Emergency contraceptive pill users’ risk perceptions for sexually transmitted infections and future unintended pregnancy
Unintended pregnancies and sexually transmitted infections (STIs) are major public health concerns and key priorities of Healthy People 2020 (U.S. Department of Health and Human Services [USDHHS], 2013). Women between the ages of 18 and 24 are disproportionately affected by these consequences of sexual activity (Centers for Disease Control and Prevention [CDC], 2009; Guttmacher Institute, 2012; Jones, Mosher, & Daniels, 2012; Mosher, Jones, & Abma, 2012). Approximately half of all pregnancies in the United States are unintended; women between the ages of 15 and 29 have the highest rates (Guttmacher Institute, 2012; Jones et al., 2012; Mosher et al., 2012). Between 2006 and 2010, nearly 42% of women aged 20–24 were not using a method of contraception; of those who were using contraceptives, oral contraceptives are the most common particularly among younger, white women (Jones et al., 2012). Condom use has also declined from 32% in 1995 to 22% in 2006–2010, particularly among never married women (Jones et al., 2012). STIs have reached epidemic proportions, with nearly 19 million new infections reported each year (CDC, 2009). Chlamydia and gonorrhea are the two most commonly reported bacterial STIs, particularly among women between the ages of 15 and 24 (CDC, 2009). Low‐risk perception, increased risk taking, and a lack of preventive or protective behaviors related to sexual activity, particularly among young adults, are associated with the increased prevalence of both STIs and unintended pregnancy in this age group (Certain, Harahan, Saewyc, & Fleming, 2009; Corbett, Mitchell, Taylor, & Kemppainen, 2006; Hickey, 2009; Hickey & Cleland, 2013; Moore & Smith, 2012; Neustadt, Holmquist, Davis, & Gilliam, 2011). Decreased risk perception and decreased condom use has been noted among those in this age group with fewer lifetime partners or one current partner (Hickey & Cleland, 2013; Masaro, Dahinten, Johnson, Ogilvie, & Patrick, 2008).
In an attempt to reduce the numbers of unintended pregnancy, in 2006, the progestin‐only oral form of emergency contraception pills (ECPs), Plan B, became available “over the counter” (OTC), meaning without a prescription Food and Drug Administration [FDA], 2006. At that time, women were able to go to the pharmacy counter and request emergency contraception, or Plan B. In 2013, age restrictions were reduced to 16, and ECP was moved from behind the pharmacy counter to directly “on the shelf” (Guttmacher Institute, 2012). Despite the increased availability, barriers to access and use still exist, including cost, confidentiality, and incomplete and inaccurate information among potential users (Corbett et al., 2006; Hickey, 2009; Hickey & White, 2015; Johnson, Nshom, Nye, & Cohall, 2010; Kavanaugh, Williams, & Schwarz, 2011). Various researchers have noted that women do not obtain information on sexual and reproductive health, including ECP, from healthcare providers (Corbett et al., 2006; Hickey, 2009; Hickey & White, 2015; Kavanaugh et al., 2011; Moore & Smith, 2012). This is an important consideration given the increased access.
Since its availability OTC in 2006, almost no research has been done with direct OTC ECP users, and none specifically investigating the risks or perception of risk for STI and/or future unintended pregnancy with this group. Analysis of the National Survey of Family Growth (NSFG) data explored the relationship between ECP use and use of STI testing services; however, the data do not distinguish advanced provision of ECP, prescription ECP, or OTC ECP, nor is there a link between direct ECP use and intentional STI testing related to that use (Habel & Leichliter, 2012).