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IntroductionOral emergency contraception (EC) can prevent unintended pregnancy but it is important to start a regular method of contraception. Women in the UK usually access EC from a pharmacy but then need a subsequent appointment with a general practitioner or a sexual and reproductive health (SRH) service to access regular contraception. Unintended pregnancies can occur during this time.Methods and analysisBridge-It is a pragmatic cluster randomised cohort cross-over trial designed to determine whether pharmacist provision of a bridging supply of a progestogen-only pill (POP) plus rapid access to a local SRH clinic, results in increased uptake of effective contraception and prevents more unintended pregnancies than provision of EC alone. Bridge-It involves 31 pharmacies in three UK regions (London, Lothian and Tayside) aiming to recruit 626–737 women. Pharmacies will give EC (levonorgestrel) according to normal practice and recruit women to both intervention and the control phases of the study. In the intervention phase, pharmacists will provide the POP (desogestrel) and offer rapid access to an SRH clinic. In the control phase, pharmacists will advise women to attend a contraceptive provider for contraception (standard care).Women will be asked 4 months later about contraceptive use. Data linkage to abortion registries will provide abortion rates over 12 months. The sample size is calculated on the primary outcome of effective contraception use at 4 months (yes/no) with 90% power and a 5% level of significance. Abortion rates will be an exploratory secondary analysis. Process evaluation includes interviews with pharmacists, SRH clinicians and women. Cost-effectiveness analysis will use a healthcare system perspective and be expressed as incremental cost-effectiveness ratio.Ethics and disseminationEthical approval was received from South East Scotland REC June 2017. Results will be published in peer-reviewed journals and conference presentations.Trial registration numberISRCTN70616901.

This study investigated the knowledge, awareness, and use of emergency contraceptives (ECs) among female Senior High School students in the Akuapem South Municipality of Ghana, guided by the Theory of Planned Behaviour (TPB). A cross-sectional quantitative design was employed, surveying 300 students from two schools. Data were collected using a structured, self-administered questionnaire and analyzed with descriptive statistics and regression models. Results showed while awareness of ECs was high (98%), its actual use was moderate (50%). Attitude (p<0.001) and subjective norms (p<0.001) significantly predicted intention, while perceived behavioural control (p<0.005) predicted actual use of emergency contraceptives. Mean construct scores reflected positive attitudes (M=3.9), low subjective norms (M=2.7), moderate perceived control (M=3.5), weak intentions (M=2.8), and low reported behaviour (M=2.6). Cultural, religious, and moral concerns were major deterrents to EC use. The findings highlighted the need for culturally sensitive interventions to: bridge the gap between awareness and effective use of ECs, that would help reduce unintended pregnancies among students (including adolescents) in Ghana. Cette étude a examiné les connaissances, la sensibilisation et l'utilisation des contraceptifs d'urgence (CU) chez les lycéennes de la municipalité d'Akuapem Sud, au Ghana, en s'appuyant sur la théorie du comportement planifié (TCP). Une étude transversale quantitative a été menée auprès de 300 élèves de deux établissements scolaires. Les données ont été recueillies à l'aide d'un questionnaire structuré auto-administré et analysées par des statistiques descriptives et des modèles de régression. Les résultats ont montré que si la sensibilisation aux CU était élevée (98 %), leur utilisation réelle était modérée (50 %). L'attitude (p < 0,001) et les normes subjectives (p < 0,001) prédisaient significativement l'intention, tandis que le contrôle comportemental perçu (p < 0,005) prédisait l'utilisation réelle des contraceptifs d'urgence. Les scores moyens des construits reflétaient des attitudes positives (M = 3,9), de faibles normes subjectives (M = 2,7), un contrôle perçu modéré (M = 3,5), de faibles intentions (M = 2,8) et un faible taux d'utilisation déclarée (M = 2,6). Les préoccupations culturelles, religieuses et morales constituaient des freins majeurs à l'utilisation de la contraception d'urgence. Les résultats ont mis en évidence la nécessité d'interventions adaptées au contexte culturel afin de combler le fossé entre la sensibilisation et l'utilisation effective de la contraception d'urgence, contribuant ainsi à réduire les grossesses non désirées chez les élèves (y compris les adolescentes) au Ghana.

