Class of 2009 Abstract / OBJECTIVES: The purpose of this work is to explore the correlations between demographics, knowledge, and attitudes that student pharmacists have in regards to oral emergency contraception (OEC) and their dispensing. METHODS: University of Arizona pre-rotation student pharmacists were asked to complete a questionnaire during a regularly scheduled required class. The questionnaire had three sections consisting of general OEC knowledge, specific attitudes regarding OEC, and demographic data. RESULTS: Students who stated moral and/or ethical objections to dispensing OEC had significantly lower knowledge scores. They also showed a response pattern to attitude and belief questions opposite to that of students who stated feeling comfortable dispensing OEC in most situations. There were no significant differences in total correct scores on the knowledge questions between gender or year in school, however, there were significant differences in some specific questions. CONCLUSIONS: Students who did not feel comfortable dispensing OEC or had moral and/or religious objections to dispensing OEC were found to have lower knowledge scores. With the exception of two knowledge questions, total correct scores on OEC knowledge questions increased with year in school. Lack of knowledge about OEC may in part contribute to unease and objections to dispensing them.

The availability of accessible, effective, and timely emergency contraception (EC) technologies is an important issue in women’s reproductive health. In Canada, three methods of EC are currently available: the levonorgestrel pill (LNg-EC), the Copper-T intrauterine device (IUD), and ulipristal acetate (UPA). This study explores the EC knowledge, attitudes, and practices of Ontario pharmacists through a mixed-methods study. The mixed-methods study includes a bilingual mailed survey with a representative sample of retail pharmacists and in-depth interviews with a subset of respondents. Results of the survey indicate that there is considerable interest among pharmacists to expand access to EC in Ontario; however, the results indicate that LNg-EC continues to be a behind-the- counter product and knowledge of other EC modalities is modest. Pharmacists view themselves as playing a critical role in patient education and counseling, as well as raising awareness about EC in the community. Developing and implementing continuing education efforts targeting pharmacists appears warranted. This research could ultimately play a role in expanding access to IUDs and UPA, as well as raising awareness of these modalities within the pharmacy community. La disponibilité à des technologies de contraception d’urgence (CU) accessible, efficace et dans un délai raisonnable est une problématique d’importance pour la santé reproductive des femmes. Au Canada, trois méthodes de CU sont actuellement disponibles : le comprimé de levonorgestrel (CU-LNg), le dispositif intra-utérin de cuivre (DIU) et l’acétate ulipristal (UPA). Cette étude multi-méthodes qui est composée d’une sondage bilingue posté à un échantillon représentatif de pharmaciens travaillant en milieu communautaire et d’entrevues réalisées avec un sous-ensemble de participants a pour but d’explorer les connaissances, les attitudes et la prestation de services des pharmaciens en Ontario par rapport à la contraception d’urgence. Les résultats des sondages démontrent qu’il y a un intérêt considérable de la part des pharmaciens quant à l’amélioration de l’accessibilité à la CU en Ontario. Toutefois, nos résultats démontrent que la CU-LNg continue d’être un produit situé en Annexe II et que les connaissances des pharmaciens quant aux autres méthodes de contraception d’urgence sont limitées. Les pharmaciens croient qu’ils sont un élément clé pour l’éducation de leurs patients et pour prodiguer des conseils sur la CU dans la communauté. Le développement et l’implantation de formation continue spécifiques aux pharmacies sont nécessaires. Cette recherche pourrait favoriser l’accessibilité au DUI et à l’UPA en plus d’améliorer les connaissances de ces technologies au sein de la communauté pharmaceutique.

