Emergency contraception (EC) is the use of a method of contraception after
unprotected intercourse to prevent unintended pregnancy. Although first des
cribed over 20 years ago, physician awareness of EC has been limited and ma
ny feel uncomfortable prescribing it.
Objective. To assess the knowledge, attitudes, and opinions of practicing p
ediatricians regarding the use of EC in adolescents.
Methods. An anonymous questionnaire was mailed to all 954 active members of
New York Chapter 2, District II of the American Academy of Pediatrics. The
questionnaire assessed basic knowledge, attitudes, and opinions regarding
EC in adolescents. Data were analyzed by physician age, gender, year comple
ted residency, and practice type.
Results. Two hundred thirty-three practicing pediatricians (24.4%) complete
d the survey. Of the respondents, 23.7% had been asked to prescribe EC to a
n adolescent and 49% of these cases involved a rape victim. Only 16.7% of p
ediatricians routinely counsel adolescent patients about the availability o
f EC, with female pediatricians more likely to do so. Most respondents (72.
9%) were unable to identify any of the Food and Drug Administration-approve
d methods of EC. Only 27.9% correctly identified the timing for its initiat
ion and only 31.6% of respondents felt comfortable prescribing EC. Inexperi
ence with use was cited as the primary reason for not prescribing EC by 70%
of respondents. Twelve percent cited moral or religious reasons and 17% we
re concerned about teratogenic effects. There were no differences in comfor
t level based on age, gender, or practice type. Twenty-two percent of respo
ndents believed that providing EC encourages adolescent risk-taking behavio
r and 52.4% would restrict the number of times they would dispense EC to an
individual patient. A minority of respondents (17%) believed that adolesce
nts should have EC available at home to use if necessary and only 19.6% bel
ieved that EC should be available without a prescription. The vast majority
(87.5%) were interested in learning more about EC.
Conclusions. Despite the safety and efficacy of EC, the low rate of use is
of concern. Pediatricians are being confronted with the decision to prescri
be EC but do not feel comfortable prescribing it because of inadequate trai
ning in its use. Practicing pediatricians are aware of their lack of experi
ence and are interested in improving their knowledge base.