Pharmacists' Knowledge and Perceptions of Emergency Contraceptive Pills in Soweto and the Johannesburg Central Business District, South Africa
Blanchard, Kelly, Harrison, Teresa, Sello, Mosala, International Family Planning Perspectives
CONTEXT: In South Africa, emergency contraceptive pills are available directly from pharmacies without a prescription, yet few studies have assessed pharmacists' knowledge of and attitudes toward the medication.
METHODS: In-person interviews were conducted with 34 pharmacists practicing in Soweto and the Johannesburg Central Business District, from February through April 2003. The pharmacists provided data on their knowledge of emergency contraceptive pills and their attitudes toward providing the medication to women in specific situations.
RESULTS: Nearly all pharmacists sold at least one of the two types of dedicated emergency contraceptive pills available in South Africa. Although most had accurate knowledge about the method's dosing schedule, side effects and mechanism(s) of action, more than half erroneously believed that repeated use posed health risks. A large majority of pharmacists believed the pills should be available to rape victims, to single or married women and to women who had never given birth, but almost half did not think the pills should be given to women younger than 18, and a fourth said they would not give them to women with a late menstrual period. About one-third to half of pharmacists supported advance provision of the medication under certain circumstances. Most were willing to display promotional materials on emergency contraceptives in their pharmacies.
CONCLUSIONS: Interventions aimed at educating pharmacists about the benefits of emergency contraceptive pills, especially for adolescents, are needed. Government and medical authorities should take advantage of pharmacists' willingness to display educational materials as a way to increase women's knowledge and use of the medication in South Africa.
International Family Planning Perspectives, 2005, 31(4):172-178
Emergency contraceptive pills contain either progestin alone or a combination of estrogen and progestin in higher doses than regular oral contraceptives. If taken within 72 hours of unprotected intercourse, they can reduce a woman's risk of pregnancy by at least 75%. (1) They are safe and effective (2) and, according to World Health Organization guidelines, the only contraindication to use is a confirmed pregnancy. (3) The pills are not harmful to a pregnant woman or her fetus, and they will not terminate a pregnancy. Women taking these pills will sometimes experience short-term nausea and vomiting, (4) neither of which poses a significant health risk. Even with repeated use, women would be exposed to lower hormone levels than if they used regular birth control pills, which themselves have an excellent safety profile. (5)
Although an estimated 76 million unintended pregnancies occur every year in developing countries, (6) research on the global demand and need for emergency contraceptive pills is scant. The consequences of these pregnancies, particularly where abortion is legally restricted, may be life-threatening. (7) To lower rates of unintended pregnancy, women need better access to both regular contraceptive methods and emergency contraceptive pills.
Pharmacy provision of these pills could increase access by eliminating the barriers associated with obtaining a prescription from a health care provider within 72 hours of unprotected intercourse. (8) Although recent research has shown that emergency contraceptive pills are still effective when taken up to 120 hours after unprotected intercourse, (9) other research has indicated that the sooner they are taken, the better they work. (10) For some women, getting a prescription and locating a provider quickly enough may be difficult or impossible, particularly on holidays or weekends. Forty-two percent of women in the U.S. state of California and 54% in Canada who obtained the pills through pharmacy access programs purchased the method within 24 hours of contraceptive failure or unprotected intercourse, indicating that pharmacy provision allows for quick access to this time-sensitive medication. …