The visit before the morning after: barriers to preprescribing emergency contraception.
BACKGROUND
Research suggests that while advance prescription of emergency contraception (EC) increases women's access, this prescribing model is rarely used. The present study sought to explore attitudes towards EC among patients and physicians, with the goal of understanding potential barriers to advance prescription.


METHODS
Qualitative, semistructured interviews were conducted with patients and clinicians in a New York City family practice clinic.


RESULTS
Using qualitative interviews, we found that attitudes towards EC among patients and clinicians are complex. Both groups of participants reported favorable attitudes towards EC. There was general agreement that physicians should take a proactive role in educating patients about the method. A notable minority in each group described substantial reservations, however, especially regarding the potential for EC abuse. Such attitudes emerged mainly in the context of discussions about advance prescription. Advance prescription was viewed as greatly facilitating access to EC, but some patients and clinicians feared that ready access would encourage irresponsible sex. Some participants condoned the occasional, accidental, or emergency use of EC; however, habitual use, or the plan not to plan for sex, was viewed as morally indefensible.


CONCLUSIONS
Findings suggest that even when attitudes towards EC are generally favorable, some physicians and patients have substantial reservations about advance prescription. Education and dialogue are needed to overcome these reservations.
Karasz
Alison
A
Albert Einstein College of Medicine, Bronx, NY 10467, USA. akkarasz@montefiore.org
Kirchen
Nicole Tan
NT
Gold
Marji
M
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003281:Contraceptives, Postcoital; D011307:Drug Prescriptions; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D012725:Sexual Behavior
D003281:Contraceptives, Postcoital