IMR Press / CEOG / Volume 47 / Issue 1 / DOI: 10.31083/j.ceog.2020.01.5280
Open Access Original Research
Knowledge and availability of the emergency contraceptive pills: an Italian women survey
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1 Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, University of Ferrara, Ferrara
2 Department of Gynecological and Urological Sciences, “Sapienza” University of Rome, Rome
3 Department of Medical and Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Rome
4 Complex Operative Unit of Obstetrics and Gynecology, “Alto Tevere” Hospital of Città di Castello, ASL 1 Umbria
5 School of Law, Legal medicine. University of Camerino, Italy
Clin. Exp. Obstet. Gynecol. 2020 , 47(1), 93–98; https://doi.org/10.31083/j.ceog.2020.01.5280
Published: 15 February 2020
Abstract

Aim: Assessing to what extent do Italian women actually know about the emergency contraceptive pills and about their availability. Materials and Methods: A 12-questions questionnaire was organized to investigate the knowledge about the emergency contraceptive pills in a sample of Italian women. The sample was built by sending the questionnaire on time, by using the Computer Assisted Web Interviewing (CAWI). Both open and closed answers were collected. Results: 1, 580 eligible women fully answered the questionnaire. It appears that women still face some difficulties to obtain emergency contraceptive pills and have poor knowledge about how the post-coital pills work, and how they can obtain them in Italy. The difficulties to obtain emergency contraceptive pills seems to be in relation to the pharmacologists’ resistance to provide them. Women’s perception of the pharmacologists’ resistance to provide pills is unspecific. Conclusion: The pharmacologists’ resistance to provide pills should be best investigated, as ethical goals and liability issues could be both involved.

Keywords
Emergency contraceptive pills
Liability
Computer Assisted Web Interviewing (CAWI)
Introduction

Emergency contraception refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse at risk for fertilization. These are recommended for use within five days, but are more effective the sooner they are used after the act of intercourse. Both pills and intrauterine copper devices are recommended for emergency contraception, and it is not acknowledged these provoke abortion [1].

Emergency contraceptive pills (post coital pills) prevent pregnancy by preventing or delaying ovulation. There are no absolute contraindications for using emergency contraceptive pills at any age of a fertile woman aiming to prevent an unintended pregnancy [1]. Two pills have been registered worldwide as emergency contraceptives. The first one is the levonorgestrel-based pill, while the second one is the ulipristal-acetate based pill (also called “five day-pill”). Both are effective in preventing the fertilization with similar pregnancy rate [2,3]. Side effects of emergency contraceptive pills are not common, mild, and do not need further medications [1].

In Italy, both levonorgestrel-based and ulipristal-acetate pills are bought at the pharmacy. From 2011 to 2015, the ulipristal-acetate pill was available with some restrictions: it was mandatory a medical prescription and a negative pregnancy blood sample test. After 2015, the medical prescription for ulipristal-acetate pill is only mandatory for less than 18-year-old women (without pregnancy test), and, since 2016, same kind of prescription to younger women is needed for the levonorgestrel pill. In summary, the Italian law has been organized with the aim to facilitate availability to emergency contraception for preventing unwanted pregnancy. However, in the past, the suspicious that both emergency pills could provoke abortion (by interfering with the implant processes) still causes many religious concerns among physicians and pharmacologists, leading to hamper the availability of the emergency contraception.

The aim of the following investigation is to assess to what extent do Italian women know about the emergency contraceptive pills and about their availability.

Materials and Methods

A 12-question questionnaire was organized to investigate the knowledge about the emergency contraceptive pills in a sample of Italian women. The questions’ scheme was adapted according to the questionnaire already administered to women and pharmacists in 2015 [4]. The 2015 questionnaire aimed to assess the ulipristalacetate pill availability in Italy after the Italian governmental change in the prescription of emergency contraceptive ulipristalacetate pill.

The questions of the current questionnaire are listed in Table 1 and were administered from the first to the last one. Responders did not known the succeeding question before answering the previous one, thereby avoiding conditioning. The answers are both closed and open, providing the chance to give comments or to answer with open statements to the questions. For questions 2 and 7, an additional question was queried in case of the answer “no” (Question 2) or “hardly” and “very hardly” (Question 7). The concepts expressed in the open answers were summarized and aggregated, when appropriate. The questionnaire was administered in Italian language between April 2018 and August 2018.

