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Glossary:

EC: Emergency Contraception

OCP: Oral Contraceptive Pill

LARC: Long Acting Reversible Contraception

LNG: Oral Levonorgestrel

IUD: Intrauterine Device UPA: Ulipristal Acetate

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Overview:

This project was especially important for me to do further research on because not many women in the world know the different options they have when it comes to contraception methods and not many have the financial resources to be able to obtain certain types of contraceptives depending on their financial situation and what is readily available to them. In which it was shown from a study about emergency contraception that “Providers are often unaware of the range of EC options or are unsure of how to counsel patients regarding the access and use of EC” (Batur et al., 2016). Some also prefer different methods over others and with that, sometimes they don’t know how each one affects them individually and their satisfaction with each one, and this can be seen from women all over the world. 

After further research, I learned how controversial but important this is to a wide variety of women, not only just locally, but globally. For my project specifically, I looked at experiences and satisfaction levels from women in places such as Kenya in two slum communities one in a urban site known as Nairobi Slums and the other in a rural site known as Homa Bay in Western Kenya, listings of pharmacies via Google Business for five municipalities across southern and eastern Louisiana: New Orleans, Baton Rouge, Lafayette, Monroe, and Houma, women from Galway city, west of Ireland and from Turkey and Jamaica. 

It is also important to note that there are many unintended pregnancies in the United States, and with that, women having multiple and complete access to contraception methods and emergency contraception will allow women to feel like they have a choice and are protected in case of a pregnancy which can happen in multiple ways such as contraceptive method failure, unprotected sex, or even in worst cases such as sexual assault.

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Birth Control ad's

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Birth Control ad's

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“Women’s Socioeconomic Status and Choice of Birth Control Method: An Investigation for the Case of Turkey.”

This article aims to identify a woman’s social and economic status and how it impacts their behavior on birth control compared to modern methods and traditional methods in Turkey. The factors used to determine this was by looking at education level, urban/rural residence, determinants of contraceptive use varied across college educated/ non-college-educated women. The authors looked at how important fertility is and it relates to the costs and accessibility of fertility and use of contraceptives. 

 In order to determine the best source of birth control methods, data was collected from the Turkey Demographic and Health Surveys (DHS), and included detailed information on the health and reproductive issues of women of reproductive age (between 15 and 49 years). It contains several questions on women’s current pregnancy status, last menstrual cycle and choice of birth control methods, as well as information on both the woman’s and the husband’s demographic and socioeconomic status (for instance, couples’ employment statuses, types of occupation and education levels, and the wealth index category of the household). Finally, it contains information about the region where the couple lives and their ethnicities, as well as married women’s empowerment issues such as having an arranged marriage or having a husband with controlling behavior. 

The results showed that the older the women, the less likely it was for them to use any birth control method, but more likely to use traditional methods, although the effect was not statistically significant.  Those who lived in urban areas who used any contraception method were more likely to use modern than traditional methods compared with contracepting women in rural areas. Specifically, women of Kurdish and Arabic ethnicities were less likely to use any birth control method compared with women of Turkish ethnicity. As the amount of younger children living in the house increased, women were more likely to use some type of birth control. Regarding education level, contraceptive women were more likely to use modern birth control methods, rather than traditional methods, as both women's and their husbands’ years of schooling increased. Employment status showed that women who were not employed were less likely to use any birth control compared with women with regular or formal jobs, but the effect was statistically insignificant, and being employed in the formal sector and informal sector and the choice of birth control method had no differences. Lastly, women from the lowest socioeconomic groups had a lower probability of using any birth control method compared with women from the highest socioeconomic group. Conceivably, compared with women of lower socioeconomic status, women of highest socioeconomic status probably have greater access to, and greater means of benefiting from, available birth control resources.

This is important because it shows us information that those who have already had children tend to not want more, those who are of low economic status either cannot afford birth control or will take it because they can’t afford another child, and those who have their life planned out choose when is the best and right time to have a family once they are successful. Turkey proofs and disproofs of some of our traditional ways of thinking, and this is only the start. Women from many other countries around the world may be different and that just proves that having an option like this makes things easier for women in their life and doesn’t put a burden on them to make a choice they’re not sure about.

Source: Karaoğlan, Deniz, and Dürdane Şirin Saraçoğlu. 2021. “Women’s Socioeconomic Status and Choice of Birth Control Method: An Investigation for the Case of Turkey.” Journal of Biosocial Science 53(1):137–56. 

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Table 2: Addressing Emergency Contraception Within a Routine Health Visit

Questions to ask during a routine health visit:

When did your last menstrual period begin?