Somalia’s reproductive health indices are among the worst in the world. Rates of maternal death, total fertility, and sexual and gender based violence reflect the poor reproductive health outcomes of women living in Somalia. Over two decades of civil unrest left the majority of the population without access to basic health care, particularly reproductive health services. Currently, it is estimated that about 1% of women in Somalia use a modern method of contraception, and the country has yet to register a dedicated progestin-only emergency contraceptive pill. This study seeks to explore levels of awareness and the perceived need for emergency contraception (EC), as well as stakeholders’ knowledge of and experiences with reproductive health services in Somalia. Through interviews and focus group discussions with stakeholders in Somalia, I learned that awareness about vital services like EC is low, while the need for EC and broader reproductive health services is high. Evidently, stakeholders believe awareness, availability, quality care, culture, religion and good governance are important factors for both delivering and accessing reproductive health care. These study findings will fill an important gap in the literature and support efforts to expand and improve reproductive health service delivery in the country.

The study was motivated by studies which have revealed that teenage pregnancy, maternal mortality and unsafe abortion are high in Lesotho. The purpose of the study was to examine whether or not lack of access to emergency contraception as one of the essential forms of contraception could be the reason for the aforementioned health challenges facing adolescent girls in Lesotho. The study was a desktop review with content analysis of documents applicable to the health of adolescents and those relating to access to family planning services for adolescent girls. The woman question was used as a tool for ascertaining whether the health rights of adolescent girls are fulfilled by Lesotho. The legal framework relevant to access to emergency contraception was also scrutinised to ascertain whether they are compliant with human rights treaties ratified by Lesotho. The study is also a comparative analysis of Lesotho's policy frame with South Africa. From the analysis of the literature review, the study uncovered how religious, cultural practices and some areas of the laws relevant to access to emergency contraception for adolescents were not responsive to the female adolescent question, thereby perpetuating infringement of various human rights belonging to adolescent girls. The study also revealed that lack of political will and poor coordination and monitoring of policies, budgetary deficiencies and shortages in human resources are some of the factors inhibiting adolescent's realisation of their full access to family planning services. The study made recommendations which the Government of Lesotho could use to change the current state of access of adolescent girls to emergency contraception. / tm2017 / Centre for Human Rights / LLM / Unrestricted

Ensuring that women have timely access to safe, effective and affordable emergency contraception (EC) is of critical importance. There are four primary modalities of EC available in Canada: the levonorgestrel emergency contraceptive pill (LNg-ECP), the copper-T intrauterine device (IUD), ulipristal acetate (UPA) and the Yupze method (combined oral contraceptive pills). This is a mixed methods study dedicated to exploring women’s knowledge of, access to and experiences with EC in New Brunswick (NB). This study consisted of a two-part mystery client study, a community-based survey, and in-depth, semi-structured interviews with women in NB. The results of the mystery-client study indicate that 180 (87%) pharmacies had at least one brand of LNG-ECPs in stock. Although availability and knowledge of LNG-ECPs among NB pharmacists is relatively high, some are still providing incorrect medical and regulatory information. The findings of this study illustrate where improvement in pharmacy provision of LNG-ECPs in NB is required. Knowledge of EC among women in NB is relatively low, especially with respect to the IUD and UPA. Continuation of education efforts among pharmacists and sexual education teachers concerning ECPs in NB appears warranted. Exploring the barriers that NB women face in obtaining ECPs is not only imperative for improving access, but also yielding better quality reproductive health services in the province.

