Emergency contraception: Pediatricians' knowledge, attitudes, and opinions

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.