Women enrolled were between 18- and 40-years-old and they could not be neither physicians nor pharmacists. The sample was built by sending the questionnaire by e-mail, by using the Computer Assisted Web Interviewing (CAWI). The questionnaire was build by using “Google moduli”. The link of the questionnaire form was sent by e-mails or by Facebook and WhatsApp contacts of one of the Author (Anna Clara Castigliego) of this paper. People contacted were invited to share the questionnaire by using the same social-network way. An additional way of administration of the questionnaire was through direct interview, in crowded places, drawn by Anna Clara Castigliego. Women were invited to communicate some information (age, education, place of Italy where they were from, parity, previous pregnancy interruption), along with the answers to the questionnaire. All data were treated anonymously according to Italian law. Incomplete questionnaires or information and questionnaires with nonsense open answers were rejected. The answers and the general information of women were crossed in order to find relationships in a univariate way. Chisquare test was used for comparisons, with a p-value set at ≤ 0.01 for significance.

Results

1, 490 questionnaires were sent by the CAWI technique, while 182 were collected by direct interview. Among them, 1, 580 eligible women fully answered to the questionnaire (1, 419 online and 161 direct interview).

Table 1 reports rates of each answer for each question, along with details of open answers. Tables 2 and 3 report crude numbers and rates of age, education, place of Italy where the women were from, parity and previous pregnancy interruption in the first lines. The Tables also report answering rate according to general information provided by women (age, education, place of Italy where the women were from, parity, and previous pregnancy interruption) along with univariate comparisons. Significant results indicated that age and/or education and/or place of Italy where the women were from and/or parity and/or previous pregnancy interruption conditioned the answers rates.

As it appears in Tables 2 and 3, the majority of interviewed were young (between 18- and 24-years old) and 79.7% were under 30 years. Therefore, the majority of interviewed were students, with middle or secondary school bachelor and they did have not had previous pregnancies (higher proportion of nulliparas and with no previous pregnancy interruption). Concerning the place of Italy were the women were from, the sampling was overall homogeneous, with a higher prevalence of respondents from the center of Italy. A smallest quote of respondents were not Italian, but lived in Italy and participated to the Italian health system. It was chosen to provide data even for this small proportion of patients.

The wide majority of interviewed feel it is appropriate to plan a pregnancy (Question 1). Education and parity significantly condition the rates of answers. Additionally, the wide majority of interviewed are in favour of oral contraceptive use (Question 2). The wide majority of women know the “post-coital pill” (Question 3), despite many respondents do not know both pills (Question 4), and someone mistakes the abortive pill (RU486) or the common contraceptive pill with the emergency contraceptive pill (Table 1). Less than an half of women disclosed they have taken the emergency contraception pill (Question 5). Age, place of Italy, education, and previous pregnancy interruption condition the rates of answers. Assessing answers of Question 6, it appears that a consistent proportion of respondents (18.2%) think that the “post-coital pill” is useless, and 9.3% provided other answers, suggesting poor knowledge of the “post-coital pills” or own religious beliefs (Table 1). Place of Italy where women were from conditioned the rates of answers. A quite large proportion of women found it difficult to obtain the “post-coital pill” (Question 7). Reasons seems linked with the need of the prescription (Table 1).

