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Objectives: This study aimed to investigate Vietnamese community pharmacists and pharmacy customers' knowledge, attitudes, and practices about emergency contraceptive pills (ECPs)., Study Design: We recruited 400 pharmacists and 396 customers via a nonprobability convenience sampling technique. We used univariate and multivariate linear regression models to determine factors associated with the knowledge and attitudes toward ECPs among pharmacists and customers. We selected variables in the multivariate models through the Bayesian Model Averaging method using R software (version 4.2.3)., Results: In medicine outlets, levonorgestrel and mifepristone (ECPs) were highly available. The average knowledge scores on ECPs among pharmacists and customers were 9.98 ± 2.00 and 6.24 ± 2.33, respectively. Many pharmacists did not have adequate knowledge of ECPs' mechanism of action, dosage, and contraindications. Customers lacked knowledge about their legislation, effectiveness, and side effects. The attitudes toward ECPs among participants were relatively positive. Reliable information sources about ECPs (such as the package leaflet, courses, and books) played an essential role in increasing ECP knowledge and attitudes (p < 0.001). The availability of ECPs (p < 0.001), being educated (p < 0.01 and 0.01), and daily sales (p < 0.001) were significantly associated with pharmacists' knowledge/attitudes. Age, education level, marital status, and occupation were significantly associated with customers' knowledge. Participants' knowledge of was significantly associated with their attitude toward ECPs (p = 0.02 and p < 0.001, respectively)., Conclusions: The knowledge of ECPs among pharmacists was relatively good, while that of customers was poor. There is a need to have policies and interventions to enhance the knowledge and attitudes toward ECPs for both pharmacists and customers., Implications: Community pharmacies are ideal settings to dispense contraceptive methods, especially over-the-counter ECPs. Community pharmacists can help ensure the availability of ECPs in medicine outlets, increase women's access to ECPs, and counsel customers on up-to-date and comprehensive knowledge about these medications, thereby guaranteeing rational ECP use., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To estimate the cost-effectiveness of ulipristal acetate (UPA) and levonorgestrel (LNG) emergency contraception (EC) on pregnancy prevention among combined oral contraceptive (COC) pill users with an extended pill-free interval. We accounted for the potential interaction of COCs and obesity on EC efficacy., Methods: We built a decision-analytic model using TreeAge software to evaluate the optimal oral EC strategy in a hypothetical cohort of 100,000 twenty-five-year-old women midcycle with a prolonged "missed" pill episode (8-14 days). We used a 5-year time horizon and 3% discount rate. From a healthcare perspective, we obtained probabilities, utilities and costs inflated to 2018 dollars from the literature. We set the threshold for cost-effectiveness at a standard $100,000 per quality-adjusted life-year. We included the following clinical outcomes: number of protected cycles, unintended pregnancies, abortions, deliveries and costs., Results: We found that UPA was the optimal method of oral EC, as it resulted in 720 fewer unintended pregnancies, 736 fewer abortions and 80 fewer deliveries at a total cost savings of $50,323 and 79 additional adjusted life-years. UPA continued to be the optimal strategy even in the case of obesity or COCs impacting UPA efficacy, in which a COC interaction would have to change efficacy of UPA by 160% before LNG was the dominant strategy., Conclusion: Our models found that UPA was the dominant choice of oral EC among COC users with a prolonged "missed" pill episode, regardless of body mass index or an adverse interaction of COCs on UPA., Implications: Ulipristal acetate is the dominant choice of oral emergency contraception among combined oral contraceptive users., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Ulipristal acetate (UPA) is a prescription emergency contraceptive pill (ECP). Despite the potential for UPA to reduce the risk of unintended pregnancies, a recent study in Hawaii demonstrated less than 3% of pharmacies stocked UPA and less than 23% reported the ability to order it. The primary outcome of our study was to assess the availability of UPA in a sample of large cities nationwide., Study Design: We conducted a telephone-based secret shopper study of 533 retail pharmacies sampled proportionally from 10 large cities in five geographic regions across the US. Callers represented