Volume 86, Issue 7 p. 861-869
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The use of emergency contraception in young Polish women

JAROSLAW OLSZEWSKI

Corresponding Author

JAROSLAW OLSZEWSKI

Department of Nursing, Medical University of Gdansk, Gdansk, Poland

: Jaroslaw Olszewski, Department of Nursing, Medical University of Gdansk, ul. Tuwima 15, 80-210, Gdansk, Poland [email protected]Search for more papers by this author
HANNA OLSZEWSKA

HANNA OLSZEWSKA

Department of Gynecology, Medical University of Gdansk, Gdansk, Poland

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ANNA ABACJEW

ANNA ABACJEW

Medical Students’ Association, Medical University of Gdansk, Gdansk, Poland

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LUKASZ CHMYLKO

LUKASZ CHMYLKO

Medical Students’ Association, Medical University of Gdansk, Gdansk, Poland

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ALEKSANDRA GAWORSKA-KRZEMINSKA

ALEKSANDRA GAWORSKA-KRZEMINSKA

Department of Nursing, Medical University of Gdansk, Gdansk, Poland

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First published: 31 December 2010
Citations: 10

Abstract

Background. The aim of this work was to assess the frequency of use of emergency contraception (EC) and the factors that influence young women in Poland to choose this method of contraception. Methods. The study included 1,154 randomly chosen young women of whom 843 were students of the four largest universities and 311 were pupils aged 18 and over of six randomly chosen secondary schools in the Gdansk region of Poland. A diagnostic review was made by means of a survey based on an anonymous self-administered questionnaire, that was handed directly to the respondents. The factors affecting EC choice were assessed. The characteristics of women who used EC and those who did not were described and compared. Results. The mean age of the respondents was 21.692.10. In a group of young sexually active women EC was used by only 14%, and among these the frequency with which it had been used varied from once to eight times. The students who most often turned to the EC were from institutions of higher education, came from large cities, and did not have a steady partner. Women in Poland have a general familiarity with the possibility of using EC, but there is insufficient exact knowledge of the way it works, as evidenced by the high proportion of women (68.3%) who regarded the EC as a means of early termination of pregnancy. Conclusions. EC is not routinely employed in Poland. Thus there is a need for thorough and comprehensive sexual education which covers EC.

Abbreviations:

  • EC
  • emergency contraception
  • ECP
  • emergency contraceptive pill
  • IUD
  • copper-T intrauterine device
  • Emergency contraception (EC) is a postcoital contraceptive method and is therefore used after unprotected sexual intercourse or when other methods of contraception have failed. The use of EC reduces the risk of unintended pregnancy (1).

    Contraception after intercourse consists of either hormonal tablets, known as the emergency contraceptive pill (ECP), composed of progestogen-only (levonorgestrel), or combined pills containing both estrogen and progestogen, or the copper-T IUD (2), (3).

    A scheme for EC was first described in 1974 by Albert Yuzpe et al. and was based on a dose of 100 μg ethinyl estradiol and 0.5 mg levonorgestrel taken within 72 h of intercourse and an equal dose 12 h later (4). In order to reduce side effects, the emergency contraceptive levonorgestrel-only tablet was introduced, which was less likely to lead to nausea and vomiting than Yuzpe's method and more efficient in preventing pregnancy (5).

