Comprehensive knowledge of emergency contraception does not always result
in improved use of the method: evidence from women attending an unplanned
pregnancy clinic
E. Acha, N. Mullin
Highfield Clinic, Widnes, Cheshire, UK
Background: Emergency contraception (EC) provides a safe and effective
means of preventing at least 75% of expected pregnancies resulting from
unprotected sexual intercourse. Knowledge of emergency contraception is crucial
to its proper use. In the United Kingdom (UK) there is increasing awareness of
this method but estimates of use are low; and there were 175,600 abortions in
England and Wales in 2002.
Objectives: To discover the extent of knowledge and use of EC in women
attending a dedicated unplanned pregnancy clinic.
Design and method: A review of the literature suggested that we could
expect 20% of women to have correct knowledge of EC. An anonymous questionnaire
was offered to all women attending for their appointment at the clinic and it
was completed in the waiting room prior to the consultation.
Results: There was a 100% response rate (222 women). We found 39%
(87/222) were under age 20 and over two-thirds (77%, 171/222) of the group
described themselves as single. Of the women, 97% (215/222) admitted being aware
of EC and 65% (116/178) knew the correct time frame for use (within 3 days);
however, 44 respondents did not answer this particular question. We found 68%
(152/222) of the sample were using contraception at the probable time of
conception, when 40% (89/222) were aware of a failure of their regular method or
unprotected sexual intercourse occurred in barrier contraception users. Very few
of this alerted group obtained EC (17%, 15/89) and no-one else in the sample
admitted using it. So, only 6.8% (15/222) of the whole sample obtained EC on
this occasion even when 58% (128/222) had used EC previously.
Conclusion: The majority of women attending the unplanned pregnancy
clinic had heard of EC, knew how to use it correctly and could all give examples
of where to obtain EC. However, only a tiny proportion of this group of women
actually took EC, even when over half of them recognised a possible or actual
failure of their contraceptive method and risk of pregnancy. The decision making
process influencing a woman’s use of EC is obviously complex, with more than
just factual knowledge being important. Advance prescribing may be one possible
solution to improve accessibility of EC and may increase effective use of EC.