themselves as uninsured 18-year-old women attempting to fill prescriptions for UPA between February and May 2016. Using a semi-structured questionnaire, callers inquired regarding availability and use of UPA., Results: Less than 10% (33/344; 95% CI: 6.5-12.7%) of pharmacies indicated the ability to immediately fill a UPA prescription, while 72% (224/311; 95% CI: 65.0-77.0%) of pharmacies without immediate availability reported the ability to order UPA, with the median predicted wait time of 24 h (IQR: 21.5 to 26.0 h)., Conclusion: Despite evidence for increased efficacy of UPA over levonorgestrel (LNG) ECPs, the availability of UPA in a sample of US major cities is extremely limited. Given that ECPs should be taken as soon as possible after unprotected sex, the long wait times when ordering UPA present an access barrier. Efforts to improve the availability of UPA are important to optimize the potential of ECPs to decrease unintended pregnancy following unprotected sex., Implications: Interventions are needed to address barriers to obtaining UPA from retail pharmacies nationwide., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: The copper intrauterine contraceptive (IUC) is the most effective method of emergency contraception (EC), yet it is underutilized. The objective was to evaluate a pilot project integrating the copper IUC into EC care., Study Design: Single-group evaluation study. Nine geographically diverse reproductive health centers implemented 6-month pilot interventions. All interventions included staff education and inclusion of the IUC in EC patient counseling; some sites developed patient education materials. Health center staff completed manual monthly tracking forms of the number of EC patients receiving oral levonorgestrel, ulipristal acetate or the copper IUC. Sites also tracked and reported the number of patients returning for removal during the 6-month pilot period and for 5 subsequent months. Main study outcomes included the number of IUC for EC insertions, the proportion that were same-day insertions and the proportion of patients receiving each EC type during the pilot period. A secondary outcome was the number of patients who had returned for removal at 5 months postpilot., Results: There were 101 IUC insertions for EC during the pilot period. Seventy-seven percent were same-day insertions; the remainder returned for insertion within 5 days of unprotected intercourse. The percentage of EC patients choosing the IUC varied by site from 1 to 16% (overall=7%). At 5 months postpilot, 20 patients (20%) had returned for removal., Conclusions: Some women will be interested in the copper IUC for EC, and therefore, all women should be offered this option. Results suggest that the large majority continued to use the IUC for ongoing contraception., Implications: Copper IUCs are a viable option for women in need of EC. All women should be offered the most effective EC option., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: In 2001, we provided benchmark estimates of probability of pregnancy given a single act of intercourse. Those calculations assumed that intercourse and ovulation are independent. Subsequent research has shown that this assumption is not valid. We provide here an update of previous benchmark estimates., Study Design: We reanalyze earlier data from two North Carolina studies that collected daily urine samples and recorded daily intercourse for multiple menstrual cycles. One study comprised 68 sexually active women with either an intrauterine device or tubal ligation. The second was of 221 women who planned to become pregnant and had discontinued use of any birth control at enrollment. Participants had no known fertility problems. New statistical analyses were based on Monte Carlo simulations and Bayesian methods., Results: The probability that a single act of intercourse occurs within a woman's fertile window is 25%, compared with 20% in previous calculations. The probability of pregnancy with intercourse on a given menstrual cycle day is correspondingly higher than previously estimated, with the largest increases occurring on menstrual days 12-22. These increases are, however, fairly small (for example, the peak chance of conception on menstrual day 13 increased from 8.6% to 9.7%)., Conclusions: Previous benchmark rates of pregnancy with one act of intercourse were moderately underestimated due to a mistaken assumption about the independence of intercourse and ovulation., Implications Statement: The chance of pregnancy with a single act of unprotected intercourse is greater than previously estimated. Previous benchmarks may underestimate the efficacy of post-coital contraception., (Published by Elsevier Inc.)

