The remaining barriers to the use of emergency contraception: perception
of pregnancy risk among women undergoing induced abortions
C. Moreau, J. Bouyer, H. Goulard, N. Bajos
National Institute of Health & Medical Research INSERM-INED U569/IFR
69, Le Kremlin Bicêtre, France
Objective: The purpose of this study is to assess the remaining
barriers of emergency contraception (EC) use in a context of expanded access (available
over the counter) and high awareness about EC, in a population of women
presenting for pregnancy termination. Particular attention will be drawn on the
impact of unperceived pregnancy risk, rarely explored in such a context.
Population & methods: The study was conducted between June and
November 2002 in four abortion centres in France. Altogether, 1365 women
requesting an abortion (response rate 90.2%) completed a 10 minute self
administrated questionnaire at the abortion clinic. The questionnaire collected
information on women’s social demographic characteristics, the circumstances
that led to the current pregnancy, awareness of pregnancy risk, knowledge and
use of EC.
Results: Whereas most women had heard of EC before (89%), access to
information remained limited in socially disadvantaged populations. Also, a
majority of women (68%) lacked information about the conditions of use of the
method. Nevertheless, our results suggest that the unperceived risk of pregnancy
may be the most important limiting factor for EC use. Only 38.5% of women in our
study were aware of pregnancy risk at the time of the intercourse that made them
pregnant. Perception of pregnancy risk was mostly dependent on the type of
contraception used around the time of conception. Women using the pill or
periodical abstinence were less aware of pregnancy risk than others. Conversely,
women living alone, those without children or with a high educational level were
more likely to be aware of pregnancy risk than others. Risk perception is a
complex phenomenon, likely to be re-evaluated by women over time. Thus, among
women who thought they were at risk of pregnancy at the time of the intercourse
that made them pregnant, 41% re evaluated the risk, which resulted in the
decision not to use EC. In our study, 33% of women met the three conditions for
EC use (unintended pregnancy, knowledge of EC, recognised risk of pregnancy).
Among these women, 25% used EC to try to prevent the current pregnancy. Assuming
a 74% effectiveness rate of EC, approximately 18% of abortions in our study
could have been avoided by using EC.
Conclusion: Beyond easy access to emergency contraception, more
information about the conditions of use of the method seems necessary to improve
its utilisation. However, unperceived pregnancy risk may be the most important
barrier to EC use. As the perception of risk is commonly re evaluated by women,
which probably impacts on its use, it could be important to promote advance
supply of EC, as a medication women could use immediately after a recognised
unprotected intercourse.