    Levonorgestrel in a single dose of 1.5 mg has, since 2002, been recommended by the WHO as having the greatest contraceptive effect, and this has been confirmed by data presented in the literature (6). This preparation was only introduced onto the Polish pharmaceutical market at the beginning of 2006 (7). Until then the only emergency contraceptive registered in Poland had been the levonorgestrel-only preparation, made up of two tablets of 750 μg each taken with a 12-h interval between them. The effectiveness of this method has been put at 75–85% on the basis of extensive clinical tests and depends closely on the time lapse between intercourse and taking the contraceptive (5), (6). It is recommended that EC be taken within 72 h of unprotected intercourse, although the literature on the subject (8) confirms that its action is effective even up to 120 h. However, the earlier the preparation is taken, the greater its effectiveness, besides which it works optimally within the first 24 h. This is linked to the main mechanism by which it works, which is the slowing down of follicular growth and delay in ovulation by suppressing the secretion of luteinizing hormone (8–12). It does not, however, cause a miscarriage, as a pregnancy must be “involved” for this to occur (13). The levonorgestrel preparation has been registered in Poland since 1980 (7) and is issued only on prescription. As with other hormonal contraceptives, a prescription for EC may be issued by any doctor who works in a local health center or has a private practice. However, it is usually prescribed by a gynecologist and in some cases by a family doctor. In exceptional situations, if it is impossible to obtain a prescription for EC from these specialists, doctors in the casualty or gynecology–obstetrics out-patient departments are also authorized to issue one. The cost is relatively high (at 60 zl or approximately 15.5 euros).

    The purpose of this work was to assess the frequency of use of EC and the factors that influence young women in Poland to choose this method of contraception.

    Material and methods

    The study included 1,154 randomly chosen young women, of whom 843 were students of the four largest higher education institutions in Gdansk and 311 were pupils aged 18 and over of six randomly chosen secondary schools in the Gdansk region of Poland. A diagnostic review was made by means of a survey based on an anonymous questionnaire. The form to be completed was made up of sections for recording the respondent's age, the type of educational institution currently attended, and the size of her town or city of origin. It also contained questions, mainly of the closed type, dealing with her knowledge of contraception, her use of it in practice, and the profile of her sexual life. The open questions mainly involved issues such as the respondent's reasons for using EC.

    The questionnaires were handed directly to the respondents, who, after acquainting themselves briefly with the purpose and form of the research, gave their consent to taking part. The time taken to complete the questionnaire amounted to between 15 and 20 min, depending on the individual, after which the women gave the forms directly back to the person conducting the survey, in this case the present author. In the case of the students this took place on the premises of their higher education institution during a break between teaching sessions, in the halls of residence, or at the student gynecology–obstetrics surgery, while in the case of the pupils it took place in a lesson period designated for the purpose. A total of 1,398 questionnaires were distributed and the response rate was 82.6%.

    When the results were analyzed the factors influencing the choice of EC among women in the group who had made use of it were assessed: the reasons for its use, the time lapse between sexual intercourse and taking the contraceptive, the availability of EC, and the individual's level of knowledge about this method of contraception. Profiles of the women who had used EC and also of those who had not done so were drawn up and compared. A profile was made up of the sexual behavior of the young women, including the number of sexual partners, the age of sexual initiation, and the contraceptive choices made.

    In the analysis of results, percentages, arithmetic means, and standard deviation were calculated. Percentage values obtained from discrete groups were compared using the χ2 test, while age at the time of the survey, age at the time of sexual initiation, and length of sexual experience were compared using the Mann–Whitney U-test. In both tests the degree of significance was taken as p<0.05. Statistical analysis was carried out with the assistance of the STATISTICA PL software.

    The study was made between January and April 2005.

    Results

    General analysis of the group studied

    The study included 1,155 women of between 18 and 30 years of age (with a mean age of 21.6±2.10). Of these 1,154 were entered for analysis, of which 843 were students in higher education and 311 were secondary school students over the age of 18 from large cities in the Gdansk region of Poland. One student was excluded from the analysis because she had used EC while not having embarked on active sexual relations, citing “risky behavior” as her reason.

    Of the women examined, 35.3% (n = 407) had not yet begun a sexual relationship, while 64.7% (n = 747) had already had sexual intercourse.

