Emergency contraceptive use among 5677 abortion seeking women in Shanghai
Chun-Xia Meng (China), Kristina Gemzell (Sweden), Olof Stephansson (Sweden), Li-Nan Cheng (China)
Woman and Child Health Department, Division of Gynecology and Obstetrics, Karolinska University Hospital / Karolinska Institute, Stockholm, Sweden, and International Peace Maternity and Child Health Hospital / School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Introduction.Unintended pregnancy is a global reproductive health problem. Emergency contraceptive pill (ECP) provides women with a safe and convenient means of preventing pregnancy following unprotected sexual intercourse. Levonorgestrel only or low dose of mifepristone has recently emerged as the most effective ECP with a low rate of side effect and both are over-the-counter available in China. Discrepancy between the wide-spread use of ECP and large proportion of abortions indicates that how women use ECP may be a strong determinant of its final effect. Lack of understanding of fertility and concerns about its side effects may contribute to the underutilization of emergency contraceptive pill. This study aims to study the use of ECP among women seeking abortions and different demographic factors involved, as well as to explore the possible concerns for not using ECP.
Materials & Methods.A six-month cross-sectional survey was done by using face-to-face questionnaire interview among abortion seeking women in Shanghai, China. Respondents were asked about their experience in using ECP and from which source did they access ECP. The differences between ECP users and non-users regarding various demographic characteristics and their cited reasons for seeking abortion were analysed by using chi-square test. Respondents who had previously used ECP, but did not use it to try to prevent this current pregnancy were asked to state their reasons for non-use.
Results. A total of 5677 abortion seeking women aged between 15 to 48 years were recruited, among whom 48.8% are ECP users and 55.3% had experienced at least one abortion. Young, married, well-educated, nulliparous women were more likely to use ECP. Unawareness of the risk of pregnancy was the main reason for not using any contraceptive methods among abortion applicants who had never used ECP. Among 2773 women who had experience in emergency contraceptive use, 72.7% did not use it to try to prevent this current pregnancy, for which the major reason was not realizing the need to use ECP. Pharmacy was the preferable source to access ECP for the sake of convenience and privacy protection.
Conclusions. The large proportion of repeated abortions necessitates the sexual education to avoid unintended pregnancy. We need to find ways to raise people’s awareness of the high risk of pregnancy associated with non-use, incorrect or inconsistent use of contraception. Women of reproductive age should be well-informed of knowledge about and access to emergency contraceptive pill, which provides a “second-chance” to prevent an unwanted pregnancy. All reproductive health-care providers including pharmacists should be trained for family planning counselling with a special emphasis on emergency contraception.