Kaller Shelly, Mays Aisha, Freedman Lori, Harper Cynthia C, Biggs M Antonia
Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 3333 California St, Suite 335, San Francisco, CA, 94143, USA.
BMC Womens Health. 2020 Jan 28;20(1):15. doi: 10.1186/s12905-020-0886-z.
The recent focus on increasing access to long-acting reversible contraceptive methods has often overlooked the diverse reasons why women may choose less effective methods even when significant access barriers have been removed. While the copper intrauterine device (IUD) is considered an acceptable alternative to emergency contraception pills (ECPs), it is unclear to what extent low rates of provision and use are due to patient preferences versus structural access barriers. This study explores factors that influence patients' choice between ECPs and the copper IUD as EC, including prior experiences with contraception and attitudes toward EC methods, in settings where both options are available at no cost.
We telephone-interviewed 17 patients seeking EC from three San Francisco Bay Area youth-serving clinics that offered the IUD as EC and ECPs as standard practice, regarding their experiences choosing an EC method. We thematically coded all interview transcripts, then summarized the themes related to reasons for choosing ECPs or the IUD as EC.
Ten participants left their EC visit with ECPs and seven with the IUD as EC option. Women chose ECPs because they were familiar and easily accessible. Reasons for not adopting the copper IUD included having had prior negative experiences with the IUD, concerns about its side effects and the placement procedure, and lack of awareness about the copper IUD. Women who chose the IUD as EC did so primarily because of its long-term efficacy, invisibility, lack of hormones, longer window of post-coital utility, and a desire to not rely on ECPs. Women who chose the IUD as EC had not had prior negative experiences with the IUD, had already been interested in the IUD, and were ready and able to have it placed that day.
This study highlights that women have varied and well-considered reasons for choosing each EC method. Both ECPs and the copper IUD are important and acceptable EC options, each with their own features offering benefits to patients. Efforts to destigmatize repeated use of ECPs and validate women's choice of either EC method are needed to support women in their EC method decision-making.
近期对增加长效可逆避孕方法可及性的关注，常常忽视了即便重大的获取障碍已被消除，女性仍可能选择效果较差方法的各种原因。虽然铜宫内节育器（IUD）被认为是紧急避孕药（ECP）的可接受替代方法，但提供率和使用率较低在多大程度上是由于患者偏好而非结构性获取障碍尚不清楚。本研究探讨在两种选择均免费提供的情况下，影响患者在ECP和铜IUD作为紧急避孕方法之间选择的因素，包括既往避孕经历以及对紧急避孕方法的态度。
我们对来自旧金山湾区三家为青少年服务的诊所的17名寻求紧急避孕的患者进行了电话访谈，这些诊所将IUD作为紧急避孕方法且将ECP作为常规做法，询问她们选择紧急避孕方法的经历。我们对所有访谈记录进行主题编码，然后总结与选择ECP或IUD作为紧急避孕方法的原因相关的主题。
10名参与者离开紧急避孕就诊时选择了ECP，7名选择了IUD作为紧急避孕方法。女性选择ECP是因为它们熟悉且易于获取。不采用铜IUD的原因包括既往有过IUD的负面经历、对其副作用和放置过程的担忧，以及对铜IUD缺乏了解。选择IUD作为紧急避孕方法的女性主要是因为其长期有效性、不可见性、不含激素、性交后使用窗口期更长，以及不想依赖ECP。选择IUD作为紧急避孕方法的女性既往没有IUD的负面经历，已经对IUD感兴趣，并且当天准备好且能够放置。
本研究强调女性选择每种紧急避孕方法都有多样且经过深思熟虑的原因。ECP和铜IUD都是重要且可接受的紧急避孕选择，各自具有为患者带来益处的特点。需要努力消除对重复使用ECP的污名化，并认可女性对任何一种紧急避孕方法的选择，以支持女性进行紧急避孕方法的决策。