Emergency contraceptives are used within 72 hours after unprotected sexual intercourse to prevent unwanted pregnancy. Although emergency contraceptives are widely available in Ethiopia, termination of pregnancy remains a public health problem indicating low uptake of emergency contraceptives after unprotected sexual intercourse. This study aimed to assess utilization and determinants of emergency contraceptives among women seeking termination of pregnancy in Northwest Ethiopia. An institutional-based cross-sectional study was carried out, supplemented by phenomenologically approached in-depth interviews. Systematic random sampling was used to select study participants. A structured questionnaire and an in-depth interview guide were used to collect data. Data were entered by EPI-info and analyzed through SPSS version 23 to conduct logistic regressions. Thematic analysis was used to conduct qualitative interpretation. Almost one-fifth (78; 19.2%) of the study participants used emergency contraceptives to prevent their index pregnancy. Women who had secondary education (aOR 3.28; 95% CI 1.59, 6.79) and women who had no living children (aOR 4.52; 95% CI 1.40, 14.57) had a positive significant association with emergency contraceptive utilization. On the other hand, women who did not discuss contraceptives with their sexual partner (aOR 0.49; 95% CI 0.27-0.91) and women without a history of abortion (aOR 0.45; 95% CI 0.24-0.97) had a negative significant association with emergency contraceptive utilization. There is relatively low utilization of emergency contraception among pregnancy terminating women. Reproductive health programs should encourage women discussion with their partners about emergency contraceptives to decrease occurrence of unwanted pregnancy and termination of pregnancy.

Background Proper use of emergency contraception can reduce unintended pregnancy and the risk of abortion. Despite this fact, there is a high rate of unwanted pregnancies among adolescents in Ethiopia. Therefore, determining the level of knowledge and use of Emergency contraceptives (EC) among female youth is important. Objective To assess Knowledge and use of EC methods and their associated factors among female college students in Gondar City, Northwest Ethiopia, 2023. Methods Institution-based cross-sectional study was employed among 814 female college students in Gondar City from April 15 to 28, 2023. A multi-stage sampling technique was applied to select the study participants. A self-administered questionnaire was used to collect the data. Epi-data version 4.6 and STATA Version 16, respectively, were used for data entry and analysis. A logistic regression model was fitted to identify factors associated with the outcome variables. Statistical significance was defined at a p -value < 0.05 and a corresponding 95% confidence interval. Result In this study, 46.2% [95% CI (42.78, 49.63%)] of the participants had adequate knowledge about EC and 26.1% [95% CI (22.82–29.74%)] of sexually active participants used EC. Muslim religion [AOR = 1.82: 95% CI (1.07, 3.09)], being single [AOR = 0.34: 95% CI (0.19, 0.63)], no discussion about reproductive health issues with their husband/partner [AOR = 0.43: 95% CI (0.27, 0.69)], year of study; second year [AOR = 1.63: 95% CI (1.03, 2.58)], third year [AOR = 1.80: 95% CI (1.11, 2.94)], and fourth-year students [AOR = 2.91: 95% CI (1.43, 5.96)] were significantly associated with knowledge about EC. While no discussion about reproductive health with their husband/partner [AOR = 0.09: 95% CI (0.04, 0.20)], monthly allowance [AOR = 3.03: 95% CI (1.54, 5.95)], perceive use emergency contraceptives as not a sin [AOR = 2.59: 95% CI (1.20, 5.60], knowledge about EC [AOR = 2.32: 95% CI (1.253, 4.29)] were associated with the use of EC. Conclusions Participants’ knowledge and of use EC in the study area was low. Religion, years of study, marital status, monthly allowance, perception and knowledge, and having discussion were associated with the use of EC. School-based health education, and behavioral change communication interventions should be established and/or strengthened to address students in need of EC services.

Background Unintended pregnancy is a major public health problem in sexually active female students in Ethiopia. In higher education, female students are exposed to unprotected sex and are at risk of pregnancy, abortion, and its associated problems. Objective The objective of this study was to assess knowledge of female students about emergency contraceptives and determine factors associated with utilization among college female students at Bonga College of Education, Southwest Ethiopia. Methods The study was conducted from November 10, 2022 to May 30, 2023. All female students of Bonga College of education in all departments were included in this study purposively. Data were collected using Amharic version pretested questionnaire. Data obtained from the survey was entered into Microsoft Excel 2010 and analysed with SPSS version 20.0. Data summary was done with descriptive statistics. Logistic regression was used to measure associations between dependent and independent variables. Odds ratio was used to measure strengths of association between variables. Statistical significance was considered at 95% confidence level (CL). P -value less than 0.05 was considered significant during the analysis. Results In this study a total of 103 College female students were involved. The mean age of the respondents was 20.6 (SD ± 2.06) years. The finding showed that 31 (31.1%) female students had started sexual intercourse and among them 58.1% faced pregnancy. Among the total sexually experienced respondents, 93.5% use contraceptive methods while others 6.5% do not use. Among the total 31 study participants, 27(87.1%) started using EC. The majority of pregnancy (83.3%) was intended type whereas 16.7% was unwanted pregnancy. Regarding the general knowledge about contraceptive methods, 19(18.4%) had poor knowledge. Among the total 103 female college students, 66(64.1%) heard about emergency contraceptives. Forced sex and unprotected free sex are predicting factors that induces female students to use emergency contraceptives. Fear of discontinuing school was the main inducing factor to commit abortion. Logistic regression analysis showed that college female students whose age category above 25 years were more likely to use emergency contraceptives. Students who came from urban area are more likely to use EC than rural areas. Married female students (AOR = 2.5, 95% CI: 0.76, 8.7) were two times likely to use EC as contraceptive method. Conclusions Female students who came from urban area use EC better than who came from rural areas. Majority of sexually active female students had good practice and knowledge of using EC but some had poor knowledge. Forced sex and free sexual practice are key determinant factors that induces to use EC. Abortion was mainly done in private clinic. Fear of discontinuing school was determinant factors identified to commit abortion. Therefore, responsible bodies should develop strategies to improve female students’ reproductive health related to emergency contraceptives.

