As emergency contraceptive pills (ECPs) are being
incorporated into family planning programs and dedicated products are
being registered in more countries, the word is spreading among youth
that ECPs are available to help prevent pregnancy after unprotected
intercourse. But youths' detailed knowledge of ECPs is limited, and
their rates of use are still low.1 According to Dr. Irina
Yacobson, an associate medical director at FHI and youth-friendly
services specialist for FHI's YouthNet program, one of several ways to
increase youths' knowledge and use of ECPs is to focus on pharmacies —
a growing outlet for ECP information and provision.
"In countries where ECPs are available
through pharmacies, youth prefer to go to a pharmacy for ECPs because it
is a convenient way to obtain services and has fewer barriers than many
traditional outlets," says Dr. Yacobson. But more youth need to
know that pharmacies can provide ECP services, and pharmacists need to
take a greater interest in distributing ECP information, she says.
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A PATH brochure directs youth to pharmacies for
emergency contraceptive pills.
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Studies from Zambia and the United Kingdom have
shown that youth often view staff from traditional health care
facilities as unwelcoming and judgmental, and may not seek their
services because of embarrassment, lack of privacy, and the fact that
clinics may not be open when emergency contraception is needed.2
To identify alternative outlets for ECP services in Zambia, the
Population Council, CARE/Zambia, Lusaka's University Teaching Hospital,
and the Zambia Society for Family Health conducted a study in which
clinic-based health care providers, pharmacists, peer counselors, and
community sales agents were trained to provide ECP information and, if
possible, services. Resear-chers then measured, among other outcomes,
how many of some 400 women in the study visited each group of providers
and how effective each group was at delivering ECP information and
services.3
Pharmacists proved to be the lead provider of
both ECP information and pills. About half of youth in the study turned
to pharmacists for information and nearly three-quarters for ECP
provision. However, pharmacists were the least likely of all the groups
to offer clients detailed information about ECPs or to offer information
on alternative contraceptive options. They did not raise the issue of
sexually transmitted infections (STIs), and they were just as likely not
to mention the potential side effects of emergency contraception as they
were to do so, noted the authors of a report on the study.
Because some pharmacists may be uncomfortable
discussing family planning issues in public and clients want to maintain
their privacy, providing information that clients can read on their own
may help pharmacies in Zambia to better serve youth needing ECPs. For
instance, once a dedicated ECP product is available there, an insert
that provides accurate information about ECPs could be created. An ECP
brochure could also be developed and distributed to youth who visit the
pharmacies, the authors recommended.
The U.S.-based Program for Appropriate Technology
for Health (PATH) is conducting a three-year project in Cambodia, Kenya,
and Nicaragua to strengthen pharmacies' capacity to provide
youth-friendly reproductive health services focused on needs arising
from unprotected intercourse. Emergency contraception is one of those
needs, says Jolene Beitz, a program associate at PATH. (The project also
emphasizes STI risk assessment and contraceptive management.) If
successful, the Reproductive Health Access Project — which is funded
by the William and Flora Hewlett Foundation and is now in its final year
— may serve as a model for other developing countries where pharmacies
provide reproductive health services to youth.
As part of the project, educational materials for
clients and providers are being developed, and pharmacists and other
frontline staff are being trained to give youth correct, up-to-date ECP
information and services, including provision, counseling, and referral.
An outreach component is also being implemented in collaboration with
local youth-service organizations. "The purpose of this component
is to increase peer counselors' knowledge about emergency contraception
and to increase their knowledge that pharmacies, as well as traditional
health care facilities, are available to provide emergency contraception
and other reproductive health information and services," says Beitz.
— Kerry L. Wright
YouthLens is an activity of YouthNet, a
five-year program coordinated by FHI and funded by the U.S. Agency for
International Development to improve reproductive health and prevent
HIV/AIDS among young people.
References
- Arowojolu AO, Adekunle AO. Perception and practice
of emergency contraception by post-secondary school students in
southwest Nigeria. Afr J Reprod Health 2000;4(1):56-65;
Arowojolu AO, Adekunle AO. Knowledge and practice of emergency
contraception among Nigerian youths. Int J Gynaecol Obstet
1999;66(1):31-32; Sorhaindo A, Becker D, Fletcher H, et al.
Emergency contraception among university students in Kingston,
Jamaica: a survey of knowledge, attitudes, and practices. Contraception
2002:66(4):261-68.
- Ahmed Y, Ketata M, Skibiak J. Emergency
Contraception in Zambia: Setting a New Agenda for Research and
Action. Nairobi, Kenya: Population Council, 1998; Bullock J.
Raising awareness of emergency contraception. Community Nurse
1997:3(7):28-29.
- Skibiak JP, Chambeshi-Moyo M, Ahmed Y. Testing
Alternative Channels for Providing Emergency Contraception to Young
Women. Final Report. New York, NY: Population Council, 2001.
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