    Factors that influence the choice of EC (Table I)

    Table I. Circumstances of using EC and sexual history of young women.
    Variable (n = 111) n (%)
    Main reasons for adopting ECa
     Condom breakage 44 (39.6)
     Total absence of contraception measures 25 (22.5)
     Discarding the condom 3 (2.7)
     Forgetting to take the oral contraceptive pill 3 (2.7)
     Fear of becoming pregnant 8 (7.2)
     Lack of care during intercourse 4 (3.6)
     Other imprecise reason 4 (3.6)
     No answer 20 (18.0)
    Time from intercourse to ECa
     Within 12 hours 56 (51.8)
     Within 24 hours 38 (35.2)
     Later than 24 hours 14 (13.0)
    Difficulty in obtaining ECb
     No problem 89 (80.2)
     Refusal from doctor 9 (8.1)
     Refusal from pharmacist 5 (4.5)
     Refusal from both doctor and pharmacist 1 (0.9)
     No answer 7 (6.3)
    Side effects associated with taking ECb
     None 46 (41.4)
     ‘Spotting’ 35 (31.5)
     A general feeling of being unwell 24 (21.6)
     Abdominal pain 13 (11.7)
     Bleeding from the reproductive tract 13 (11.7)
     Nausea 9 (8.1)
    • aThe totaling of percentages to more or less than 100 reflects discrepancies in rounding up or rounding down.
    • bThe percentage values do not total 100% because more than one answer was possible.

    Of 747 sexually active respondents, one in seven (14.9%) had used EC. The frequency with which this had been used by an individual woman ranged from once to eight times, with a mean of 1.5 times (±1.01). The main reasons for adopting EC by young women were condom breakage (39.6%) and total absence of contraception measures during sexual intercourse (22.5%). Among other reasons cited by respondents were the discarding of condoms (2.7%) and forgetting to take the oral contraceptive pill (2.7%). Nearly a third of the young women (32.1%) were unable to give a precise reason for adopting EC but mentioned such factors as fear of becoming pregnant (7.2%) and lack of care during intercourse (3.6%), but 18% supplied no answer to the question.

    The time elapsing between sexual intercourse and taking the EC varied. Over half the women (51.8%) took the contraceptive within 12 h, 35.2% within 24 h, and 13.0% later than 24 h.

    Obtaining the contraceptive posed no problem for 80.2% of the respondents, while 13.5% were met by refusal, in the case of 8.1% by a doctor and 4.5% by a pharmacist; 0.9% failed to reach an understanding with either a doctor or pharmacist.

    Nearly half the respondents from the group analyzed (41.4%) experienced no side effects associated with taking EC. The remaining women studied complained of “spotting” (31.5%), a general feeling of being unwell (21.6%), abdominal pain (11.7%), bleeding from the reproductive tract (11.7%), and nausea (8.1%).

    Profiles of the users and non-users of EC in the young women surveyed (Table II)

    Table II. Characteristics of the respondents.
    Sexually active women
    Variable, n (%) Non-sexually active women (n = 407) EC users (n = 111) EC non-users (n = 636) p2)
    Community origina
      > 100,000 inhabitants 131 (32.2) 47 (42.3) 201 (31.6) 0.0266*
     25,000–100,000 inhabitants 148 (36.4) 35 (31.5) 205 (32.2) 0.8839
      < 25,000 inhabitants or village 125 (30.7) 26 (23.4) 219 (34.4) 0.0226*
     No answer 3 (0.7) 3 (2.7) 11 (1.7) 0.4854
    Current level of educationa
     in secondary education 165 (40.5) 10 (9.0) 136 (21.4) 0.0024*
     in higher education 424 (59.5) 101 (91.0) 500 (78.6) 0.0024*
    No. of sexual partnersa
     1 42 (39.3) 411 (66.1) 0.0000*
     2 or more 65 (60.8) 211 (33.9) 0.0000*
    • *Significant at p<0.05.
    • aThe totaling of percentages to more or less than 100 reflects discrepancies in rounding up or rounding down.

    The ages of the women who had used EC fell within the range of 19–28 years, with a mean age of 22.4±1.99. The mean age of the women who had not used EC was similar (p = 0.0795) at 22.1±2.16, falling within the range of 18–30 years.

    Of the group under investigation, a sizeable majority were students of institutions of higher education (91.0%), while secondary schoolgirls made up the minority (9.0%). The former turned to EC more often, the difference between the two groups being statistically significant in this respect.