Background Proponents of abortion restriction cite advancements in contraceptive technology as a reason against the need for abortion care today, most recently through oral arguments in the Supreme Court of the United States case, Dobbs v. Jackson Women’s Health. However, consistent and correct use of contraception requires reproductive health literacy. Our objectives were to quantify contraceptive risk events and assess contraceptive history and preferences among a population well-equipped to evade contraceptive risks, family planning specialists following initiation of their medical training. “Risk events” are defined as reported episodes of contraceptive failure, emergency contraception use and/or unprotected or underprotected intercourse. Methods This was a cross-sectional study among current members of a professional organization of family planning specialists. Inclusion criteria included: status as a current or retired clinician, consensual penile-vaginal intercourse and personal or partner capacity to become pregnant since the start of medical training. Descriptive statistics were performed. This study was IRB exempt. Results Among 229 respondents, 157 (69%) reported experiencing a contraceptive risk event since training. Twenty-nine (13%) respondents reported an occurrence within the last year. By category, 47% (108/229; 3 reported unknown) reported under- or unprotected intercourse, 35% (81/229) reported emergency contraception use, and 52% of participants (117/227; 2 unknown) reported known or suspected contraceptive failure. The mean number of contraceptive methods used was 3.7 (SD 1.7) out of the 13 methods listed. Almost all (97%) participants reported at least one method was not an acceptable option, with a mean of 5.6 (SD 2.7) of the 13 listed methods. Conclusions The majority of family planning specialists have experienced contraceptive risk events during times of active pregnancy prevention since their medical training. Contraceptive method change is common and most respondents were limited in the number of methods that were personally acceptable to them. Dialogue idealizing the role of contraception in minimizing or eliminating abortion need is simplistic and inaccurately represents the lived realities of pregnancy-capable individuals and their partners, including among those with exceptional contraceptive literacy and access. Plain English Summary Since Dobbs v. Jackson, the landmark Supreme Court of the United States case overturning the right to abortion, it is very important to better understand current birth control use and the risk of unintended pregnancy. While birth control helps people to avoid unintended pregnancy, current methods are not perfect. This study examined the limitations of current birth control, even when used by expert clinicians with special knowledge and access. We provided an online survey to doctors and advanced practice clinicians who specialize in birth control. We measured risk of unintended pregnancy by asking about experiences with birth control failure, emergency contraceptive use (such as plan B), and unprotected sex since the start of medical training. We also asked about reasons for changing or avoiding certain birth control methods. Among 229 expert clinicians, we found that nearly 70% had experienced a risk of unintended pregnancy since beginning their medical training. Birth control method change was common, and many reported that several options were unacceptable. Participants shared that they found methods difficult, unreliable, unpleasant, or had health conditions that limited the number of safe options available. Our findings suggest that, even among experts, everyone remains at risk of unintended pregnancy. The study highlights the need for improved birth control options as well as access to safe and legal abortion.

ObjectiveTo describe patterns of oral emergency contraception (EC) orders among users of a free service, commissioned by the UK National Health Service, ordered online and delivered by post.Study designRoutinely collected anonymised data from an online sexual health service in the UK from 1 January to 31 December 2023 were analysed. The number of times EC was ordered and prescribed was calculated and the age and level of deprivation assigned to the postcode where the user resided were extracted. Individual time lines were developed for those prescribed more than 10 times in 12 months.ResultsDuring 2023 there were 32 659 oral EC requests from 19 501 users, resulting in 29 073 prescriptions from 17 576 users. Ulipristal acetate (UPA) was prescribed in 90% of the orders. The majority of users (n=12 238; 69.63%) received EC once a year, 5237 (29.80%) received it more than once and 101 (0.57%) received it more than 10 times. The mean (SD) number of prescribed orders per user was 1.65 (1.49) and the highest was 29. Oral EC had been used in the previous week by 794 of the 17 576 users (4.5%) and nine (0.05%) were prescribed more than 150 mg of UPA in 30 days.ConclusionsA small group of people order EC repeatedly, sometimes within the same cycle, putting them at increased risk of pregnancy. A minority of people order doses of UPA of >150 mg in 30 days.