10.31083/j.ceog.2020.01.5280.t0001 Table 1List of questions and rates of answers.
Question 1. Do you think is right that the women plan the pregnancy?-Yes-No 1541 (97.5%)39 (2.5%)
Question 2. Are you in favour to the oral contraceptive use?-Yes-No 1497 (94.7%)83 (5.3%) If no, why?-Religious believing-Harmful for the health -I do not know-Others 14 (16.9%)55 (66.3%)7 (8.4%)7 (8.4%)
Question 3. Do you know the “post coital” pill?-Yes-No 1573 (99.6%)7 (0.4%)
Question 4. Which “post coital” pill do you know?-Levonorgestrel pill (trade name)-Ulipristal acetate (trade name)-Both levonorgestrel and ulipristal acetate pill-I do not know-Others 372 (23.5%)224 (14.2%)33 (2.1%)947 (59.9%)4 (0.3%) Detail of answers for “others”:-Estroprogestinic pills-RU486 3 (75.0%)1 (25.0%)
Question 5. How many time did you take the “post coital” pill?-Never-1-2 -3 or more 1000 (63.3%)366 (23.2%)144 (9.1%)70 (4.4%)
Question 6. Do you think that the “post coital” pill is:-Useful-Useless-Others 1146 (72.5%)287 (18.2%)147 (9.3%) Detail of answers for “others”:-Useful but harmful-I do not know-To be used cautiously-Unnecessary-To be banned-It causes abortions 55 (37.4%)18 (12.2%)56 (38.1%)9 (6.1%)8 (5.4%)1 (0.7%)
Question 7. In your opinion, is the “post coital” pill easily available?-Very easily-Quite easily-Hardly-Very hardly-I do not know 197 (12.5%)629 (39.8%)421 (26.6%)122 (7.7%)211 (13.4%) If you answered hardly or very hardly, why?*-Pharmacologists resistance-It's hard to obtain the prescription within 24 hours-Pharmacologists want the prescription-A pregnancy test is needed-I do not know-Conscience objection of the physicians or pharmacologists-Others 192 (25.5%)224 (29.7%)185 (24.6%)8 (1.1%)111 (14.7%)25 (3.3%)8 (1.1%)
Question 8. In your opinion, how does the “post coital” pill work?-Causing abortion-Interfering with ovulation-Others 545 (34.5%)638 (40.4%)397 (25.1%) Detail for “others”-I do not know-blocking the onset of the pregnancy-causing menstruation-killing or blocking the spermatozoa-blocking the pregnancy implant 315 (79.4%)30 (7.6%)7 (1.8%)3 (0.08%)42 (10.6%)
Question 9. Do you know that, if the pregnancy is implanted on the uterine wall, the “post coital” pill could not work?-Yes-No 974 (61.6%)606 (38.4%)
Question 10. The last available “post coital” pill name is “trade name” (ulipristal acetate). It is also called 5-days pill. From your knowledge, do you know if the medical doctor prescription is needed to buy it?-Yes-No -I do not know 277 (17.5%)568 (35.9%)735 (46.5%)
Question 11. In your opinion, do women face resistance by pharmacologists for obtaining the “5-days pill”, despite the medical doctor prescription is not needed?-A lot of resistance-Quite resistance-Little resistance-No resistance-I do not know 110 (7.0%)513 (32.5%)233 (14.7%)102 (6.5%)622 (39.4%)
Question 12. In your opinion, why the pharmacologists make resistance to provide the 5-days pill?-They are against abortion/conscience objection-It is harmful-They want prescription-Religious believing-I do not know-Others 572 (36.2%)404 (25.6%)176 (11.1%)23 (1.5%)383 (24.2%)22 (1.4%) Detail for “others”-They would that a physician ascertain the health wellness-Defensive policy-They do not want to exceed in the assumption-Because the prescription is mandatory-To empower in using the drug-Because it is expensive 2 (9.1%)2 (9.1%)11 (50.0%)2 (9.1%)4 (18.2%)1 (4.5%)

More than an half of the interviewed did not know how the emergency contraceptive pills works (Question 8). Age, place of Italy where the women were from, and parity affected the rate of answers. The answers given to the Question 9 confirm that women poorly know how the emergency contraceptive pills work. The Questions from 10 to 12 investigate how difficult is to obtain the five-day pill and why. It seems that the need of prescription is sometimes advocated to create resistance to give the pill, while the resistance of the pharmacologists to provide the pill seems unspecific. Age, place of Italy where the women were from, and parity affected the rate of answers for Questions 10, 11, and 12.

Discussion

Information from the current questionnaire should be retained for improving the knowledge on the availability of the emergency contraceptive pills in Italy. As reported below, in 2015 [4], a similar online interview of Italian women and pharmacists had highlighted that the availability of ulipristal acetate pill and of the post-coital pills overall was difficult due to resistance of pharmacists to provide them. Results from the current questionnaire, drawn in 2018, confirm that the behavior of the Italian pharmacists remain unchanged from the women’s point of view, despite the diffusion of the knowledge that the post-coital pills are safe and easily available. The resistance of Italian pharmacists does not seem linked only to religious concern, or, in case of religious concern, it cannot be excluded that it is advocated to avoid providing emergency contraception. It is unclear if such a kind of resistance of the pharmacists could favor the misunderstanding of emergency contraception for women, who feel that the pharmacists are aware that the pills are dangerous. Poor knowledge of emergency contraceptive pills seems in relation to age, education, and place of Italy where respondents were from (rates of answers for Question 6, 7, and 8). It could be supposed that, if women were not well informed about the emergency contraceptive pills, they referred to pharmacists for counseling on the post-coital pills, and, for avoiding liability, the pharmacists delegate the counseling to physicians by querying the prescription of emergency contraception. As in Italy, the jurisprudence orientation has acknowledged that the pharmacist has not liability if he carefully follows the prescription of the physicians [5]; can the pharmacist pose resistance for the emergency contraception to be a “defensive pharmacology?” Recently, in United States, Lio et al. [6] have reported that the discomfort of pharmacists to provide contraception was linked to concern on liability, confirming similar behavior previously suggested by Hilverding et al. [7] and by Rodriguez et al. [8] in case of pharmacists’ prescription of contraceptives. Moreover, since 2014, Italian pharmacists have also acknowledged that the prescription of some drugs is needed to avoid abuse, minimize risks, and educate patients on the correct use of medicines [9], thereby achievig their ethical goal of providing the best drugs administration. Therefore, it could be supposed that the current resistance of pharmacists to provide emergency contraception would involve at least ethic, religious, and liability issues in Italy.