    Nearly half the women who had used EC came from cities of more than 100,000 inhabitants (42.3%), while the remaining women came from towns numbering 25,000–100,000 (31.5%), towns of fewer than 25,000 inhabitants or villages (23.4%). EC was used more often by women from cities of over 10,000 and less often by those from communities of fewer than 25,000 inhabitants, the difference being statistically significant.

    Almost two thirds of the women who had used EC (60.7%) had two or more current sexual partners and over a third had one partner (39.3%). However, of those who had not used EC (p = 0.0795), as many as 66.1% had one partner only.

    Knowledge of methods of contraception (Table III)

    Table III. Knowledge of methods of contraception.
    Sexually active women
    Variable, n (%) Non-sexually active women (n = 407) EC users (n = 111) EC non-users (n = 636) p2)
    Mechanism of action of ECa
     Contraceptive 59 (14.5) 29 (26.6) 122 (19.3) 0.0791
     Early termination of pregnancy 266 (65.5) 76 (69.7) 443 (70.0) 0.9565
     Unable to classify 81 (20.0) 4 (3.7) 68 (10.7) 0.0212*
    Circumstances for using ECa
     Exceptional circumstances 278 (68.5) 107 (96.4) 547 (86.3) 0.0027*
     On all occasions following sexual intercourse 24 (5.9) 2 (1.8) 23 (3.6) 0.3244
     No view 104 (25.6) 2 (1.8) 64 (10.1) 0.0046*
    Time from intercourse to ECa
     Within 72 h 195 (47.9) 88 (79.3) 416 (65.4) 0.0040*
     Within 24 h 96 (23.6) 18 (16.2) 137 (21.5) 0.2018
     Later than 72 h 4 (1.0) 1 (0.9) 4 (0.6) 0.7457
     No view 112 (27.5) 4 (3.6) 79 (12.4) 0.0064*
    The most effective contraceptive methodsb
     Oral contraceptive pill 555 104 (93.7) 590 (92.8) 0.7258
     IUD 239 (58.7) 79 (71.2) 430 (67.6) 0.4575
     Condom 225 (55.3) 52 (46.8) 400 (62.9) 0.0014*
     EC 121 (29.7) 43 (38.7) 205 (32.2) 0.1793
     Spermicide 84 (20.6) 9 (8.1) 71 (11.2) 0.3368
     Natural methods 49 (12.0) 1 (0.9) 38 (6.0) 0.0266*
     Coitus interruptus 20 (4.9) 4 (3.6) 31 (4.9) 0.2289
    • *Significant at p<0.05.
    • aThe totaling of percentages to more or less than 100 reflects discrepancies in rounding up or rounding down.
    • bThe percentage values do not total 100% because more than one answer was possible.

    Of all the young women questioned, 86.7% were aware of the existence of EC. In both of the groups compared, approximately 70% of the young women regarded EC as a method of abortion. Of the women who had used EC, only 26.6% regarded it as a contraceptive, with a similar proportion among non-users, only 19.3%, viewing it as a contraceptive.

    Of all those questioned, a clear majority of women were aware that EC was to be used in exceptional circumstances, whereas 4.3% claimed that it could be used on all occasions following sexual intercourse, and 14.7% had no view on the subject. Considerably more of the women who had used EC (96.4%) answered correctly that it was to be used in exceptional circumstances.

    Over three quarters of the women who had used EC (79.3%) answered correctly that the contraceptive should be used within 72 h, while 16.2% thought that it had to be used earlier than 24 h, and 0.9% that it could be used after 72 h. The number who were aware of the advisability of observing the 72-h time limit was markedly smaller among those had not had direct contact with EC (65.4% of non-users and 47.9% of women who were not sexually active).

    The opinion of those woman questioned who had made use of EC came out in favor of the oral contraceptive pill, with 93.3% identifying it as the most effective method of contraception. Confidence was placed in condoms by 46.4% of these. More respondents expressed confidence in condoms among women who had not used EC (62.9%), a difference that was statistically significant.