ObjectiveTo determine whether increasing the dose of ulipristal acetate (UPA)-containing emergency contraception (EC) improves pharmacodynamic outcomes in individuals with obesity.Study designWe enrolled healthy, regularly-cycling, confirmed ovulatory, reproductive-age individuals with body mass index (BMI) >30 kg/m2 and weight >80 kg in a randomised crossover study. We monitored participants with transvaginal ultrasound and blood sampling for progesterone, luteinising hormone (LH), and estradiol every other day until a dominant follicle measuring >15 mm was visualised. At that point, participants received either oral UPA EC 30 mg or 60 mg and returned for daily monitoring up to 7 days. After a no treatment washout cycle, participants returned for a second monitored cycle and received the other UPA dose. Our primary outcome was the proportion of subjects with no follicle rupture 5 days post-dosing (yes/no). For reference, we also enrolled a control group with BMI <25 kg/m2 and weight <80 kg who received UPA EC 30 mg during a single cycle. We also obtained blood samples for pharmacokinetic parameters for UPA and its active metabolite, N-monodemethyl-UPA (NDM-UPA) as an optional substudy.ResultsWe enrolled a total of 52 participants with BMI >30 kg/m2 and 12 controls, with the following cycles completed: 12 controls, 49 UPA 30 mg, and 46 UPA 60 mg. The entire cohort demographics were a mean (SD) age of 29.8 (3.4) years and BMI by group: controls 22.5 (1.4) kg/m2, group 1 37.9 (6.7) kg/m2, and group 2 39.3 (5.4) kg/m2. All 12 (100%) of controls had a delay of at least 5 days for follicle rupture. Among the high BMI group, dosing groups (UPA EC 30 mg vs 60 mg) were similar in the proportion of cycles without follicle rupture over 5 days post-UPA dosing (UPA 30 mg: 47/49 (96%), UPA 60 mg: 42/46 (91%), Fisher’s exact test p=0.43). However, after excluding cycles where dosing occurred too late (after LH surge), a delay of at least 5 days occurred in all participants at both doses. The 60 mg UPA dose resulted in a twofold increase in maximum observed concentration and the area under the curve of both UPA and NDM-UPA levels compared with 30 mg.ConclusionA standard 30 mg dose of UPA is sufficient to delay ovulation regardless of BMI or weight. Results of our study do not support dose adjustment for body size.

To examine the associations of recent intimate partner violence (IPV) and reproductive coercion (RC) with frequency of use of reproductive and sexual health services, a cross-sectional survey was administered to 16–29 year old women seeking care in five family planning clinics (n = 1,262). We evaluated associations of recent experiences of IPV, RC, or both IPV and RC with recent care seeking for pregnancy testing, emergency contraception, and sexually transmitted infection testing using multinomial logistic regression. Sixteen percent of respondents reported IPV and 13.5 % reported RC in the past 3 months. Four percent of all respondents reported both IPV and RC. Recent RC without IPV was associated with increased odds of seeking one (AOR = 2.0, 95 % CI 1.3–2.9) or multiple pregnancy tests (AOR = 2.3, 95 % CI 1.2–4.5), multiple STI tests (AOR = 2.5, 95 % CI 1.5–4.1), or using emergency contraception once (AOR = 2.6, 95 % CI 1.2–5.8) or multiple times (AOR = 2.2, 95 % CI 1.7–2.7). Recent IPV without RC was associated with increased odds of seeking one (AOR = 1.4, 95 % CI 1.1–1.7) or multiple pregnancy tests (AOR = 2.2, 95 % CI 1.4–3.2) and using emergency contraception once (AOR = 1.6, 95 % CI 1.3–2.0). The combined effect of recent IPV and RC increased the odds of seeking multiple pregnancy tests (AOR = 3.6, 95 % CI 3.3–3.8), using emergency contraception multiple times (AOR = 2.4, 95 % CI 1.5–4.1) and seeking STI testing once (AOR = 2.5, 95 % CI 1.6–3.9) or multiple times (AOR = 2.9, 95 % CI 1.02–8.5). Frequent requests for pregnancy and STI testing and emergency contraception among young females seeking care may be an indicator of greater risk for recent RC, alone and in combination with IPV.