Emergency Contraception: Knowledge and Attitudes of Family Physicians of a Teaching Hospital, Karachi, Pakistan
Abdulghani, Hamza M., Karim, Syed I., Irfan, Farhana, Journal of Health Population and Nutrition
Contraception is one of the major determinants of fertility levels. In the developing world, an estimated 122.7 million women have an unmet need for contraception (1). Almost half of the Asian countries had a contraceptive prevalence of 60% or higher (2). This represents a continuous challenge for governments and agencies concerned about ensuring access to contraceptives. Unplanned/mistimed pregnancies generally result from a high unmet need and ineffective use of contraceptives that end in induced abortions (3). Each year, about 79 million unintended pregnancies occur worldwide (4). According to the new worldwide estimates of abortion rates and trends, the overall abortion rates are almost similar in both developing and developed world. However, unsafe abortions are dominating in developing countries (5).
Abortion is a public-health concern because of its impact on maternal morbidity and mortality. In Pakistan, where only 28% of couples use some form of contraception and the gap between the desire to space/limit births and the contraception usage (33%) is one of the widest in the world, and abortion is often the only choice for couples to deal with an unplanned and unwanted pregnancy (6). An estimated 900 million women who wanted to avoid having a child undergo induced abortion annually in Pakistan. This estimates the annual abortion rate of 29 per 1,000 women aged 15-49 years (7). Although the socioeconomic burden of unintended pregnancies is significant, at the same time it is largely preventable (8). In the cases of unprotected sex or method failure, the knowledge about back-up support and use of emergency contraception is the most important factor to prevent unplanned or mistimed pregnancies.
Post-coital emergency contraception may be defined as the use of a drug or a device to prevent pregnancy after intercourse, which has been shown to be safe and effective (9-12). Sooner the first dose was taken after intercourse, the greater is the effectiveness. No single mechanism of action for emergency contraception has been identified. Some studies reported biochemical changes within endometrium while other studies suggest interference within tubal transport of sperm, egg, or embryo that may result in failure of implantation.
Different methods of emergency contraception, including the use of combination estrogen and progestin, progestin alone, and post-coital insertion of an intrauterine device, are available (13). The popular methods include the administration of two doses of a combination estrogen and progestin pill (Yuzpe method) or two doses of progestin alone taken 12 hours after unprotected intercourse, with estimated efficacies of 57% and 85% respectively (14).
Currently, two 0.75-mg doses of levonorgestrel are licensed in Pakistan for use within 72 hours of unprotected sex. Results of a multicentre trial of the World Health Organization also showed a good efficacy with a single dose of levonorgestrel initiated up to 120 hours after intercourse (15). An intrauterine device (IUD) can be inserted up to five days after the first act of unprotected sex. Progestin-only pills reduce the chance of pregnancy by 85%, and combined hormone emergency contraception pills by 57% when taken within 72 hours of unprotected sex. Insertion of copper-T (IUD) reduces the chance of pregnancy up to 99% (16). Despite being effective and safe, emergency contraception is still not widely used (17). The first step towards understanding its use is assessing local physicians' knowledge of the methods and willingness to prescribe them. Previous studies have identified lack of awareness as the most notable barrier to the use of emergency contraception (18,19). Research has examined knowledge, attitudes, and practice patterns of obstetrician-gynaecologists (20), paediatricians, and family-planning specialists with respect to emergency contraception (21).
An extensive literature search in the Internet has failed to show any study from Pakistan on emergency contraception to indicate the attitudes of family physicians. …