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postgraduate thesis: Novel use of emergency contraceptive pills in Hong Kong

TitleNovel use of emergency contraceptive pills in Hong Kong
Authors
Issue Date2012
PublisherThe University of Hong Kong (Pokfulam, Hong Kong)
Abstract
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.
DegreeDoctor of Medicine
SubjectEmergency contraceptives - China - Hong Kong.
Dept/ProgramMedicine

 

DC FieldValueLanguage
dc.contributor.authorLo, Seen-tsing, Sue.-
dc.contributor.author羅善清.-
dc.date.issued2012-
dc.description.abstractEmergency 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.-
dc.languageeng-
dc.publisherThe University of Hong Kong (Pokfulam, Hong Kong)-
dc.relation.ispartofHKU Theses Online (HKUTO)-
dc.rightsThe author retains all proprietary rights, (such as patent rights) and the right to use in future works.-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.source.urihttp://hub.hku.hk/bib/B48273570-
dc.subject.lcshEmergency contraceptives - China - Hong Kong.-
dc.titleNovel use of emergency contraceptive pills in Hong Kong-
dc.typePG_Thesis-
dc.identifier.hkulb4827357-
dc.description.thesisnameDoctor of Medicine-
dc.description.thesislevelmaster's-
dc.description.thesisdisciplineMedicine-
dc.description.naturepublished_or_final_version-
dc.date.hkucongregation2012-

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