The remaining barriers to the use of emergency contraception: perception of pregnancy risk among women undergoing induced abortions

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.

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