Emergency contraception and morality: reflections of health care workers and clients

In this study, we explore the retrospective reports of 21 US Planned Parenthood clients about their use of emergency contraception pills (ECPs) and the views of ten Planned Parenthood health care workers at two clinics about providing ECPs. We elucidate the sociological phenomena that frame emergency contraception usage: cultural ideology about contraception, sexuality, unintended pregnancy, and abortion. We focus on the ways in which interactions between health care workers and clients both mediate and reinforce such cultural ideology. Our research indicates that the distinctions between fertilization and pregnancy, between contraception and abortion, between responsible and irresponsible procreative behavior, are not hard and fast boundaries upon which everyone agrees. We illuminate the dividing lines and continuities our participants invoked, affirmed, and questioned when contemplating the continuum from potential fertility to realized (and unwanted) pregnancy.Abortion Contraception Contraceptive counseling Emergency contraception USA

Do Mexico City pharmacy workers screen women for health risks when they sell oral contraceptive pills over-the-counter?

Context: In Mexico, oral contraceptives (OCs) are available to women over-the-counter in pharmacies. While past research has suggested that nonmedical providers, such as pharmacy workers, are capable of screening women for contraindications to OCs, little is known about their practices. Methods: After selecting a 10% random sample of all pharmacies in Mexico City (n = 108), we surveyed the first available pharmacy worker to learn more about pharmacy workers\u27 screening practices when selling OCs over-the-counter to women. Results: While nearly all of the pharmacy workers surveyed had sold OCs without a prescription, only 31% reported asking women any questions before selling pills. Among those who asked questions, the most commonly asked questions were about other medications a woman was taking, about blood pressure and about alcohol intake. Pharmacy workers did not ask these questions consistently to all clients. Conclusion: Training pharmacy workers might be one strategy to improve screening of women for pill contraindications. However, pharmacy workers may lack the time and motivation to carry out such screening. An alternative strategy might be to better inform women to self-screen for pill contraindications

Measuring induced abortion in Mexico: A comparison of four methodologies

The authors compare four methods of collecting information on abortion through survey research to measure the levels of induced abortion in Mexico: face-to-face interview (FTF), audio computer-assisted self-interview (ACASI), self-administered questionnaire (SAQ), and a random-response technique (RRT). They tested all methods in three samples: (1) hospital patients in Mexico City, (2) rural women in Chiapas, and (3) women randomly chosen as part of a house-to-house survey in Mexico City. In each sample, RRT found the highest rate of attempted induced abortion in the hospital, rural, and household samples (21.7, 36.1, and 17.9 percent, respectively), followed by the SAQ (19.3, 10.1, and 10.8 percent, respectively). The ACASI and FTF interviews yielded fewer reported abortion attempts. The RRT seems the most promising methodology to measure the levels of induced abortion. With SAQ, detailed information was obtained, and the reported frequency rates were slightly lower than the RRT rates in urban areas

Routine follow-up visits after first-trimester induced abortion

Routine follow-up visits after abortion are intended to confirm that the abortion is complete and to diagnose and treat complications. Many clinicians also take advantage of the follow-up visit to provide general reproductive health care: discussing contraceptive plans and providing family planning services; diagnosing sexually transmitted infections; performing a Pap test or discussing abnormal Pap results. We reviewed the evidence related to the routine postabortion follow-up visit. Other than mifepristone medical abortion performed at 50 days of gestation or later and methotrexate medical abortion, we found little evidence that mandatory follow-up visits typically detect conditions that women themselves could not be taught to recognize. In addition, the natural history of the most severe complications after abortion—infection and unrecognized ectopic pregnancy—have time courses inconsistent with the usual timing of the follow-up visit. Costs associated with this visit can be great. These include travel expenses, lost wages, child-care expenses, privacy and emotional burdens for women, and scheduling disruptions and the related opportunity costs caused by “no-shows” for the provider. Follow-up appointments should be scheduled for those women likely to benefit from a physical examination. For the remainder of women, simple instructions and advice about detecting complications, possibly coupled with telephone follow-up, might suffice. Although arguably valuable in their own right, counseling, family planning services, or sexually transmitted infection diagnosis and treatment should not be so inflexibly bundled with postabortion care. Protocols that require in-person follow-up after abortion may not make the best use of a women\u27s time or abilities, or of the medical system

Abortion, revised: participants in the U.S. clinical trials evaluate mifepristone