10.31083/j.ceog.2020.01.5280.t0002 Table 2Descriptive and inferential statistics. Sub-groups analyses for each question.
Age Place of Italy Education Parity Previous pregnancy interruption
18-24771 48.8% 25-30489 30.9% 31-35168 10.6% 35-40152 9.6% North463 29.3% Middle618 39.1% South483 30.6% Foreigner16 1.0% Middle school88 5.6% Secondary school770 48.7% University degree722 46.0% Nulliparity1272 80.5% Multiparity308 19.5% Yes98 6.2% No1482 93.8%
Question 1YesNo 756 98.1%15 1.9% 475 97.1%14 2.9% 162 96.4%6 3.6% 148 97.4%4 2.6% 454 98.1%9 1.9% 603 97.6%15 2.4% 469 97.1%14 2.9% 15 93.8%1 6.3% 78 88.6%10 11.4% 754 97.9%16 2.1% 709 98.2%13 1.8% 1250 98.3%22 1.7% 291 94.5%17 5.5% 92 93.9%6 6.1% 1449 97.8%33 2.2%
P=0.267 P=0.825 P<0.001 P<0.001 P=0.038
Question 2FavoredUnfavored 735 95.3%36 4.7% 458 93.7%31 6.8% 163 97.0%5 3.0% 141 92.8%11 7.2% 450 95.5%13 2.8% 586 94.8 %32 5.2% 446 92.3%37 7.7% 15 93.8%1 6.3% 81 92.0%7 8.0% 731 94.9%39 5.1% 685 94.9%37 5.1% 1208 95%64 5.0% 289 93.8%19 6.2% 92 93.9%6 6.1% 1405 94.8%77 5.2%
P=0.267 P=0.013 P=0.504 P=0.509 P=0.869
Question 3YesNo 768 99.6%3 0.4% 487 99.6%2 0.4% 166 98.8%2 1.2% 151 99.3%1 0.7% 463 100%0 614 99.4%4 0.6% 480 99.4%3 0.6% 16 100%0 87 98.9%1 1.1% 767 99.6%3 0.4% 719 99.6%3 0.4% 1269 99.8%3 0.2% 304 98.7%4 1.3% 98 100%0 1475 99.5%7 0.5%
P=0.803 P=0.518 P=0.600 P=0.041 P=0.918
Question 4LevonorgestrelUlipristalBothI do not knowOther 153 19.8%137 17.8%18 2.3%461 59.8%2 0.3% 144 29.4%64 13.1%12 2.4%268 54.8%1 0.2% 44 26.2%16 9.5%3 1.9%105 62.5%0 31 20.4%7 4.6%0113 74.3%1 0.7% 96 20.7%79 17.1%12 2.6%276 59.6%0 134 21.7%90 14.6%8 1.3%383 62.0%3 0.5% 139 28.8%51 10.6%13 2.7%279 57.8%1 0.2% 3 18.8%4 25.0%09 56.3%0 10 11.4%15 17.0%1 1.1%61 69.3%1 1.1% 169 21.9%116 15.1%15 1.9%469 60.9%1 0.1% 193 26.7%93 12.9%17 2.4%417 57.8%2 0.3% 313 24.6%195 15.3%30 2.4%730 57.4%4 0.3% 59 19.2%29 9.4%3 1.0%217 70.5%0 31 31.6%12 12.2%3 3.1%51 52.0%1 1.0% 341 23.0%212 14.3%30 2.0%896 60.5%3 0.2%
P<0.001 P<0.001 P<0.002 P<0.001 P=0.127
Question 5Never12 3 or more 524 68.0%155 20.1%63 8.2%29 3.8% 267 54.6%139 28.4%51 10.4%32 6.5% 96 57.1%42 25.0%23 13.7%7 4.2% 113 74.3%30 19.7%7 4.6%2 1.3% 288 62.2%119 25.7%36 7.8%20 4.3% 395 63.9%145 23.5%56 9.1%22 3.6% 309 64.0%99 20.5%48 9.9%27 4.4% 8 50.0%3 18.8%4 25.0%1 6.3% 60 68.2%21 23.9%6 6.8%1 1.1% 516 67.0%158 20.5%62 8.1%34 4.4% 424 58.7%187 25.9%76 10.5%35 4.8% 792 62.3%293 23.0%124 9.7%63 5.0% 208 67.5%73 23.7%20 6.5%7 2.3% 40 40.8%35 35.7%14 14.3%9 9.2% 960 64.8%331 22.3%130 8.8%61 4.1%
P<0.001 P=0.010 P=0.006 P=0.059 P<0.001
