Strategies
used to enhance acceptability of emergency contraception
M.M. Lech
School of Public Health, National Postgraduate Center of Medical
Education, Warsaw, Poland
Abortion rates
in most European countries are unacceptably high [Russia – 1860 for 1000 live
births (1997), Hungary – 782 (1997), Lithuania – 518 (1999)]. Emergency
contraception [EC] is a type of the “last resort method” of the reduction of
the number of unplanned pregnancies and abortions. The EC use (with
levonorgestrel) during the first 72 hours after unprotected sexual intercourse
may decrease the risk of unwanted pregnancy by over 75%. This is a simple,
highly effective and not expensive method of reduction of unintended
pregnancies, especially in adolescent and teenagers girls.
In
some countries, in spite of the availability of EC methods, these methods are
the best-kept secrets of society. Some physicians and other persons who are not
familiar with the current state of knowledge often spread unproven information
about the mechanism of action of EC pills. The mechanism of action of hormones
in EC is still not completely known, but from this what is known EC has nothing
to do with an “early abortive pills”. It has been discovered that hormones used
in EC have effect on the migration and function of spermatozoas, they affect
ovulation but the effect on endometrium is rather doubtful. The patients’
beliefs concerning the mechanism of action of EC may have an important
influence on their individual decision. Some of them may not wish to use EC (as
a method which may harm the development of fertilized ova) because of ethical
reservations. There are also other barriers to use EC like lack of awareness in
general public and difficult access both to prescribers and pharmacies. Lack of
awareness is the result of ambivalent attitude policy makers to EC, lack or
failure of sexual education. There is also a lot of not used space for EC
social marketing.
Hormonal
products which are registered for EC are available in all European countries,
in several countries (Belgium, France, UK, Spain, Portugal, Norway, Sweden,
Finland, Switzerland) these products are registered for OTC in other countries
EC products are provided by special emergency contraception clinics. But what
is most important, it is the reliable information for general public and active
EC promotion in settings where young adults are likely to engage in casual and
risky sex. There is a big room for EC promotion and information in internet
(very popular medium for spread of information in young adult group). There is
also space for EC promotion in the community of health workers, there are
suggestions that European Society of Contraception should play active role in
this process and the Seminar entitled “From Biology to Emergency Contraception”
should be organized in the nearest future. The ECS and other international
organizations (IPPF, WHO, UNICEF, UNFPA) supposed to start the campaign for
treatment of EC products as an OTC products all over the Europe.