Enhancing pharmacy ECP provision to youth. (Youthlens).

As emergency contraceptive pills (ECPs) are being incorporated into family planning programs and dedicated products are being registered in more countries, the word is spreading among youth that ECPs are available to help prevent pregnancy after unprotected intercourse. But youths' detailed knowledge of ECPs is limited, and their rates of use are still low. (1) According to Dr. Irina Yacobson, an associate medical director at FHI and youth-friendly services specialist for FHI's YouthNet program, one of several ways to increase youths' knowledge and use of ECPs is to focus on pharmacies--a growing outlet for ECP information and provision.

"In countries where ECPs are available through pharmacies, youth prefer to go to a pharmacy for ECPs because it is a convenient way to obtain services and has fewer barriers than many traditional outlets," says Dr. Yacobson. But more youth need to know that pharmacies can provide ECP services, and pharmacists need to take a greater interest in distributing ECP information, she says.

Studies from Zambia and the United Kingdom have shown that youth often view staff from traditional health care facilities as unwelcoming and judgmental, and may not seek their services because of embarrassment, lack of privacy, and the fact that clinics may not be open when emergency contraception is needed. (2) To identify alternative outlets for ECP services in Zambia, the Population Council, CARE/ Zambia, Lusaka's University Teaching Hospital, and the Zambia Society for Family Health conducted a study in which clinic-based health care providers, pharmacists, peer counselors, and community sales agents were trained to provide ECP information and, if possible, services. Researchers then measured, among other outcomes, how many of some 400 women in the study visited each group of providers and how effective each group was at delivering ECP information and services. (3)

Pharmacists proved to be the lead provider of both ECP information and pills. About half of youth in the study turned to pharmacists for information and nearly three-quarters for ECP provision. However, pharmacists were the least likely of all the groups to offer clients detailed information about ECPs or to offer information on alternative contraceptive options. They did not raise the issue of sexually transmitted infections (STIs), and they were just as likely not to mention the potential side effects of emergency contraception as they were to do so, noted the authors of a report on the study.

Because some pharmacists may be uncomfortable discussing family planning issues in public and clients want to maintain their privacy, providing information that clients can read on their own may help pharmacies in Zambia to better serve youth needing ECPs. For instance, once a dedicated ECP product is available there, an insert that provides accurate information about ECPs could be created. An ECP brochure could also be developed and distributed to youth who visit the pharmacies, the authors recommended.

The U.S.-based Program for Appropriate Technology for Health (PATH) is conducting a three-year project in Cambodia, Kenya, and Nicaragua to strengthen pharmacies' capacity to provide youth-friendly reproductive health services focused on needs arising from unprotected intercourse. Emergency contraception is one of those needs, says Jolene Beitz, a program associate at PATH. (The project also emphasizes STI risk assessment and contraceptive management.) If successful, the Reproductive Health Access Project--which is funded by the William and Flora Hewlett Foundation and is now in its final year--may serve as a model for other developing countries where pharmacies provide reproductive health services to youth.

As part of the project, educational materials for clients and providers are being developed, and pharmacists and other frontline staff are being trained to give youth correct, up-to-date ECP information and services, including provision, counseling, and referral. An outreach component is also being implemented in collaboration with local youth-service organizations. "The purpose of this component is to increase peer counselors' knowledge about emergency contraception and to increase their knowledge that pharmacies, as well as traditional health care facilities, are available to provide emergency contraception and other reproductive health information and services," says Beitz.

YouthLens is an activity of YouthNet, a five-year program coordinated by FHI and funded by the U.S. Agency for International Development to improve reproductive health and prevent HIV/AIDS among young people.

REFERENCES

(1.) Arowojolu AO, Adekunle AO. Perception and practice of emergency contraception by post-secondary school students in southwest Nigeria. Afr J Reprod Health 2000;4(1):56-65; Arowojolu AO, Adekunle AO. Knowledge and practice of emergency contraception among Nigerian youths. IntJ Crynaecol Obstet 1999;66(1):31-32; Sorhaindo A, Becker D, Fletcher H, et al. Emergency contraception among university students in Kingston, Jamaica: a survey of knowledge, attitudes, and practices. Contraception 2002:66(4):261-68.

(2.) Ahmed Y, Ketata M, Skibiak J. Emergency Contraception in Zambia: Setting a New Agenda for Research and Action. Nairobi, Kenya: Population Council, 1998; Bullock J. Raising awareness of emergency contraception. Community Nurse 1997:3(7):28-29.

(3.) Skibiak JP, Chambeshi-Moyo M, Ahmed Y. Testing Alternative Channels for Providing Emergency Contraception to Dung Women. Final Report. New York, NY: Population Council, 2001.