“I love my ECPs”: challenges to bridging emergency contraceptive users to more effective contraceptive methods in Ghana: Table 1

Abstract

Background and methods Emergency contraceptive pills (ECPs) are becoming more popular, yet little is known about the contraceptive preferences of women who take ECPs. Women purchasing ECPs were recruited from pharmacies in Accra, Ghana. A total of 24 semi-structured, qualitative interviews were conducted in May 2008. Results Nearly all participants preferred ECPs to other contraceptive methods. Although fear of side effects from oral contraceptive pills (OCPs), intrauterine devices and injectables were deterrents to use of those methods, side effects from ECPs were acceptable to this small and highly self-selected group of ECP users. Participants had little knowledge about how other contraceptive methods work and expressed a strong distrust and dislike of condoms. Discussion and conclusion Study participants loved their ECPs, despite minor discomforts like bleeding, and most had no concerns about repeated use, though these fi ndings may not apply to women outside Accra or women who obtain ECPs from non-pharmacy settings. Future interventions should work to dispel myths about OCPs, condoms and other modern methods, and focus on basic contraception education.Emergency contraceptive pills (ECPs) represent a small but growing segment of the contraceptive market. Recent availability of emergency contraception (EC) products in the private sector has fuelled interest in ECPs as an important contraceptive option for women. ECPs are currently underutilised, 1 2 but private sector promotion in pharmacy settings, coupled with preliminary data indicating increased demand, suggest that ECPs will become increasingly important as an alternative contraceptive option for women and couples. [3][4][5] ECPs are recommended to avoid unwanted pregnancy when no contraceptive has Article effects than other hormonal contraceptive methods, and frequent use of ECPs is likely to lead to a higher incidence of side effects and a higher total hormone intake than other hormonal contraceptive methods. 11Furthermore, most contraceptive options cost less than ECPs (Research International/Ghana, personal communication, May 2008).Given the drawbacks of ECPs and the availability of other options, it may be beneficial for some ECP users to switch to contraceptive methods that are more effective and possibly safer for long-term use -a transition known as 'bridging'.12 Successful bridging of ECP users to more effective contraception, however, is dependent on understanding the reasons women choose ECPs beyond use in emergency situations, and women's acceptance of a longer-term contraceptive method. The goal of this formative research study was to investigate the potential for bridging ECP users who purchase the product in pharmacies to longer-term contraception. MethodsData for the current study were collected in May 2008 in Accra, Ghana during the formative research phase of a larger intervention study. The intervention was designed to target ECP users in pharmacies, and transition them to OCPs through the provision of two free cycles of OCPs a...

Emergency contraceptive use in Addis Ababa, Ethiopia: Challenging common assumptions about young people’s contraceptive practices

“…This builds on findings in other sub-Saharan African countries that young people's EC use is disconnected from prescribed use. [2][3][4] The findings provide insights into the features of contraceptive methods that young people consider highly desirable and question common assumptions held by reproductive health experts about young people's contraceptive practices.…”

“…[2][3][4] This raises the question of whether existing contraceptive technologies meet the needs of young people engaged in premarital sex. Emergency contraceptives are unique in offering discreetness, ease of use, and minimal (perceived) negative effects on future fertility and physical appearance, and these characteristics should guide the development of new contraceptive methods for young, unmarried people.…”

“…6 In sub-Saharan Africa, women using ECs have repeatedly been portrayed as irresponsible by service providers and the local press. 2,3,8,9 The disconnect between envisioned and actual use has been noted for other contraceptives as well. When contraceptive technologies are developed, they are inscribed with "specific competences, actions, and responsibilities" about envisioned users.…”

“…Repeat users claim that ECs fit their everyday lives because they are convenient in situations where they have infrequent sex, the number of pills is small and they do not experience disturbing side effects. [1][2][3][4] In contrast, reproductive health experts, while acknowledging that ECs can be taken safely as often as needed, do not recommend them for regular use because they are less effective than other contraceptive methods and frequent use can result in menstrual irregularities. 5 ECs are intended and marketed as a "back-up" method to be used after unprotected intercourse, when other contraceptives have failed (for example, after breakage or slippage of condoms), after incorrect use of contraceptives (for example, after having missed one or more regular contraceptive pills), or after being forced or coerced into having unprotected intercourse.…”

Misperceptions, misinformation and myths about modern contraceptive use in Ghana

“…Fear of side effects, especially those perceived to impair fertility, remain the leading cause of non-use of modern contraception in Ghana based on the Demographic and Health Survey (DHS)12 and other sources 14 15. Fear of side effects increased in importance as a reason for non-use from 18% in 1998 to 26% in 2003 and 2008 12.…”