Feasibility and Acceptability of LNG 1.5 mg as an On‐Demand Pericoital Contraceptive in Ghana

Abstract

Globally, there is a need for more family planning method options as currently, available options do not adequately meet the needs of women, specifically those who have infrequent sex. Levonorgestrel (LNG) 1.5 mg is widely available as emergency contraception pills (ECP), and recent research has shown that certain women take it as their main form of contraception. Furthermore, limited studies have found repeat, on‐demand use safe and efficacious.This 12‐month prospective, single‐arm, interventional study in Ghana tested whether a single LNG 1.5 mg on‐demand or pericoital (“around the time of sex”) dose contraceptive was acceptable to women who have infrequent sex and if pharmacy provision was feasible. The study sample (1,890) comprised women of reproductive age recruited from urban areas, having infrequent sex (i.e., coital frequency ≤ 6× per month), and not using any other modern methods except condoms or ECP at the time of study inclusion.Results indicated that there is demand and acceptability for a pericoital pill and that pharmacy provision is feasible. Furthermore, precoital use of the pill had high levels of satisfaction and was popular with new users. Adding LNG 1.5 mg for pericoital use to the family planning method mix has the potential to address an important segment of the population currently underserved, decrease unwanted pregnancies, and increase modern contraceptive prevalence rates.

Acceptability of an on-demand pericoital oral contraceptive pill: a systematic scoping review

“…The current range of contraceptive options has enabled significant sexual and reproductive health progress but is unlikely to help us meet goals outlined in the UNSDGs and FP2030. This paper updates findings from a prior review [ 13 ] and complements findings from recent international studies that suggest that these on-demand pills can be efficacious [ 10 ], feasible [ 11 , 12 ], acceptable [ 10 – 12 ] and safe with limited side effects [ 10 – 12 ]. Our analyses – which privilege the socially and culturally located perspectives, preferences, needs and desires of women – indicate that introduction of an on-demand pericoital oral contraceptive pill could expand contraceptive choice for diverse women experiencing unmet need for modern contraception and constrained sexual and reproductive agency across international settings.…”

Acceptability of an on-demand pericoital oral contraceptive pill: a systematic scoping review

“…The current range of contraceptive options has enabled significant sexual and reproductive health progress but is unlikely to help us meet goals outlined in the UNSDGs and FP2030. This paper updates findings from a prior review [ 13 ] and complements findings from recent international studies that suggest that these on-demand pills can be efficacious [ 10 ], feasible [ 11 , 12 ], acceptable [ 10 – 12 ] and safe with limited side effects [ 10 – 12 ]. Our analyses – which privilege the socially and culturally located perspectives, preferences, needs and desires of women – indicate that introduction of an on-demand pericoital oral contraceptive pill could expand contraceptive choice for diverse women experiencing unmet need for modern contraception and constrained sexual and reproductive agency across international settings.…”

On-demand self-care products: a systematic scoping review of user perspectives

“…Costs were reported as influencing choices about whether to use daily or on-demand products. 17 , 19 , 21 , 23 , 26 , 28 , 29 , 31 , 34 , 37 , 47 , 48 Because of their as-needed nature, on-demand SRH products need to be easily accessible to users, which typically entails availability via the private sector (i.e. pharmacies, drug shops).…”

“…They remain important as sources of information, training on how to use products, for answering questions, dealing with side effects, and access to the products themselves. 18–21 , 31 , 48 , 49 Positive experiences with on-demand self-care and product provision may also form a trusting bridge to other longer-acting/more effective methods when and if people want these.…”

“…Methodologically, these papers used different study designs, reporting on research produced from qualitative ( n = 12), 17 , 19 , 26 , 29–31 , 33 , 37 , 39–41 , 47 quantitative ( n = 14), 20 , 23 , 27 , 28 , 32 , 34 , 35 , 38 , 42 , 44–46 , 48 , 49 and mixed methods ( n = 7) 18 , 21 , 22 , 24 , 25 , 36 , 43 studies.…”

“…Papers reported on research conducted in 20 countries across four WHO regions (see Figure 2 ): nine countries in Africa, including Benin, 22 Ghana, 47 , 48 Kenya, 46 , 49 Niger, 21 Nigeria, 46 South Africa, 20 , 29 , 33 , 36 , 43 Uganda, 17 , 30 , 33 , 36 Zambia, 47 and Zimbabwe; 30 , 33 , 36 , 43 four countries in Western Pacific, in Australia, 31 , 37 Cambodia, 39 Malaysia 34 and Vietnam; 38 four countries in Europe, in Belgium, 25 France, 27 the Netherlands, 26 and Ukraine; 23 three countries in the Americas, in Brazil, 41 Canada, 40 and the US. 18 , 19 , 24 , 28 , 32 , 35 , 42 , 45 There was variation in where research about each type of product was reported.…”

Acceptability of an on-demand pericoital oral contraceptive pill: a systematic scoping review