Introdução: A contracepção de emergência, embora disponível há mais de 30 anos, ainda nos dias atuais encontra resistências de natureza religiosa, cultural e social em diferentes regiões do mundo. Estados como o Pará, segundo maior da Amazônia brasileira e da Região Norte do Brasil, com características continentais, têm, certamente na geografia, na diversidade populacional e no ecossistema, fatores que contribuem sobremaneira para a ocorrência de gestações precoces e indesejadas, assim como a prática de abortamento. Pouco se sabe sobre o nível de conhecimento sobre a contracepção de emergência pelas mulheres e sua utilização pela população brasileira. Objetivo: Avaliar o nível de conhecimento sobre contracepção de emergência entre mulheres atendidas nos Ambulatórios de Ginecologia do Hospital da Fundação Santa Casa de Misericórdia do Estado do Pará. Métodos: Foi realizado estudo transversal com 316 mulheres sexualmente ativas, com idade entre 18 e 50 anos, que frequentaram o Ambulatório de Ginecologia entre junho e julho de 2012. As pacientes responderam a um questionário contendo 29 perguntas, incluindo: idade em anos, nível educacional, conhecimento e uso prévio do método de contracepção de emergência. Resultados: A idade média das participantes foi de 31,84 ± 8,00 anos, 46,84% delas concluíram o ensino médio e apenas 8,55% possuíam o ensino superior. A maioria obtivera informações sobre contracepção de emergência por meio de amigos (48,61%, n = 152) e apenas 7,30% através de seus médicos. Embora 83,54% das participantes relatassem estar familiarizadas com o método, apenas 0,63% disseram que o contraceptivo de emergência poderia ser usado até 5 dias após a relação sexual desprotegida e 76,58% nunca tinham utilizado o método. Conclusão: As mulheres incluídas neste estudo demostraram ter elevado conhecimento e prevalência de uso da contracepção de emergência, apesar de pouco conhecimento sobre o tempo máximo para sua utilização e, devem receber mais informações sobre o contraceptivo de emergência. / Introduction: emergency contraception although available as a safe and effective method for more than 30 years, even today, meets resistance as religious, cultural and social development in different regions of the world, limiting their use and compromising your knowledge on the part of the population. States such as Pará, the second largest Brazilian Amazon State, and of the northern region of Brazil, with continental characteristics, has certainly, in geography, population diversity, ecosystem, factors that contribute greatly favoring the occurrence of premature and unwanted pregnancies, as well as the practice of abortion. Little is known about the level of knowledge about emergency contraception by women and their use in Brazil. Objective: To assess the level of knowledge about emergency contraception among women attending at gynecology clinics in the Hospital Santa Casa de Misericordia of State of Pará. Methods: cross-sectional study was conducted with 316 sexually active women aged 18-50 years attending the gynecology outpatient clinic, between June and July 2012. The patients answered a questionnaire containing 29 questions, including: age in years, education level, knowledge and previous use of emergency contraception method. Results: The mean age of participants was 31.84 ± 8,00 years. 46.84% of them completed high school, and only 8.55% have higher education. Most women obtained information on emergency contraception through friends (48.61%, n = 152) and only 7.30% of its physicians. 83.54% participants reported being familiar with the method, only 0.63% said that emergency contraception could be used up to 5 days after unprotected intercourse, 57.59% did not know, and 76,58% (n = 242) had never used the method. Conclusion: The women in our study seem to have high level of knowledge and prevalence of use of emergency contraception, although little known about the time limit for its use and should receive more information about the emergency contraceptive.