This paper centers on the questions: How do non-surgical abortion methods affect private experiences of abortion? How might they influence public conceptions of abortion? Drawing on interviews with clients who participated in the 1994-95 U.S. clinical trials of mifepristone at one trial site (conducted during the trials), and focus group interviews conducted with health care workers at all 17 trial sites (after the trials were completed), we examine participants' evaluations of this method of abortion. Surgical abortion functioned as the reference point by which research participants assessed medical abortion. They discussed mifepristone abortion in terms of nature and invasion, privacy and bodily integrity, denial and agency. Clients frequently portrayed mifepristone abortion as a better moral choice than surgical abortion--in some cases even depicting it as not-really-an-abortion but rather as a miscarriage. Clients felt that mifepristone offered them a greater measure of control over their abortion experiences. Health care providers offered critical analysis of their clients' perceptions, yet affirmed the potential of medical abortion to offer women greater variety and latitude in procreative decision-making, and perhaps even to depoliticize the issue of abortion in the U.S. by thwarting the efforts of anti-abortionists to target providers and aborting women.abortion, clinical trials, mifepristone, RU-486

Barriers to Contraceptive Use in Product Labeling and Practice Guidelines

Many contraceptives are encumbered with potentially unnecessary restrictions on their use. Indeed, fear of side effects, fostered by alarmist labeling, is a leading reason that women do not use contraceptives. In the United States, hormonal methods currently require a prescription, although research suggests that women can adequately screen themselves for contraindications, manage side effects, and determine an appropriate initiation date, leaving little need for routine direct physician involvement. Sizing, spermicidal use, and length-of-wear limits burden users of cervical barriers and may be unnecessary. Despite recent changes in the labeling of intrauterine devices, clinicians commonly restrict use of this method and in some countries may limit the types of providers authorized to insert them. Although in some cases additional research is necessary, existing data indicate that evidence-based demedicalization of contraceptive provision could reduce costs and improve access

The measure of induced abortion levels in Mexico using random response technique

The authors used the random response technique (RRT) to measure frequency of induced abortion in Mexico, where its practice is illegal under most circumstances. They applied RRT to a national, multistage probabilistic sample of 1,792 women ages 15 to 55. The distribution of women who reported having had an induced abortion was analyzed by sociodemographic characteristics. Bivariate and multiple logistic regression analyses were performed to identify factors associated with having had an induced abortion. Overall prevalence of induced abortion was 16.3 percent. Three factors were associated with reported induced abortion: having grown up in the city (bivariate odd ratio [OR] 2.16, multiple logistic OR 2.24), having never given birth (bivariate OR 1.60, multiple logistic OR 2.06), and having had an unwanted pregnancy (bivariate OR 2.09, multiple logistic OR 2.81). RRT produced a better estimation of induced abortion compared with other methodologies. This technique works best with urban and educated women

Policy implications of a national public opinion survey on abortion in Mexico

In Mexico, recent political events have drawn increased public attention to the subject of abortion. In 2000, using a national probability sample, we surveyed 3,000 Mexicans aged 15-65 about their knowledge and opinions on abortion. Forty-five per cent knew that abortion was sometimes legal in their state, and 79% felt that abortion should be legal in some circumstances. A majority of participants believed that abortion should be legal when a woman\u27s life is at risk (82%), a woman\u27s health is in danger (76%), pregnancy results from rape (64%) or there is a risk of fetal impairment (53%). Far fewer respondents supported legal abortion when a woman is a minor (21%), for economic reasons (17%), when a woman is single (11%) or because of contraceptive failure (11%). In spite of the influence of the Church, most Mexican Catholics believed the Church and legislators\u27 personal religious beliefs should not factor into abortion legislation, and most supported provision of abortions in public health services in cases when abortion is legal. To improve safe, legal abortion access in Mexico, efforts should focus on increasing public knowledge of legal abortion, decreasing the Church\u27s political influence on abortion legislation, reducing the social stigma associated with sexuality and abortion, and training health care providers to offer safe, legal abortions

What do Family Planning Clients and University Students in Nairobi, Kenya, Know and Think about Emergency Contraception?

Currently, emergency contraception is seldom used in Kenya. As part of a larger study designed to provide insight into the possible roles for the method in Kenya, we assessed the knowledge of and attitudes towards emergency contraception in two groups of potential users, and we focus on these data specifically in this paper. We interviewed clustered samples of clients at ten family planning clinics in Nairobi (n = 282) and conducted four focus group discussions with students at two universities in Kenya (n = 42). Results show that despite relatively low levels of awareness and widespread misinformation, when the method was explained, both clients and students expressed considerable interest, but also expressed some health and other concerns. (Afr J Reprod Health 2000; 4[1]: 77-87) Key Words: Emergency contraception, Kenya, family planning clients, students, knowledge, attitude