pills among women of childbearing age is an obvious step. This can be taken up by groups with interests in women′s health as well as by national or state governments. Puri identifies health care professionals as having a role in informing women of their options. Emergency contraception should be a part of any consultation related to contraceptive choices at the primary care level. However, the value of community health workers and peer educators should also not be underestimated, particularly in disadvantaged and rural populations. For these efforts to be successful, a suitable product needs to be readily available from accessible sites in the community, urban or rural. In addition, the potential providers, whether they be physicians, nurses, pharmacists or other auxiliary health care workers, need to be aware of and accept hormonal emergency contraception and know its appropriate use so as to be able to advise potential users. This needs to be underpinned with wider public education of the issues involved. Such a holistic approach is necessary to ensure that true access is granted to those who are in need. References
Copyright 2007 - Indian Journal of Medical Sciences |
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