Unintended pregnancy: What more can we do?

Prevention is better than cure – especially in the field of sexual and reproductive health and especially in Australia, where the teenage pregnancy and abortion rate is higher than in any other Western country.

Such rates are not inevitable, and recent contraceptive strategies, including improved access to the emergency contraceptive pill (ECP) through over the counter methods, have been developed to help reduced the high numbers.

A recent Monash University study of over 600 women aged 16 to 35 years found that although 95 per cent had heard of the ECP and 26 per cent had used it, just under half (48 per cent) were aware that the ECP was available over the counter.

Under half the participants (45 per cent) thought the ECP was safe and most (61 per cent) believed it would damage a pre-existing pregnancy.

Dr. Safeera Hussainy from the Center for Medicine Use and Safety at Monash University said that access to the ECP was a crucial issue, given that the sooner it is taken after unprotected intercourse, the more effective it is.

In fact, a recent study has shown that the ECP has proven efficacy up to 96 hours (4 days) after intercourse, and while there is no harm in giving it up to the fifth day (120 hours) post coitus, there is greater than a five times increase in risk of pregnancy compared to administration within the first 24 hours.

“By making the emergency contraceptive pill available over the counter, we hope that women are able to obtain the pill more easily within the narrow time frame recommended, especially after hours and on weekends when it is more difficult to access a general practitioner,” said Dr. Hussainy.

The study showed that various views and beliefs influenced women’s attitudes towards the ECP. They included moral and religious reasons, fear of side effects and unrealistically low perceptions of pregnancy risk.

Surprisingly, some women thought they were unlikely to become pregnant, even when having unprotected intercourse at the most fertile time of the menstrual cycle.

Through the study, the research group found that women prefer to receive information from a doctor rather than a pharmacist, offering an important opportunity for GPs to help patients prevent unintended pregnancy and abortion.

“GPs can play a critical role in educating women about their risks of becoming pregnant, the use of contraceptives generally and how to use them correctly and consistently.”

“Although women are being offered greater options when making the decision about unintended pregnancy, there is still a need to generate awareness about what is available and how it can be accessed,” said Dr. Hussainy.

The Center for Medicine Use and Safety at Monash University works collaboratively with health care professionals and researchers to develop, implement and evaluate new models and systems of health care practice, with the ultimate goal of optimizing the safe and effective use of medicines.

The report, Unintended pregnancy in Australia: what more can we do? was published in the August issue Medical Journal of Australia.