Emergency contraception is an effective backup for contraceptive failure. In
Hong Kong, levonorgestrel emergency contraceptive pill is a prescription drug.
In most developed countries, it is provided in advance or over-the-counter to
eliminate the barrier to access. The objective of this thesis is to evaluate the
feasibility and acceptability of these novel delivery modes in Hong Kong. Four
studies were conducted to study pertinent subject matters.
A retrospective review on 11014 clinical records of The Family Planning
Association of Hong Kong on emergency contraception prescription between
2006 and 2008 was performed to delineate the characteristics of emergency
contraceptive users. One-year follow-up data was available in 4728 records,
with 89.4% used emergency contraception once and 8.5% used it twice. The
proportion of subjects not using ongoing contraceptives reduced from 20.6% at
the emergency contraception visit to 4.5% at post-treatment follow-up, 3.9% at
6th month and 3.3% at 12th month. Young age was not associated with not
using ongoing contraceptives and repeat use of emergency contraceptives.
A randomized controlled trial with 1030 women was conducted to compare the
behavior of those given three courses of levonorgestrel emergency
contraceptive pills in advance against those who had to get them from clinics
when needed. After one year, 29.9% of women in the advanced provision
group had used the pills versus 12.9% in the control group (odds ratio 2.87,
95% confidence interval 2.07-3.97). The advanced provision group used three
times more pills than the control group (278 versus 95 courses, p<0.001). The
median coitus-treatment interval in the advanced provision group was
significantly shorter than the control group (11 h versus 20 h; p<0.001). Most
women used condoms before (90%) and during (89%) the study. In both
groups, consistency of use was higher after emergency contraception (65%)
than before (60%) (p<0.001). This study confirmed that advanced provision
increased the utilization of emergency contraceptive pill, facilitated its early
use and did not hamper ongoing contraceptive use.
A questionnaire survey was conducted to evaluate the acceptability of novel
use of emergency contraceptive pill among women practicing contraception.
Of the 1405 questionnaires analyzed, 46.3% of women supported more
advertising on emergency contraception; 48.7% supported advanced provision
of emergency contraceptive pill and 25.7% supported over-the-counter
provision. Another questionnaire survey assessed the attitude of physicians
who provide family planning services. Half (54.2%) of them supported
advanced provision of emergency contraceptive pill; 32.5% supported
advanced provision to girls aged 16 and below and 40.2% supported over-thecounter
provision. Among 352 physicians who provided emergency
contraception, only 21.7% of private family physicians and 15.9% of private
obstetrician-gynaecologists prescribed emergency contraceptive pills in
advance.
In conclusion, local women used emergency contraception responsibly and
remained vigilant with ongoing contraception even when they got pills in
advance. Minority of physicians practice advanced provision. The acceptance
of advanced provision, among women and physicians who do not know much
about it, is around 50%. It is thus possible to improve when more education on
advanced provision is provided. The support for over-the-counter provision
was too weak to boost. / published_or_final_version / Medicine / Master / Doctor of Medicine
| Identifer | oai:union.ndltd.org:HKU/oai:hub.hku.hk:10722/173862 |
| Date | January 2012 |
| Creators | Lo, Seen-tsing, Sue., 羅善清. |
| Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
| Source Sets | Hong Kong University Theses |
| Language | English |
| Detected Language | English |
| Type | PG_Thesis |
| Source | http://hub.hku.hk/bib/B48273570 |
| Rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works., Creative Commons: Attribution 3.0 Hong Kong License |
| Relation | HKU Theses Online (HKUTO) |
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