Question 6UsefulUselessOther 559 72.5%141 18.3%71 9.2% 357 73.0%82 16.8%50 10.2% 126 75.0%27 16.1%15 8.9% 104 68.4%37 24.3%11 7.2% 363 78.4%62 13.4%38 8.2% 447 72.3%101 16.3%70 11.3% 324 67.1%122 25.3%37 7.7% 12 75.0%2 12.5%2 12.5% 59 67.0%21 23.9%8 9.1% 556 72.2%140 18.2%74 9.6% 531 73.5%126 17.5%65 9.0% 933 73.3%221 17.4% 118 9.3% 213 69.2%66 21.4%29 9.4% 77 78.6%19 19.4%2 2.0% 1069 72.1%268 18.1%145 9.8%
P=0.213 P<0.001 P=0.661 P=0.240 P=0.038
Question 7Very easyQuite easyHardVery hardI do not know 110 14.3%330 42.8%195 25.3%48 6.2%88 11.4% 56 11.5%204 41.7%144 29.4%41 8.4%44 9.0% 18 10.7%52 31.0%53 31.5%10 6.0%35 20.8% 13 8.6%43 28.3%29 19.1%23 15.1%44 28.9% 66 14.3%198 42.8%115 24.8%32 6.9%52 11.2% 68 11.0%236 38.2%158 25.6%57 9.2%99 16.0% 58 12.0%191 39.5%142 29.4%32 6.6%60 12.4% 5 31.3%4 25.0%6 37.5%1 6.3%0 12 13.6%33 37.5%15 17.0%4 4.5%24 27.3% 104 13.5%321 41.7%183 23.8%56 7.3%106 13.8% 81 11.2%275 38.1%223 30.9%62 8.6%81 11.2% 159 12.5%526 41.4%352 27.7%94 7.4%141 11.1% 38 12.3%103 33.4%69 22.4%28 9.1%70 22.7% 11 11.2%30 30.6%32 32.7%14 14.3%11 11.2% 186 12.6%599 40.4%389 26.2%108 7.3%200 13.5%
P<0.001 P<0.001 P<0.001 P<0.001 P=0.041
10.31083/j.ceog.2020.01.5280.t0003 Table 3Descriptive and inferential statistics. Sub-groups analyses for each question (following).
Age Place of Italy Education Parity Previous pregnancy interruption
18-24771 48.8% 25-30489 30.9% 31-35168 10.6% 35-40152 9.6% North463 29.3% Middle618 39.1% South483 30.6% Foreigner16 1.0% Middle school88 5.6% Secondary school770 48.7% University degree722 46.0% Nulliparity1272 80.5% Multiparity308 19.5% Yes98 6.2% No1482 93.8%
Question 8Causing abortionInterf. with ovulationOther 251 32.6%347 45.0%173 22.4% 157 32.1%214 43.8%118 24.1% 62 36.9%51 30.4%55 32.7% 75 49.3%26 17.1%51 33.6% 127 27.4%234 50.5%102 22.0% 252 40.8%213 34.5%153 24.8% 162 33.5%185 38.3%136 28.2% 4 25.0%6 37.5%6 37.5% 30 34.1%25 28.4%33 37.5% 271 35.2%323 41.9%176 22.9% 244 33.8%290 40.2%188 26.0% 414 32.5%567 44.6%291 22.9% 131 42.5%71 23.1%106 34.4% 42 42.9%37 37.8%19 19.4% 503 33.9%601 40.6%378 25.5%
P<0.001 P<0.001 P=0.027 P<0.001 P=0.160
Question 9YesNo 502 65.1%269 34.9% 326 66.7%163 33.3% 78 46.4% 90 53.6% 68 44.7%84 55.3% 311 67.2%152 32.8% 344 55.7%274 44.3% 305 63.1%178 36.9% 14 87.5%2 12.5% 45 51.1%43 48.9% 473 61.4%297 38.6% 456 63.2%266 36.8% 844 66.4%428 33.6% 130 42.2%178 57.8% 62 63.3%36 36.7% 912 61.5%570 38.5%
P<0.001 P<0.001 P=0.090 P<0.001 0.816
