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The Adoption of a New Contraceptive Method – Surveys and Interventions Regarding Emergency Contraception
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to examine the adoption of emergency contraceptive pills (ECP) in Sweden. Two cross-sectional surveys and two quasi-experimental studies were used. Reasons for induced abortion, contraceptive practices and contraceptive failure were examined in a group of abortion applicants with a waiting-room questionnaire (I) and knowledge, use and practices of ECP were assessed with a postal questionnaire in a population-based sample of young women (II). One community-based information campaign was evaluated with a repeated postal questionnaire (III) and a school-based education intervention was evaluated with repeated class-room questionnaires (IV). Abortion applicants had inadequate contraceptive practices and a low use of ECP. One year after the deregulation of ECP women were highly aware of the method and preferred the pharmacy for the purchase of ECP. Correct knowledge and positive attitudes influenced the willingness to use ECP in the future. The information campaign was noticed by two-thirds of the women and there was an overall trend towards better knowledge, improved attitudes and increased use among all women at follow-up. The school-based intervention improved the students’ knowledge of, and attitudes to, ECP without jeopardizing condom use. The adoption of ECP in Sweden seems to have gone through the first stages of diffusion of an innovation, i.e., developement, dissemination, and adoption, and has reached the stage of implementation since the studies indicated a general awareness of more than 90%, an intention to use in case of need of more than 70%, and womens’ own experience of use of around 30%. The most cited information channels were media, friends and the local Youth Clinic. ECP is gradually becoming a more widely known, accepted and used contraceptive method in Sweden, but must be considered as being only one of many tools in the prevention of unintended pregnancies.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2004. , p. 62
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1345
Keywords [en]
Obstetrics and gynaecology, Abortion applicants, adolescents, induced abortion, contraception, emergency contraception, over-the-counter, knowledge, attitudes, practices, sexual health, community-based, intervention
Keywords [sv]
Obstetrik och kvinnosjukdomar
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-4237ISBN: 91-554-5949-8 (print)OAI: oai:DiVA.org:uu-4237DiVA, id: diva2:164493
Public defence
2004-05-25, Rosénsalen, Kvinno- och barnkliniken, Akademiska sjukhuset, Ing. 95-96, Uppsala, 13:15
Opponent
Supervisors
Available from: 2004-05-03 Created: 2004-05-03Bibliographically approved
List of papers
1. Reasons for pregnancy termination, contraceptive habits and contraceptive failure among Swedish women requesting an early pregnancy termination
Open this publication in new window or tab >>Reasons for pregnancy termination, contraceptive habits and contraceptive failure among Swedish women requesting an early pregnancy termination
2002 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 81, no 1, p. 64-71Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: More than 30 000 legal abortions are performed every year in Sweden despite sexual education in schools, widespread youth-clinics and family planning services that are free of charge. The aim of this study was to investigate reasons for induced abortion, contraceptive habits and reasons for contraceptive failure among women presenting for induced abortion.

METHODS: A questionnaire was administered to 591 Swedish-speaking women consecutively attending three different health care providers concerning an induced abortion during spring 2000.

RESULTS: The response rate was 88% (n = 518). As many as 43%, among daily smokers 53%, had experienced one or more previous legal abortions. The majority of the women (97%) had discussed the decision about abortion with someone. The most cited reasons contributing to their decision were financial concerns, worries about the relationship and bad timing of the pregnancy. Though 85% had used contraception during the previous year, 36% of the women had not used any contraceptive method at the time of conception. The main reason given for not using contraception was the belief that they could not at that time become pregnant (35%). Ninety percent of the women planned to use contraception after the abortion.

CONCLUSION: Women's decisions regarding induced abortion are multifactorial. One important reason was "poor economy". One out of three did not use any contraception, as they believed they could not become pregnant. Women presenting for induced abortion are a risk-group for further terminations. Counseling must include information about the fertile window, effective contraceptives and the emergency contraceptive pill.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-91677 (URN)10.1046/j.0001-6349.2001.00169.x (DOI)000174398000012 ()11942890 (PubMedID)
Available from: 2004-05-03 Created: 2004-05-03 Last updated: 2017-12-14Bibliographically approved
2. Emergency contraceptive pills over-the-counter: a population-based survey of young Swedish women
Open this publication in new window or tab >>Emergency contraceptive pills over-the-counter: a population-based survey of young Swedish women
2004 (English)In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 69, no 4, p. 309-315Article in journal (Refereed) Published
Abstract [en]

