Jamaican and Barbadian health care providers' knowledge, attitudes and practices regarding emergency contraceptive pills

Abstract

Context: Little is known about healthcare providers' knowledge of, attitudes toward and provision of emergency contraceptive pills in the English-speaking Caribbean, where sexual violence and unplanned pregnancies are persistent public health problems. Methods: We conducted interviewer-administered surveys of 2OO Barbadian and 228 Jamaican pharmacists, general practitioners, obstetrician-gynecologists and nurses in 2005-2006. For each country, Pearson's chi-square tests were used to assess differences in responses among the four provider groups. Results: Nearly all respondents had heard of emergency contraceptive pills, and large majorities of Barbadian and Jamaican providers had dispensed the method. However, about half had ever refused to dispense it; frequently cited reasons were medical contraindications to use, recent use, method unavailability, safety concerns and being uncomfortable prescribing it. Only one in five providers knew that the method could be safely used as often as needed, and few knew that it was effective if taken within 120 hours of unprotected sexual intercourse. About a quarter of Barbadian and half of Jamaican providers thought the method should be available without a prescription, and half of all providers believed that its use encourages sexual risk-taking and leads to increased STI transmission. Nonetheless most respondents believed the method was necessary to reduce rates of unintended pregnancy and were willing to dispense it to rape victims, women who had experienced condom failure and women who had not used a contraceptive. Conclusions: Future educational efforts among Jamaican and Barbadian health care providers should emphasize the safety and proper use of emergency contraceptive pills, as well as the need to increase the availability of the method.