Introdução: A contracepção de emergência, embora disponível há mais de 30 anos, ainda nos dias atuais encontra resistências de natureza religiosa, cultural e social em diferentes regiões do mundo. Estados como o Pará, segundo maior da Amazônia brasileira e da Região Norte do Brasil, com características continentais, têm, certamente na geografia, na diversidade populacional e no ecossistema, fatores que contribuem sobremaneira para a ocorrência de gestações precoces e indesejadas, assim como a prática de abortamento. Pouco se sabe sobre o nível de conhecimento sobre a contracepção de emergência pelas mulheres e sua utilização pela população brasileira. Objetivo: Avaliar o nível de conhecimento sobre contracepção de emergência entre mulheres atendidas nos Ambulatórios de Ginecologia do Hospital da Fundação Santa Casa de Misericórdia do Estado do Pará. Métodos: Foi realizado estudo transversal com 316 mulheres sexualmente ativas, com idade entre 18 e 50 anos, que frequentaram o Ambulatório de Ginecologia entre junho e julho de 2012. As pacientes responderam a um questionário contendo 29 perguntas, incluindo: idade em anos, nível educacional, conhecimento e uso prévio do método de contracepção de emergência. Resultados: A idade média das participantes foi de 31,84 ± 8,00 anos, 46,84% delas concluíram o ensino médio e apenas 8,55% possuíam o ensino superior. A maioria obtivera informações sobre contracepção de emergência por meio de amigos (48,61%, n = 152) e apenas 7,30% através de seus médicos. Embora 83,54% das participantes relatassem estar familiarizadas com o método, apenas 0,63% disseram que o contraceptivo de emergência poderia ser usado até 5 dias após a relação sexual desprotegida e 76,58% nunca tinham utilizado o método. Conclusão: As mulheres incluídas neste estudo demostraram ter elevado conhecimento e prevalência de uso da contracepção de emergência, apesar de pouco conhecimento sobre o tempo máximo para sua utilização e, devem receber mais informações sobre o contraceptivo de emergência. / Introduction: emergency contraception although available as a safe and effective method for more than 30 years, even today, meets resistance as religious, cultural and social development in different regions of the world, limiting their use and compromising your knowledge on the part of the population. States such as Pará, the second largest Brazilian Amazon State, and of the northern region of Brazil, with continental characteristics, has certainly, in geography, population diversity, ecosystem, factors that contribute greatly favoring the occurrence of premature and unwanted pregnancies, as well as the practice of abortion. Little is known about the level of knowledge about emergency contraception by women and their use in Brazil. Objective: To assess the level of knowledge about emergency contraception among women attending at gynecology clinics in the Hospital Santa Casa de Misericordia of State of Pará. Methods: cross-sectional study was conducted with 316 sexually active women aged 18-50 years attending the gynecology outpatient clinic, between June and July 2012. The patients answered a questionnaire containing 29 questions, including: age in years, education level, knowledge and previous use of emergency contraception method. Results: The mean age of participants was 31.84 ± 8,00 years. 46.84% of them completed high school, and only 8.55% have higher education. Most women obtained information on emergency contraception through friends (48.61%, n = 152) and only 7.30% of its physicians. 83.54% participants reported being familiar with the method, only 0.63% said that emergency contraception could be used up to 5 days after unprotected intercourse, 57.59% did not know, and 76,58% (n = 242) had never used the method. Conclusion: The women in our study seem to have high level of knowledge and prevalence of use of emergency contraception, although little known about the time limit for its use and should receive more information about the emergency contraceptive.