“…The current range of contraceptive options has enabled significant sexual and reproductive health progress but is unlikely to help us meet goals outlined in the UNSDGs and FP2030. This paper updates findings from a prior review [ 13 ] and complements findings from recent international studies that suggest that these on-demand pills can be efficacious [ 10 ], feasible [ 11 , 12 ], acceptable [ 10 – 12 ] and safe with limited side effects [ 10 – 12 ]. Our analyses – which privilege the socially and culturally located perspectives, preferences, needs and desires of women – indicate that introduction of an on-demand pericoital oral contraceptive pill could expand contraceptive choice for diverse women experiencing unmet need for modern contraception and constrained sexual and reproductive agency across international settings.…”

On-demand self-care products: a systematic scoping review of user perspectives

“…Costs were reported as influencing choices about whether to use daily or on-demand products. 17 , 19 , 21 , 23 , 26 , 28 , 29 , 31 , 34 , 37 , 47 , 48 Because of their as-needed nature, on-demand SRH products need to be easily accessible to users, which typically entails availability via the private sector (i.e. pharmacies, drug shops).…”

“…They remain important as sources of information, training on how to use products, for answering questions, dealing with side effects, and access to the products themselves. 18–21 , 31 , 48 , 49 Positive experiences with on-demand self-care and product provision may also form a trusting bridge to other longer-acting/more effective methods when and if people want these.…”

“…Methodologically, these papers used different study designs, reporting on research produced from qualitative ( n = 12), 17 , 19 , 26 , 29–31 , 33 , 37 , 39–41 , 47 quantitative ( n = 14), 20 , 23 , 27 , 28 , 32 , 34 , 35 , 38 , 42 , 44–46 , 48 , 49 and mixed methods ( n = 7) 18 , 21 , 22 , 24 , 25 , 36 , 43 studies.…”

“…Papers reported on research conducted in 20 countries across four WHO regions (see Figure 2 ): nine countries in Africa, including Benin, 22 Ghana, 47 , 48 Kenya, 46 , 49 Niger, 21 Nigeria, 46 South Africa, 20 , 29 , 33 , 36 , 43 Uganda, 17 , 30 , 33 , 36 Zambia, 47 and Zimbabwe; 30 , 33 , 36 , 43 four countries in Western Pacific, in Australia, 31 , 37 Cambodia, 39 Malaysia 34 and Vietnam; 38 four countries in Europe, in Belgium, 25 France, 27 the Netherlands, 26 and Ukraine; 23 three countries in the Americas, in Brazil, 41 Canada, 40 and the US. 18 , 19 , 24 , 28 , 32 , 35 , 42 , 45 There was variation in where research about each type of product was reported.…”

Acceptability of an on-demand pericoital oral contraceptive pill: a systematic scoping review

“…The current range of contraceptive options has enabled significant sexual and reproductive health progress but is unlikely to help us meet goals outlined in the UNSDGs and FP2030. This paper updates findings from a prior review [ 13 ] and complements findings from recent international studies that suggest that these on-demand pills can be efficacious [ 10 ], feasible [ 11 , 12 ], acceptable [ 10 – 12 ] and safe with limited side effects [ 10 – 12 ]. Our analyses – which privilege the socially and culturally located perspectives, preferences, needs and desires of women – indicate that introduction of an on-demand pericoital oral contraceptive pill could expand contraceptive choice for diverse women experiencing unmet need for modern contraception and constrained sexual and reproductive agency across international settings.…”

On-demand self-care products: a systematic scoping review of user perspectives

“…Costs were reported as influencing choices about whether to use daily or on-demand products. 17 , 19 , 21 , 23 , 26 , 28 , 29 , 31 , 34 , 37 , 47 , 48 Because of their as-needed nature, on-demand SRH products need to be easily accessible to users, which typically entails availability via the private sector (i.e. pharmacies, drug shops).…”

“…They remain important as sources of information, training on how to use products, for answering questions, dealing with side effects, and access to the products themselves. 18–21 , 31 , 48 , 49 Positive experiences with on-demand self-care and product provision may also form a trusting bridge to other longer-acting/more effective methods when and if people want these.…”

“…Methodologically, these papers used different study designs, reporting on research produced from qualitative ( n = 12), 17 , 19 , 26 , 29–31 , 33 , 37 , 39–41 , 47 quantitative ( n = 14), 20 , 23 , 27 , 28 , 32 , 34 , 35 , 38 , 42 , 44–46 , 48 , 49 and mixed methods ( n = 7) 18 , 21 , 22 , 24 , 25 , 36 , 43 studies.…”

“…Papers reported on research conducted in 20 countries across four WHO regions (see Figure 2 ): nine countries in Africa, including Benin, 22 Ghana, 47 , 48 Kenya, 46 , 49 Niger, 21 Nigeria, 46 South Africa, 20 , 29 , 33 , 36 , 43 Uganda, 17 , 30 , 33 , 36 Zambia, 47 and Zimbabwe; 30 , 33 , 36 , 43 four countries in Western Pacific, in Australia, 31 , 37 Cambodia, 39 Malaysia 34 and Vietnam; 38 four countries in Europe, in Belgium, 25 France, 27 the Netherlands, 26 and Ukraine; 23 three countries in the Americas, in Brazil, 41 Canada, 40 and the US. 18 , 19 , 24 , 28 , 32 , 35 , 42 , 45 There was variation in where research about each type of product was reported.…”