Despite widespread belief that emergency contraception is necessary to reduce levels of unintended pregnancy, almost half of more than 400 health care providers surveyed in Jamaica and Barbados have at some point refused to provide the method to women seeking it. The reasons they gave for refusing the method to eligible women revealed their misperceptions about the overall safety of emergency contraception, negative attitudes toward the method and lack of supplies.
Although nearly all surveyed providers had heard of the method, a majority of the health care providers mistakenly believed there are medical reasons not to dispense emergency contraception to some patients, such as women with thromboembolic disease or liver disease, breast-feeding women and smokers older than 35, though use of the method would not pose a risk to such women. Moreover, two out of five Jamaican and one in four Barbadian providers had refused a woman access to the method because she had recently used it, though there is no medical evidence that women should not use emergency contraception as often as necessary. Given that more than 30% of providers cited lack of availability as a reason for having refused to provide emergency contraception to women, inadequate supplies in pharmacies and clinics may be restricting Caribbean women’s timely access to the method.
Though recent studies suggest that emergency contraception can prevent pregnancy for up to 120 hours after intercourse, the percentage of Jamaican and Barbadian providers who knew this was extremely low. Further, 29% in Barbados and 13% in Jamaica believed the method is effective only within 24 hours of intercourse. These findings suggest that providers may be denying access to women they mistakenly believe cannot benefit from the method.
More than half of health care providers surveyed held negative attitudes about emergency contraception, such as the belief that the method encourages sexual risk-taking and that access to the method leads to an increase in STIs. In both countries, pharmacists and nurses held more conservative attitudes than did obstetrician-gynecologists and general practitioners. These providers, the authors suggest, may be less exposed than doctors to scientific literature on the safety and effectiveness of emergency contraception. In addition, few emergency contraception educational efforts have targeted nurses in either country, which may also contribute to their negative and erroneous beliefs.
In Jamaica, providers tended to be more accepting of emergency contraception, perhaps because Jamaica has offered it without a prescription since 2003. For example, 44% of providers in Jamaica supported advance provision and 66% supported dispensing the method to minors without parental consent; in Barbados, those figures were 7% and 30%. In both countries, relatively small percentages of providers approved supplying emergency contraception to any woman regardless of her circumstances (26% in Jamaica and 18% in Barbados). However, a large majority of providers in both countries supported access to emergency contraception for rape victims (90% in Jamaica and 84% in Barbados).
On the basis of these findings, the authors recommend better training and education for Jamaican and Barbadian providers―in particular nurses―on the safety and effective use of emergency contraception. Education programs should emphasize the necessity of timely access for pregnancy prevention. Efforts are also needed to ensure adequate supplies of emergency contraception throughout both countries.
“Jamaican and Barbadian Health Care Providers’ Knowledge, Attitudes and Practices Regarding Emergency Contraceptive Pills,” by Eileen A. Yam of Population Council, et al., appears in the December 2007 issue of International Family Planning Perspectives.
Also in this issue:
“Correlates of Premarital Relationships Among Unmarried Youth in Pune District, Maharashtra, India,” by Mallika Alexander et al.
“Prevalence of and Risk Factors for Sexual Victimization in College Women in Chile,” by Jocelyn A. Lehrer et al.
Comment: “Family Planning Policies and Their Impacts on the Poor: Peru’s Experience,” by James N. Gribble et al.
Special Report: “Introducing Sustainable Vasectomy Services in Guatemala,” by Ricardo Vernon et al.