Would you like to be pregnant in the next year?

What do you use for contraception?

Have you used this contraception consistently (especially if using oral contraceptives or barrier methods)?

Are you concerned that you may be pregnant?

Have you had unprotected sex within the last 5 days?

Would you like more information on emergency contraception?

(Batur et al., 2016)

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birth-control.jpg (700×830) (dumpaday.com)

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“Factors Influencing Satisfaction with Oral Contraceptive Pills and Injectables among Past Users in Kenya”

This article looked at the factors that were associated with the satisfaction of oral pills and injectables among past users in Kenya, more specifically two slum communities one in a urban site known as Nairobi Slums and the other in a rural site known as Homa Bay in Western Kenya.   

The factors that were included were a structured questionnaire that would capture information such as reproduction, contraceptive knowledge and beliefs and attitudes towards contraception in general and toward specific methods.

This information was important because of the desire of family planning and the proportion of currently married women who used any form of contraception and the satisfaction or dissatisfaction of that contraception usage and whether they continue to use it or not.

The results showed that with the dissatisfaction of pills and injectables were common in both the rural and urban areas of Kenya . Past users of pills who were dissatisfied with their choice of method were higher in women in the urban site rather than the rural site (56% vs 44%). About the same was seen in past injectable users (53% vs 39%). The reason for the majority of women being dissatisfied with injectables and pills was because of the side effects and irregular menstrual cycles and concerns of health problems. Though, pills also were dissatisfied because of it not being easy to use and becoming pregnant while using it (Odwe et al., 2018)

The author of this study points out that specifically for injectables , even though known to be the most commonly used method, is still viewed with a degree of fear and suspicion.

This article allows an understanding of two different options and whether or not they were satisfied or dissatisfied with those options in two different areas of Kenya. This shows that there are different reasons as to why a woman would choose a certain method over another, and how those methods affect a woman and their physical body. This alone can relate to many other women around the world, and how the reason for why they were either satisfied or dissatisfied could relate to others. It’s important to distinguish between the costs and benefits of a contraceptive method and allows for a deeper understanding behind why a woman would want to choose to partake in a method or why they wouldn’t.

Source: Odwe, George et al. 2018. “Factors Influencing Satisfaction with Oral Contraceptive Pills and Injectables among Past Users in Kenya.” Journal of Biosocial Science 51(4):491–504. 

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Most commonly reported

Abernethy, L. (2019, June 26). Woman creates review site for contraception so you can see how it affects others. Metro. https://metro.co.uk/2019/06/26/woman-creates-review-website-contraception-can-see-affects-others-10075626/ 

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“Turkey’s first family planning initiatives were implemented in 1965 and included the promotion of birth control methods and education of the public, the provision of family planning services and the liberalization of abortion. These efforts have increased awareness in the country of ‘at least one family planning method’ over time and instituted a positive attitude towards contraceptive use among the public, according to the Turkey Demographic and Health Surveys (DHSs) conducted from 1988 to 2013” (Karaoğlan & Saraçoğlu, 2020)

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Should Birth Control be free?

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Contraceptive Methods Guide - Find your best Contraception Option (your-life.com)

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Contraceptive Methods Guide - Find your best Contraception Option (your-life.com)

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Contraceptive Methods Guide - Find your best Contraception Option (your-life.com)

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"EC options in the U.S. include: the copper intrauterine device, which must be inserted by a trained medical professional; oral ulipristal acetate (UPA), which requires a prescription; and oral levonorgestrel (LNG), which is available without a prescription" (Chiccarelli et al., 2020)

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A Qualitative Study of Prescription Contraception Use: The Perspectives of Users, General Practitioners and Pharmacists.

Women all around the world struggle with cases of unintended pregnancies and have caused a continuous global, social, and economic issue in regards to the hardship a woman goes through as well as the overall well being of the child. With certain areas of the world such as in the Republic of Ireland being known as having a common occurrence of unintended pregnancies, and the passing of the Family Planning Act, general practitioners and pharmacists now have the capability to offer prescriptions of different contraceptive methods and their effectiveness. The oral contraceptive pill (OCP) is the most commonly prescribed compared to long acting reversible contraceptive (LARC) in Ireland but still has a lack of adherence which causes a lack of effectiveness for the OCP method. LARC was known to have barriers at the healthcare professional level which includes lack of skills in administration, poor knowledge, and limited financial incentives. This study specifically looks at the experiences, and attitudes amongst users, general practitioners, and pharmacists and the factors that lead these healthcare providers to choose a given contraceptive method. 