Question 10YesNo I do not know 113 14.7%319 41.4%339 44.0% 88 18.0%172 35.2%229 46.8% 38 22.6%43 25.6%87 51.8% 38 25.0%34 22.4%80 52.6% 60 13.0%215 46.4%188 40.6% 126 20.4%194 31.4%298 48.2% 86 17.8%153 31.7%244 50.5% 5 31.3%6 37.5%5 31.5% 24 27.3%23 26.1%41 46.6% 121 15.7%274 35.6%375 48.7% 132 18.3%271 37.5%319 44.2% 215 16.9%499 39.2%558 43.9% 62 20.1%69 22.4%177 57.5% 27 27.6%37 37.8%34 34.7% 250 16.9%531 35.8%701 47.3%
P<0.001 P<0.001 P=0.027 P<0.001 P=0.010
Question 11A lot of resistanceQuite resistanceLittle resistanceNo resistanceI do not know 48 6.2%282 36.6%147 19.1%51 6.6%243 31.5% 31 6.3%165 33.7%55 11.2%32 6.5%206 42.1% 15 8.9%39 23.2%17 10.1%13 7.7%84 50.0% 16 10.5%27 17.8%14 9.2%6 3.9%89 58.6% 35 7.6%183 39.5%72 15.5%29 6.3%144 31.1% 42 6.8%181 29.3%90 14.6%36 5.8%269 43.5% 33 6.8%142 29.4%71 14.7%34 7.0%203 42.0% 07 43.8%03 18.8%6 37.5% 7 8.0%21 23.9%16 18.2%9 10.2%35 39.8% 43 5.6%235 30.5%132 17.1%59 7.7%301 39.1% 60 8.3%257 35.6%85 11.8%34 4.7%286 39.6% 87 6.8%455 35.8%200 15.7%81 6.4%449 35.3% 23 7.5%58 18.8%33 10.7%21 6.8%173 56.2% 14 14.3%27 27.6%16 16.3%7 7.1%34 34.7% 96 6.5%486 32.8%217 14.6%95 6.4%588 39.7%
P<0.001 P<0.001 P<0.001 P<0.001 P=0.047
Question 12Against interruptionIt is dangerousWant prescriptionReligious believingI do not knowOthers 307 39.8%222 28.8%65 8.4%12 1.6%156 20.2%9 1.2% 181 37.0%116 23.7%69 14.1%5 1.0%111 22.7%7 23.9% 47 28.0%39 23.2%13 7.7%4 2.4%61 36.3%4 2.4% 37 24.3%27 17.8%29 19.1%2 1.3%55 36.2%2 1.3% 200 43.2%108 23.3%42 9.1%7 1.5%90 19.4% 16 3.5% 206 33.3%146 23.6%76 12.3%10 1.6%177 28.6%3 0.5%% 162 33.5%145 30.0%55 11.4%6 1.2%112 23.2%3 0.6% 4 25.0%5 31.3%3 18.8%04 25.0%0 20 22.7%19 21.6%12 13.6%1 1.1%34 38.6%2 2.3% 265 34.4%215 27.9%71 9.2%10 1.3%199 25.8%10 1.3% 287 39.8%170 23.5%93 12.9%12 1.7%150 20.8%10 1.4% 502 39.5%341 26.8%134 10.5%18 1.4%258 20.3%19 1.5% 70 22.7%63 20.5%42 13.6%5 1.6%125 40.6%3 1.0% 40 40.8%22 22.4%17 17.3%018 18.4%1 1.0% 532 35.9%382 25.8%159 10.7% 23 1.6%365 24.6%%21 1.4%
P<0.001 P<0.001 P<0.001 P<0.001 P=0.067
Conclusion

The current study provides evidence that a proportion of women in Italy still have difficulties to obtain post-coital pills despite governmental dispositions for allowing an easier emergency contraception. Poor knowledge of both the emergency contraception and of how to obtain the drugs have been proved. Additionally, a pharmacists’ resistance to provide pills is involved in the phenomenon. Pharmacists’ concerns to provide emergency contraception should be best investigated from a juridical point of view.

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