One year after emergency contraceptive pills (ECP) had become prescription-free, we sent a questionnaire to 800 randomly selected women in mid-Sweden. The aim was to investigate women's knowledge, attitudes and practices regarding the method. The response rate was 71% (n = 564). The majority of the women, 65%, would prefer to purchase ECP over-the-counter (OTC) in a pharmacy. Attitudes toward the method were predominantly positive, but one fourth (24%) had worries about side effects and one third (33%) considered ECP to be a kind of abortion. Logistic regression showed that correct knowledge of and positive attitudes toward ECP contributed to estimated future use of ECP. Although women favored the OTC option, persistent misunderstanding about ECP implies that routine information from gynecologists and health professionals as well as media campaigns is needed along with the deregulation in order to make ECP an accepted and properly used contraceptive method.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-91678 (URN)10.1016/j.contraception.2003.11.013 (DOI)15033406 (PubMedID)
Available from: 2004-05-03 Created: 2004-05-03 Last updated: 2017-12-14
3. Emergency Contraceptive Pills in Sweden: Evaluation of an information campaign
Open this publication in new window or tab >>Emergency Contraceptive Pills in Sweden: Evaluation of an information campaign
2004 (English)In: BJOG : an international journal of obstetrics and gynaecology, ISSN 1470-0328, Vol. 111, no 8, p. 820-827Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate a community-based intervention regarding emergency contraceptive pills, including a mass media campaign and information to women visiting family planning clinics.

DESIGN: Quasi-experimental.

SETTING: Two counties in Sweden.

POPULATION: Eight hundred randomly selected women aged 16-30 years, 400 women in the intervention group and 400 in a comparison group.

METHODS: Postal questionnaires before (2002) and after (2003) the intervention.

MAIN OUTCOME MEASURES: Exposure to the intervention, knowledge, attitudes, practices and intention to use emergency contraceptive pills.

RESULTS: Before the intervention, the response rate was 71% (n= 564); after the intervention, the corresponding figure was 83% (n= 467); overall response rate 58%. Two-thirds (64%) of the targeted women had noticed the information campaign. One out of six who had visited a family planning clinic during the intervention year recalled being given information about emergency contraceptive pills. Specific knowledge and attitudes improved over time in both groups, but there was no difference in change between the groups. The proportion of women who had used emergency contraceptive pills increased from 27% to 31% over time. Intention to use emergency contraceptive pills in case of need was reported by 74% of the women and remained stable over time, but logistic regression showed that information during the previous year contributed to willingness to use the method in the intervention group.

CONCLUSIONS: Knowledge, attitudes and practices about emergency contraceptive pills increased in both groups. Emergency contraceptive pills is gradually becoming a more widely known, accepted and used contraceptive method in Sweden, a trend that may have limited the impact of the intervention.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-91679 (URN)10.1111/j.1471-0528.2004.00206.x (DOI)15270930 (PubMedID)
Available from: 2004-05-03 Created: 2004-05-03 Last updated: 2016-04-22
4. Evaluation of a Sexual Education Intervention among Swedish High School Students
Open this publication in new window or tab >>Evaluation of a Sexual Education Intervention among Swedish High School Students
2006 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 34, no 2, p. 124-131Article in journal (Refereed) Published
Abstract [en]

AIMS: To evaluate an intervention aimed at improving knowledge of, attitudes to, and practices regarding condoms and emergency contraception (ECP) among Swedish high school students. METHODS: An intervention study with quasi-experimental design. A strategic sample of classes from two vocational high school programs was divided into an intervention group and a comparison group. All students completed questionnaires before and after the intervention, which included sexual education lessons by a nurse-midwife and medical students, free condoms on request and access to telephone counseling. RESULTS: Of the 461 eligible students, mean age 17 years, 390 (85%) completed the pre-test and 326 (71%) the post-test. Three out of four (77%) had experienced sexual intercourse. The majority (76%) had used contraception, mostly condoms at first intercourse. The students already had good knowledge of condoms with no change after the intervention, but attitudes improved and condom use increased. Knowledge of, and attitudes towards ECP improved but use remained stable (29%). The most important source of information about ECP changed from "friends" to "school" after the intervention. More than one out of four (28%) had opted for free condoms but only 3% had requested telephone counseling. CONCLUSIONS: Condom use increased after the intervention whereas the use of ECP remained stable. Knowledge of ECP improved and the attitudes towards both condoms and ECP became more positive. Participation of nurse-midwives and medical students, skill rehearsal, and improved access to condoms may be useful elements in sexual education.

Keywords
Adolescent, Comparative Study, Condoms, Contraception Behavior, Contraceptives; Oral, Contraceptives; Postcoital, Counseling, Female, Follow-Up Studies, Health Knowledge; Attitudes; Practice, Humans, Male, Questionnaires, Research Support; Non-U.S. Gov't, Sex Education/methods/standards, Sweden, Telephone
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-91680 (URN)10.1080/14034940510032266 (DOI)16581704 (PubMedID)
Available from: 2004-05-03 Created: 2004-05-03 Last updated: 2017-12-14Bibliographically approved

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