Why are pediatricians uncomfortable with prescribing emergency contraception for adolescents?

Amorim, Renata Vieira; Barbieri, Marco Antônio; Bôtto-Menezes, Camila; Carmona, Fábio; Ferraro, Alexandre Archanjo; Bettiol, Heloisa

doi:10.1590/1984-0462/2023/41/2022060

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Brasil

Revista Paulista de Pediatria

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Brasil

Español English

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Sumário

ORIGINAL ARTICLE • Rev. paul. pediatr. 41 • 2023 • https://doi.org/10.1590/1984-0462/2023/41/2022060 copy

Why are pediatricians uncomfortable with prescribing emergency contraception for adolescents?

Por que os pediatras têm desconforto para prescrever contracepção de emergência para adolescentes?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

Emergency contraception (EC) is an effective and safe method for preventing unplanned pregnancy after unprotected sexual intercourse among adolescents but is infrequently prescribed by pediatricians. Because of the scarcity of data on the discomfort with EC prescription among physicians in Brazil, this study aimed to identify associated factors with discomfort with EC prescription among pediatricians in the state of Amazonas.

Methods:

A web-based, cross-sectional study including sociodemographic data, knowledge, attitudes, and discomfort with EC prescription was used. Multivariate logistic regression and artificial intelligence methods such as decision tree and random forest analysis were used to identify factors associated with discomfort with EC prescriptions.

Results:

Among 151 physicians who responded to the survey, 53.0% were uncomfortable with prescribing EC, whereas only 33.1% had already prescribed it. Inexperience was significantly associated with discomfort with EC prescription (odds ratio 4.47, 95% confidence interval 1.71–11.66). Previous EC prescription was protective against discomfort with EC prescription in the three models.

Conclusions:

EC is still infrequently prescribed by pediatricians because of inexperience and misconceptions. Training these professionals needs to be implemented as part of public health policies to reduce unplanned adolescent pregnancy.

Keywords:
Contraception, postcoital; Pregnancy in adolescence; Pregnancy, unplanned; Pediatricians; Artificial intelligence

Variables	Mean±SD or n		Range or %
Age in years (n=151)	40.5±9.8		23.0–72.0
Graduation year (n=151)	2003±9.9		1972–2017
Years of experience in pediatrics (n=151)	13.8±9.9		0–45
Number of adolescents seen/month (n=140)	35.6±75.6		0–512
Interest in learning more about EC (n=151)	84.6±1.6		0–100
Gender (n=151)	Female	121	80.1
Gender (n=151)	Male	30	19.9
Pediatric residency (n=150)	Yes	92	61.3
Pediatric residency (n=150)	No	58	38.7
Practice setting (n=151)*	Public hospital	110	72.8
	Public outpatient clinic	80	53.0
	Private hospital	67	44.4
	Private clinic	66	43.7
	Emergency	62	41.1
Academic activity (n=151)		42	27.8
Working place (n=149)	Capital	145	97.3
	Inland	2	1.3
	Both	2	1.3
Adolescent patients care (n=151)	Yes	115	76.2
Adolescent patients care (n=151)	No	36	23.8
Discomfort about EC prescription (n=151)	Yes	80	53.0
Discomfort about EC prescription (n=151)	No	71	47.0

Variables		n	%
EC method released in Brazil		n	%
EC prescription
Yuzpe method and LNG (n=151)	Yes	21	13.9
Yuzpe method and LNG (n=151)	No	130	86.1
Maximum time (n=132)	24 hours	27	20.5
	72 hours	85	64.4
	120 hours	20	15.2
Physical examination before EC prescription (n=138)	Unnecessary	11	8.0
	Recommended	35	25.4
	Always necessary	92	66.7
Pelvic examination before EC prescription (n=133)	Unnecessary	26	19.5
	Recommended	60	45.1
	Always necessary	47	35.3
Pregnancy test before EC prescription (n=137)	Unnecessary	55	40.1
	Recommended	28	20.4
	Always necessary	54	39.4
Legal guardian consent (n=120)	Unnecessary most of the time	26	21.7
	Recommended	56	46.7
	Always necessary	38	31.7
Experience
Theoretical learning (n=151)	Yes	105	69.5
Theoretical learning (n=151)	No	46	30.5
Practical learning (n=151)	EC prescription	50	33.1
Practical learning (n=151)	Not prescribed	101	66.9
Reasons why prescription was requested (n=50)*
Unprotected sex		34	68.0
Forgetfulness of pill		19	38.0
Ruptured condom		18	36.0
Sexual violence		15	30.0
Has not prescribed or would not prescribe
Exceeded the maximum time to prescribe EC (n=122)		77	63.1
Inexperience with use (n=137)		74	54.0
Referral of patient to another colleague (n=129)		53	41.1
The belief that EC compromises adherence to other methods (n=128)		45	35.2
The belief that EC stimulates sexual risk behavior (n=128)		40	31.3
Fear of teratogenic effects (n=131)		36	27.5
Religious reasons (n=131)		21	16.0
Moral reasons (n=129)		19	14.7
The belief that EC causes abortion (n=125)		18	14.4
EC is not effective (n=119)		1	0.8

Factors associated with discomfort about EC prescription	OR (95%CI)
Practical experience – previous EC prescription	0.20 (0.06–0.59)
It has not been prescribed due to inexperience with the use	4.47 (1.71–11.66)
It has not been prescribed because of the belief that it compromises adherence to other methods	4.68 (1.64–13.38)
Interest in learning more about EC	0.96 (0.93–0.99)

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[1] *Corresponding author. E-mail: rvamorim@uea.edu.br (R. V. Amorim).