Background: It can prove challenging to create social marketing materials aimed at a specific subsection of the population, especially when the topic is relatively new and possibly misunderstood. Therefore, the objective of this study was to assess adolescent knowledge of and attitudes towards emergency contraception (EC), with the goal of creating a locally relevant social marketing campaign and intervention., Methods: This qualitative study consisted of 18 in-depth interviews and four focus groups (n=29) with adolescents and young adults ages 15 to 21 years, conducted in New York City between August and December 2006., Results: While respondents seemed generally aware of EC's existence, most were unclear about circumstances warranting its use and its mechanism of action. The FDA change to behind-the-counter availability appeared to increase knowledge and access to EC, although substantial barriers to EC access and use remain, including price., Conclusions: Further work remains in educating those in need of EC, especially adolescents under the age of 18 years. Results from this study initiated a social marketing campaign and intervention aimed at increasing adolescent knowledge of and access to EC.

Background: Primary care physicians care for reproductive-aged women, yet do not routinely counsel women about or prescribe contraceptives, including emergency contraception (EC)., Study Design: We used a pre-/post-study to design to assess whether the proportion of primary care physicians who counseled women about and prescribed EC increased 6 months after a peer-led intervention with educational and reminder components. Participants included 36 residents and attending physicians at an academically affiliated internal medicine practice from July 2004 to June 2005 (when prescription was required for EC in New York). Data were collected by self-administered questionnaire., Results: At baseline, 37% of participants had counseled women about EC and 34% had prescribed EC in the prior month. After the intervention, 80% of participants had counseled women about EC (p<.001) and 66% had prescribed EC (p=.03) in the prior month., Conclusion: Six months after a peer-led intervention including educational and reminder components, the proportion of primary care physicians who had counseled women about and prescribed EC in the past month increased significantly.

Objective: Previous trials of emergency contraceptive pills (ECPs) found that in menstrual cycles ending in pregnancy, ECP use was more common among women exposed to interventions that enhanced access to the medication than among women with standard access. We examined data from one such trial to explore whether this finding has implications regarding the effect of the intervention on pregnancy risk behavior., Methods: In our recent randomized trial, the intervention group received unlimited free ECPs in advance of need, whereas control participants obtained the medication when needed at usual cost. Participants were followed up for 1 year. In this secondary analysis, we examined ECP and contraceptive use in the cycles ending in pregnancy in that trial., Results: Pregnancies in the intervention group appeared to have been more likely than those in the control group to be classified as "probably" or "possibly" ECP failures (12/74 in the intervention group vs. 1/74 in the control group; p=.012) and more likely to have occurred in the context of use of less efficacious contraceptives., Conclusion: Unrestricted access to ECPs in this trial may have increased the frequency of coital acts with the potential to lead to pregnancy.

This synopsis of teens and OTC access is part of a series of briefs on emergency contraception, which address the following issues as they relate to EC: Is emergency contraception safe? Is emergency contraception effective at preventing pregnancy? Does emergency contraception promote sexual risk-taking? Is emergency contraception cost-effective? Does emergency contraception cause abortion? The full series can be found at http://crhrp.ucsf.edu.

Background: The potential that ongoing contraception and emergency contraception (EC) offer to reduce unplanned pregnancy and abortion is diminished by many barriers. Even when women seek care, their acute needs for those interventions may not be assessed., Study Design: This is a retrospective chart review of charts of women potentially at risk for unplanned pregnancy who were provided care in an OB-GYN urgent care clinic in a tertiary care, training hospital. Information was collected about the patient's age group, her presenting complaint, the specialty of the resident who saw her and whether or not her needs for EC and ongoing contraception were assessed and/or met., Results: Charts of 1006 visits were assessed; the visits of 666 potentially at-risk women were included. Slightly more than one third (37.5%) of women were asked about contraception. Only 11% of women were asked about recent unprotected intercourse; 20% of women with recent unprotected intercourse were given EC., Conclusions: Even in centers dedicated to women's reproductive health, the acute need for fertility control and EC is not adequately assessed. Many opportunities to reduce unintended pregnancy are missed.

Objective: The objective of this work was to evaluate the acceptance, use and recall of an optional advance prescription for emergency contraception (EC)., Materials and Methods: This study used as randomized controlled trial evaluating contraceptive counseling intervention with women aged 16-44 years who were at risk for unintended pregnancy (N=737). Intervention participants (n=365) received contraceptive counseling with optional advance EC prescription. Control women (n=372) received no contraceptive or EC counseling. Among intervention participants, initial acceptance and use of EC in first 2 months were evaluated. Among all participants, differences were evaluated between recall of EC discussion and use of EC., Results: Among 365 intervention women, 336 received EC counseling and 51% of these 336 accepted advance EC prescription. At 2 months, among the women who had accepted EC, 6% had filled and used their prescription and 8% had filled but not used their prescription. At 12 months, intervention women were significantly more likely than controls to recall talking about EC (33% vs. 5%) and obtaining a prescription (38% vs. 6%), but there were no differences in the use of EC (6% vs. 6%)., Conclusion: When the option is available for EC counseling, approximately half of women accepted advance prescription for EC. However, few women who received information and/or an advance prescription remembered discussing EC, filled the prescription or used EC over 12 months.

