Educating young men could expand ‘morning after pill' use
David Cohen, M.D.·Published 16 February 2014·9 min read
Key points
Young men know even less about emergency contraception than young women do, which may be limiting access to an effective means of preventing unwanted pregnancies, researchers say.
"The big finding in our study is that young men had a lot less knowledge about emergency contraception than the young women that we surveyed, and even among the young women, knowledge wasn't great," Sheree Schrager, a member of the study team, told Reuters Health.
"About half of the women understood basic facts about emergency contraception, how you get it, how you use it, and the fact that male partners were also able to buy it over-the-counter for their female partners," added Schrager, a researcher at Children's Hospital Los Angeles, California.
"But young men had significantly lower knowledge then the young women did, and this is an opportunity for providers to reach out to young men in the hopes of reaching more young women to use emergency contraception," she said.
Young men know even less about emergency contraception than young women do, which may be limiting access to an effective means of preventing unwanted pregnancies, researchers say.
"The big finding in our study is that young men had a lot less knowledge about emergency contraception than the young women that we surveyed, and even among the young women, knowledge wasn't great," Sheree Schrager, a member of the study team, told Reuters Health.
"About half of the women understood basic facts about emergency contraception, how you get it, how you use it, and the fact that male partners were also able to buy it over-the-counter for their female partners," added Schrager, a researcher at Children's Hospital Los Angeles, California.
"But young men had significantly lower knowledge then the young women did, and this is an opportunity for providers to reach out to young men in the hopes of reaching more young women to use emergency contraception," she said.
Emergency contraception, sometimes called "the morning after pill," prevents pregnancy after unprotected sex or when barrier methods of contraception fail. Currently, nine U.S. states allow pharmacists to dispense emergency contraception without a prescription under certain conditions, according to the Guttmacher Institute.
Unplanned pregnancies happen at higher rates in poor communities, and their health and economic consequences may be greater, the researchers write in The Journal of Family Planning and Reproductive Health Care.
Levonorgestrel (Plan B) has been the primary agent used for emergency contraception since its introduction in 2000, they note. But it's promise for preventing up to half of unwanted pregnancies has gone unfulfilled, in part because of lack of knowledge and access to the drug.
Emergency contraceptive pills containing both progestin and estrogen (known as “combined” pills) reduce the risk of pregnancy by 75%. In other words, if 100 women use this type of pill after having unprotected sex, only 2 of them will get pregnant. Emergency insertion of a copper-T IUD reduces the risk of pregnancy by more than 99%.
While all of these types of emergency contraceptives are safe and effective, with the exception of the IUD (if used for ongoing contraception), they are not as good at preventing pregnancy as birth control that’s used before or during sex, like the pill or condom. If emergency contraception was the only type of birth control you used for an entire year, your annual risk of getting pregnant would probably be about 20% with progestin-only EC such as Plan B One-Step, Next Choice One Dose, Next Choice, Levonorgestrel Tablets and other progestin-only emergency contraceptive pills and 40% with “combined” emergency contraceptive pills. And that’s assuming you used emergency contraceptive pills perfectly, after each and every time you had unprotected sex. For this reason, health care providers generally recommend that, if you are sexually active, you should try to find a regular method of contraception other than emergency contraception that can work for you. (Find out more about your options here or use this free, interactive online tool or ARHP's Method Match to help choose the best contraceptive method for you.)
Written and revised by
David Cohen, M.D.
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To gauge how much older teens and young adults know about emergency contraception, the researchers enrolled 101 males and 97 females ages 18 to 25 into the study during 2008 and 2009. The participants were either patients at a free health care clinic in Los Angeles or had received physical screenings as part of their training for the Los Angeles Job Corps.
Most of the participants were Hispanic - about 61 percent. Another 13 percent were White and 16 percent were African American. The remaining 6 percent identified themselves as belonging to "other" ethnic groups. Almost three quarters had not completed high school.
About 36 percent of sexually experienced young women had used emergency contraception previously, while 18 percent of the sexually experienced males had partners who had used it.
The participants answered questionnaires that included items measuring their knowledge of facts about emergency contraception attitudes about using it. Composite scores were determined from the number of correct answers and ranged from 0 to 4.
The women's average score was 2.85, while the men's average score was 1.97.
About half the women and a third of the men knew that emergency contraception was available at pharmacies without a prescription.
Only 18 percent of the women and 8 percent of men knew that emergency contraceptives were available to women under the age of 18.
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A few more men than women (26 percent versus 21 percent) knew that a man can purchase emergency contraception for his female partner.
"We also found that the young men and young women were really interested in learning about emergency contraception and other forms of contraception from their primary healthcare providers and so despite the fact they mostly get the knowledge from their friends, in the future they'd much rather be hearing about it from the doctor," Schrager said.
The findings might not apply to all young people, the authors point out.
"These were young people who are receiving medical screenings either because they were enrolled in job corps looking for training and education because they were attending Saban Clinic - a free clinic for young people who don't have money to access other kinds of care," Schrager said.
Schrager added that her group's report was targeted to healthcare providers who may have overlooked young men when thinking about pregnancy prevention in their practices.
