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ObjectiveTo synthesise evidence around over-the-counter (OTC) emergency contraceptive pills (ECPs) to expand the evidence base on self-care interventions.DesignSystematic review (PROSPERO# CRD42021231625).Eligibility criteriaWe included publications comparing OTC or pharmacy-access ECP with prescription-only ECPs and measuring ECP uptake, correct use, unintended pregnancy, abortion, sexual practices/behaviour, self-efficacy and side-effects/harms. We also reviewed studies assessing values/preferences and costs of OTC ECPs.Data sourcesWe searched PubMed, CINAL, LILACS, EMBASE, clinicaltrials.gov, WHO International Clinical Trials Registry Platform, Pan African Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, Cochrane Fertility Regulation and International Consortium for Emergency Contraception through 2 December 2020.Risk of biasFor trials, we used Cochrane Collaboration’s tool for assessing risk of bias; for other studies, we used the Evidence Project risk of bias tool.Data extraction and synthesisWe summarised data in duplicate using Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence Profile tables, reporting findings by study design and outcome. We qualitatively synthesised values/preferences and cost data.ResultsWe included 19 studies evaluating effectiveness of OTC ECP, 56 on values/preferences and 3 on costs. All studies except one were from high-income and middle-income settings. Broadly, there were no differences in overall ECP use, pregnancy or sexual behaviour, but an increase in timely ECP use, when comparing OTC or pharmacy ECP to prescription-only ECP groups. Studies showed similar/lower abortion rates in areas with pharmacy availability of ECPs. Users and providers generally supported OTC ECPs; decisions for use were influenced by privacy/confidentiality, convenience, and cost. Three modelling studies found pharmacy-access ECPs would lower health sector costs.ConclusionOTC ECPs are feasible and acceptable. They may increase access to and timely use of effective contraception. Existing evidence suggests OTC ECPs do not substantively change reproductive health outcomes. Future studies should examine OTC ECP’s impacts on user costs, among key subgroups and in low-resource settings.

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

L’Engle

Hinson²,

Chin-Quee³

2011

J Fam Plann Reprod Health Care

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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...

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Abstract: Future educational efforts among Jamaican and Barbadian health care providers should emphasize the safety and proper use of emergency contraceptive pills, as well as the need to increase the availability of the method.

Cited by 11 publications

References 5 publications

Health workers’ values and preferences regarding contraceptive methods globally: A systematic review

Health workers’ values and preferences regarding contraceptive methods globally: A systematic review

Over-the-counter provision of emergency contraceptive pills: a systematic review

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

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