Ethanolic extract of the root of Melia azedarach Linn. (family: Meliaceae) collected from the Institute campus intercepted pregnancy in 60% and 75% adult female rats when administered at 250 and 500 mg/kg daily doses, respectively, on Days 1-10 post-coitum by the oral route. On fractionation, the activity was localized in the chloroform fraction of the ethanolic extract, which showed 80-100% activity at 250 mg/kg daily dose in repeat tests. In animals that became pregnant, there was also a significant reduction in mean number of implantations and all the implantations exhibited signs of resorption. Of the four major compounds isolated in sufficient quantity and characterized from the active chloroform fraction, two compounds showed only marginal (50%) contragestational effect. Further exploration of the active chloroform fraction, which is also devoid of estrogen agonistic activity at the contraceptive dose in immature rat bioassay, is being undertaken to identify and characterize the active principle(s).

Ninety-four women attending a family planning clinic for emergency contraception (EC) were asked how certain they were of the date of their last menstrual period (LMP), of the timing of intercourse, and how many times in the cycle they had had sex. Urinary pregnanediol concentrations were analyzed in 64 women to assess whether they had ovulated before they used EC. Forty-five women were certain of the date of the LMP, the rest were not. Only four women could not accurately recall the timing of intercourse, and 60% had had intercourse more than once in the cycle. Twenty-one women had urinary pregnanediol concentrations that were inconsistent with their cycle day. Calculations of the efficacy of EC depend on knowing the timing of intercourse in relation to the estimated day of ovulation. The results of this study suggest that these calculations are likely to be inaccurate for a significant minority of women.

Emergency contraception (EC) refers to methods that women can use to prevent pregnancy after unprotected sexual intercourse, method failure, or incorrect use. There is growing worldwide acceptance and promotion of EC as a measure to reduce the level of unwanted pregnancies and, hence, unsafe abortions. The potential effect of EC in this regard could be most evident in sub-Saharan Africa. In Ghana, the Ministry of Health has since 1996 included EC in its reproductive health service policy and standards. The Planned Parenthood Association of Ghana is the only agency involved in the promotion of EC in the country. Very little is known about societal perception of EC. We undertook a study to assess knowledge and attitude toward EC among a sample of students at the University of Ghana. We used a two-page, self-administered questionnaire in a cross-sectional study among students chosen by random sampling. The aspects of EC assessed included level of knowledge, extent of use, common traditional methods of emergency contraception, as well as socially and culturally acceptable ways to promote EC in Ghana. We also assessed how the availability of EC could influence the use of condoms among male respondents. Less than half (43.2%) of the 194 respondents (88 males and 106 females) had heard of modern emergency contraceptive methods. Postinor-2, a dedicated emergency contraceptive product, which was already on the Ghanaian market, was known to 1.5% of respondents. Only 11.3% of respondents indicated correctly the recommended time within which emergency contraceptive pills (ECPs) are to be taken after unprotected sex. Taking concentrated sugar solutions, having an enema, and douching were commonly used traditional methods of EC. More than half (55.0%) of the male respondents indicated that they would either "certainly" or "probably" reduce how often they used condoms once they knew that EC was available. Almost all (97.4%) the respondents wanted to learn more about EC. The indications from this study are that the promotion of EC in Ghana is desired and must be encouraged. The fact that EC does not offer protection against sexually transmitted infections should always be emphasized.

Twenty-seven women requesting postcoital contraception were randomly allocated to take an ethinylestradiol/dl-norgestrel combination or danazol. Urine specimens were assayed for luteinising hormone (LH) and pregnanediol-3-glucuronide (P3G) levels from the day of the postcoital treatment to the next period. In addition, the urine samples of these recruits and 12 additional women were assayed for the Beta-subunit of human chorionic gonadotropin (B-hCG). A consistent pattern of alteration in urinary steroids was lacking, indicating a heterogeneous effect on ovarian function. There was no evidence of early pregnancy in successfully treated cases. We suggest that the main mechanism of action of these drugs is at the endometrial level.