"Physicians can do a good job of reaching out to not only to young women who could potentially get pregnant, but to their potential partners and it's another way to reach young women who may have been missed by someone else somewhere along the line," Schrager said.
Dr. Paula Adams Hillard told Reuters Health that the ideal way to educate young men about emergency contraception would be if all school systems provided comprehensive sexuality education.
Hillard provides pediatric, adolescent and adult gynecology services at the Lucile Packard Children's Hospital and Stanford Hospitals and Clinics in Palo Alto, California.
"It happens in some schools, but obviously not very many, and certainly not as many as we'd like," said Hillard, who is also a professor at the Stanford University School of Medicine.
"There are really excellent programs for sex and sexuality education through a number of organizations but they're outside the school systems," Hillard said. She pointed to an emergency contraception information website run by Princeton University here: http://url.health.am/1393/.
The first type of emergency contraceptive pill contains a hormone called progestin. Progestin-only pills can reduce your risk of getting pregnant by 88% (How much it reduces your chances of getting pregnant depends on which kind of emergency contraceptive you use and how quickly you take it after unprotected intercourse. In general, progestin-only emergency contraceptive pills, like Plan B One-Step, Next Choice One Dose, Next Choice and Levonorgestrel Tablets, are more effective than combined emergency contraceptive pills. And pills containing an antiprogestin, like ella, are more effective than progestin-only pills.). You are also less likely to have side effects if you use these pills for emergency contraception, as compared with combined pills (see below). In the United States, different brands of pills are sold with different regulations, so it can be quite confusing.
- Plan B One-Step is sold on the shelf (check the family planning aisle) with no restrictions. That means anyone can buy it without having to show ID. Plan B One-Step generally costs about $40-50.
- Soon, the generic one-pill products (Next Choice One Dose and My Way) will be available on the shelf next to Plan B One-Step, but you need to be 17 to buy them. Be prepared to show ID to buy these products. These generics generally cost about $35-45.
- The generic two-pill products Levonorgestrel Tablets are still available only at the pharmacy counter. Women and men aged 17 or older can buy them without a prescription. If you are 16 or younger, you need a prescription.
- ella is sold by prescription only, regardless of age. You can also order ella through an online prescription service for $42, including next-day shipping.
The second type of emergency contraceptive pill contains ulipristal acetate, and is available by prescription only in the United States (sold as ella) and Europe (sold as ellaOne). It has been found to be highly effective and well-tolerated. It can be taken up to 5 days after unprotected sex, and is believed to be more effective than levonorgestrel ECPs.
The third type of emergency contraceptive pill uses both the hormones progestin and estrogen (learn more about these "combined" emergency contraceptive pills). Many brands of the combined daily birth control pill can be used for emergency contraception in the United States (find out which ones here). These pills cut your chances of getting pregnant by 75% (What does that mean?), and you are more likely to experience side effects like nausea and vomiting.
The fourth type of emergency contraceptive pill contains small doses of mifepristone. This pill is also highly effective, with few side-effects. This type of emergency contraceptive pill is currently available only in China, Vietnam, Armenia and Russia.
Hillard said that as a gynecologist, she's always talking to young women, but also encourages them to talk to their partners about emergency contraception.
"There is a dedicated emergency contraceptive product that is now available to all ages over-the-counter, called Plan B One-Step, which is just one of several different emergency contraceptives, but it is available without a prescription over-the-counter to all ages," Hillard said.
A second study of contraceptive use published in the same issue of the journal looked at the possibility that pharmacists could play a bigger role in helping women gain access to effective contraception so they might avoid the need for emergency methods.
Dr. Lucy Michie of the Chalmers Sexual and Reproductive Health Centre in Edinburgh led the study that included 211 women who requested emergency contraception at one of nine pharmacies in January 2013.
The women were given questionnaires about their contraceptive use including ongoing and emergency methods.
The researchers found that a third of the women needed emergency contraception due to unprotected sex and half reported condom failure.
Of those women, about half expressed interest in starting ongoing contraceptive methods such as the birth control pill.
The women also said they would welcome it if during their visit to purchase emergency contraception, the pharmacist also provided a limited supply of The Pill, giving the woman time to make an appointment with her physician to find the right long-term contraceptive method for her.
Contraceptive use among women presenting to pharmacies for emergency contraception: an opportunity for intervention
Results A total of 211/232 women completed questionnaires in pharmacies (a 91% response rate). Of those women not using a hormonal method of contraception at the time of EC (n=166; 79%), almost half (44%) wished to use an effective method. Most women (64%) agreed that the option of a pharmacist being able to supply a POP would have been helpful. Among the SRH clinicians, 110 completed questionnaires out of 150 distributed (a 73% response rate). The majority of respondents (92%) were positive about a pharmacist supplying a POP at the time of EC.
Conclusions A reasonable proportion of women requesting EC would like to start using an effective contraceptive method. Both the women and the SRH clinicians we surveyed are positive about the option of a short supply of a POP being provided by the pharmacy in the UK together with EC.
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Lucy Michie, Sharon T Cameron, Anna Glasier, Elizabeth Greed
J Fam Plann Reprod Health Care doi:10.1136/jfprhc-2013-100730
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