Introdução: A contracepção de emergência, embora disponível há mais de 30 anos, ainda nos dias atuais encontra resistências de natureza religiosa, cultural e social em diferentes regiões do mundo. Estados como o Pará, segundo maior da Amazônia brasileira e da Região Norte do Brasil, com características continentais, têm, certamente na geografia, na diversidade populacional e no ecossistema, fatores que contribuem sobremaneira para a ocorrência de gestações precoces e indesejadas, assim como a prática de abortamento. Pouco se sabe sobre o nível de conhecimento sobre a contracepção de emergência pelas mulheres e sua utilização pela população brasileira. Objetivo: Avaliar o nível de conhecimento sobre contracepção de emergência entre mulheres atendidas nos Ambulatórios de Ginecologia do Hospital da Fundação Santa Casa de Misericórdia do Estado do Pará. Métodos: Foi realizado estudo transversal com 316 mulheres sexualmente ativas, com idade entre 18 e 50 anos, que frequentaram o Ambulatório de Ginecologia entre junho e julho de 2012. As pacientes responderam a um questionário contendo 29 perguntas, incluindo: idade em anos, nível educacional, conhecimento e uso prévio do método de contracepção de emergência. Resultados: A idade média das participantes foi de 31,84 ± 8,00 anos, 46,84% delas concluíram o ensino médio e apenas 8,55% possuíam o ensino superior. A maioria obtivera informações sobre contracepção de emergência por meio de amigos (48,61%, n = 152) e apenas 7,30% através de seus médicos. Embora 83,54% das participantes relatassem estar familiarizadas com o método, apenas 0,63% disseram que o contraceptivo de emergência poderia ser usado até 5 dias após a relação sexual desprotegida e 76,58% nunca tinham utilizado o método. Conclusão: As mulheres incluídas neste estudo demostraram ter elevado conhecimento e prevalência de uso da contracepção de emergência, apesar de pouco conhecimento sobre o tempo máximo para sua utilização e, devem receber mais informações sobre o contraceptivo de emergência. / Introduction: emergency contraception although available as a safe and effective method for more than 30 years, even today, meets resistance as religious, cultural and social development in different regions of the world, limiting their use and compromising your knowledge on the part of the population. States such as Pará, the second largest Brazilian Amazon State, and of the northern region of Brazil, with continental characteristics, has certainly, in geography, population diversity, ecosystem, factors that contribute greatly favoring the occurrence of premature and unwanted pregnancies, as well as the practice of abortion. Little is known about the level of knowledge about emergency contraception by women and their use in Brazil. Objective: To assess the level of knowledge about emergency contraception among women attending at gynecology clinics in the Hospital Santa Casa de Misericordia of State of Pará. Methods: cross-sectional study was conducted with 316 sexually active women aged 18-50 years attending the gynecology outpatient clinic, between June and July 2012. The patients answered a questionnaire containing 29 questions, including: age in years, education level, knowledge and previous use of emergency contraception method. Results: The mean age of participants was 31.84 ± 8,00 years. 46.84% of them completed high school, and only 8.55% have higher education. Most women obtained information on emergency contraception through friends (48.61%, n = 152) and only 7.30% of its physicians. 83.54% participants reported being familiar with the method, only 0.63% said that emergency contraception could be used up to 5 days after unprotected intercourse, 57.59% did not know, and 76,58% (n = 242) had never used the method. Conclusion: The women in our study seem to have high level of knowledge and prevalence of use of emergency contraception, although little known about the time limit for its use and should receive more information about the emergency contraceptive.

Beginning with eight women’s experiences in accessing emergency contraception from a pharmacist, this research brings into view the undocumented “sexual health work” of obtaining the drug in northern Ontario. Between 2005 and 2008, emergency contraception was deregulated to behind-the-counter, forcing women to submit to mandatory counselling and screening about sex, menstruation and contraception at the pharmacy. Situating unwanted pregnancy as harmful in this context, an institutional ethnographic analysis explores the activities of health service delivery and identifies the different ideological practices that shaped women’s access like the steady creep of neoliberalism, professional specialization and clinical power. Ideological discourses construct an ideal contraceptive user, who is patient, compliant and appears “responsible”, contributing to the stigmatization of women. Findings suggest that an inaccurate government definition of emergency contraception contributes to ignorance and misperceptions about function; this, along with an empty federal policy vacuum for women’s health contributes to its problematic status in women’s contraceptive options.

Unintended pregnancy remains to be a public health priority for adolescents as there are a myriad of negative social and developmental consequences for both young mothers and their children. The goal of this study was to examine associations of individual-level determinants of health with sexual risk behaviors and protective factors among a sample of African American female adolescents. African American adolescent females were recruited from sexual health clinics to participate in a cross-sectional survey at 18 months post-participation in a STD/HIV prevention trial. Surveys were administered using Audio Computer Assisted Self Interview (ACASI). Statistical analyses were run to determine associations of protective and sexual risk behaviors with age, education, household income status, sexual history, other contraception use and knowledge of emergency contraception (EC). A total of 410 surveys were included in the analyses. (N=410; mean age=19.06) Almost sixteen percent (n=65) of participants reported ever using emergency contraception. Bivariate analyses indicated that EC use among African American female adolescents was significantly associated with age, education level, job status, receipt of government assistance, age at first sex, knowledge of EC availability and number of average condom errors. The findings in this study are consistent with previous studies exploring social determinants and their relationship to sexual health practices among high risk populations. The findings of this study could be used to design effective pregnancy prevention initiatives including EC education and promotion targeting specific segments of the African American adolescent female population that may be at a greater risk for unintended pregnancies.