This study used an interview topic guide in order to achieve the process of exploring the experiences of, and attitudes towards, prescription contraception and semi-structured interview questions based on the emerging themes from the contraceptive users interviews were designed for general practitioners and pharmacists. The participants of the study were required to report their current use method of prescription contraception for eligibility reasons and included young university students, young mothers, older women with a third level (bachelor degree) qualification and older women from areas of higher social deprivation from Galway city, west of Ireland, to represent various stages of the reproductive life course and various socio-economic backgrounds that early and later stage of the reproductive lifespan and socioeconomic disadvantage as indexed by the participant’s age and the presence or absence of third level education.

The first group of participants was contraception users which included eighteen participants and looked at their experiences of past and current prescription contraception use and was determined by their soci-economic status, knowledge and attitudes toward LARC, and the relationship with general practitioners and pharmacists. Of the 18 women interviewed, young mothers and women from areas of higher social deprivation were using LARC’s at time of interview, had unplanned pregnancies because of poor adherence to the OCP, which was because of either forgetting to take it, or using it incorrectly. Only after giving birth did the women learn of LARCs from their general practitioner and young mothers decided to use LARC following pregnancy. Older women over the age of 30 from areas of higher social deprivation, had continuous unintended pregnancies because they were also unaware of OCPs. The university students and women holding a third level qualification were using the oral contraceptive pill and all began with OCP and didn’t have unplanned pregnancies As far as the knowledge and attitudes about contraceptive methods, For the women holding a third level qualification, their entry into contraception use was similar to that of the university students. However, as long term oral contraceptive pill users, they were reluctant to change to another prescription method, but were less informed about LARCs and held misconceptions such as infertility or delayed conception and didn’t like something long term in their body and felt more in control when using OCP. Though, young mothers and women from higher social deprivation were well informed about LARCs and had a positive attitude towards them. 

As for the participants' relationships for contraceptive use and choice, little discussion occurred between prescription, contraception users, and their general practitioners about LARCs and relied on friends and peers for information. Younger women felt uncomfortable, discussing contraception choice with their general practitioner or pharmacist. The older women had no discomfort talking to their general practitioner about contraception, but felt it was a personal matter. A potential barrier that was identified in the study was when participants had to pay for LARCs. 

As for general practitioners, there were 18 in total and the themes that were looked at were their experiences, and how they distributed information to contraceptive users, the financial implications of delivering LARC services, access to training, and maintenance of skills, and adherence awareness and responsibility. It was important that the practice of all general practitioners had to provide information on all types of contraception, but the quantity and quality of information given to these women was inconsistent. The general practitioners outlined barriers to providing contraception choice and the cost was important because in the Republic of Ireland, LARCs received limited funding by the government. When looking at the adherence awareness and responsibility, general practitioners' understanding of adherence to the oral contraceptive pill was a significant discrepancy. 

As for pharmacists, there were nine that were recruited, and the analysis of the pharmacy data identified restrictions which impacted on the role of the pharmacist in prescription, contraception delivery. The themes that emerged were to identify the legislation and practice, infrastructure and adherence awareness and responsibility. They believe they were not currently equipped to meet requirements to prescribe and monitor blood pressure as part of a comprehensive contraception service, and that they did not have access to a patient's individual medical records or family medical history and remained hesitant to intervene, or give advice on prescription, contraception choice. Similar to general practitioners, pharmacists relied on providing information to the patient through options, such as leaflets or booklets to address any queries or confusion the patient may have, and felt that providing this literature was the best approach and adhered to the OCP method being the best.

This study showed that there are contrasting perspectives between the contraception service providers and the users. It was also shown that training for healthcare providers is required in order to support and form contraceptive choice and adherence, and it is important to address the practice barriers of cost and lack of time, to give better communication around adherence issues and prescription contraception options and it is needed for a easily accessible public health information in order to give awareness on all methods of prescription contraception. These findings can be used to inform further research, policy and practice, and shows that a more comprehensive model of practice, which is service user lead and cognizant of social determinants of contraception experiences and choices are required. 

Source: Sweeney, L.-A., Molloy, G. J., Byrne, M., Murphy, A. W., Morgan, K., Hughes, C. M., & Ingham, R. (2015). A Qualitative Study of Prescription Contraception Use: The Perspectives of Users, General Practitioners and Pharmacists. PLOS ONE, 10(12), e0144074. https://doi.org/10.1371/journal.pone.0144074

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Users vs. Science

Hall, K., & Diehm, J. (2017, December 7). Look: What women don't know about birth control is frightening. HuffPost. Retrieved from https://www.huffpost.com/entry/birth-control_n_4070949?utm_hp_ref=mostpopular