    Sexual activity (Table IV)

    Table IV. The sexual histories of the young women analyzed.
    Variable, n (%) EC users (n = 111) EC non-users (n = 636) p2)
    Initiation methods of contraceptionb
     Condoms 76 (68.5) 430 (67.6) 0.8583
     Oral contraceptive pill 16 (14.4) 149 (23.4) 0.0347*
     Coitus interruptus 13 (11.7) 72 (11.3) 0.9047
     No protection 12 (10.8) 68 (10.7) 0.8426
     Natural methods 11 (9.9) 67 (10.5) 0.9702
     EC 6 (5.4) 0 (0.0) 0.0000*
    Current methods of contraceptionb
     Oral contraceptive pill 56 (50.5) 248 (39.0) 0.0234*
     Condoms 53 (47.7) 264 (41.5) 0.2198
     Coitus interruptus 13 (11.7) 67 (10.5) 0.7113
     No protection 13 (11.7) 142 (22.3) 0.0109*
     Natural 9 (8.1) 76 (11.9) 0.2396
     EC 2 (1.8) 0 (0.0) 0.0007*
     IUD 1 (0.9) 1 (0.2) 0.1618
     Hormonal patches 1 (0.9) 5 (0.8) 0.9006
    Unprotected intercourseb
     Never 45 (40.5) 338 (53.5) 0.0142*
     Occasional 52 (46.8) 231 (36.6) 0.0349*
     Frequent 14 (12.6) 63 (10.0) 0.3868
    • bThe percentage values do not total 100% because more than one answer was possible.
    • *Significant at p<0.05.

    The average age of sexual initiation of the young women using EC was 18.5 years (±1.85). There was no statistically significant difference between this and the age of initiation of the women who had not used EC (p = 0.2379), which was 18.7±1.97. However, the users of EC had already experienced a longer period of sexual activity than the non-users (3.9±1.90 versus 3.3±2.03; p = 0.0011).

    At the time of initiation most of the group who had used EC had used condoms (68.5%), while the rest reported, in order, the oral contraceptive pill (14.4%), coitus interruptus (11.7%), absence of protection (10.8%), and natural methods (9.9%). EC was therefore used by 5.4% of the women in this group. The women who had not used EC had used the oral contraceptive pill considerably more often (23.4%) at the time of their first sexual intercourse.

    Current methods of contraception used by the group who had made use of EC were: the oral contraceptive pill (50.5%), condoms (47.7%), and coitus interruptus (11.7%), while 11.7% claimed to be using no protection. The women who had not used EC resorted to the oral contraceptive pill markedly less often (39.0%). However, decidedly more women admitted to using no protection (22.3%).

    Discussion

    The evidence shows that EC used following unprotected sexual intercourse is highly effective, achieving a 75–85% rate of prevention of unintended pregnancies (14). This high degree of efficiency is closely linked to the time that elapses between sexual intercourse and taking the tablet. In countries in which abortion is banned, the use of EC is of particular importance since, as Trussell et al. have suggested, this method of contraception has the potential to reduce significantly the incidence of unintended pregnancy and the consequent need for abortion (15), (16). On the other hand, Glasier et al. (17), in a multicenter study, found that in a population of women who had extremely good access to EC, the rate of clinical abortions had not decreased. However, Glasier et al. (17), in company with other authors (18), has suggested that this situation may be caused by misidentification of the circumstances under which EC is to be used.

    In Poland records of planned and unplanned pregnancies are not kept, and from 1993 abortion for social reasons has been banned by law (19). As a result, the number of legal abortions performed is low; in 2004, for instance, it stood at 193 (20). A problem is, however, posed by illegal abortion, which is put by non-governmental agencies at about 80,000–200,000 annually (21).

    The issue of postcoital contraception is seldom aired in Poland. Several factors have influenced this. These include paucity of knowledge about it, from which often stems the view that it is a means of early termination of pregnancy (85% of respondents), and hindrances created by the health service, mainly doctors who are either basically ill-prepared or who use the terms of reference of their own religious outlook and so fail to supply the patient with full information (19). However, incontrovertibly the most important factor is the ban on the use of contraceptives (with the exception of so-called “natural methods”) by the Roman Catholic Church. The considerable influence of the Roman Catholic Church in this respect on the outlook of Poles, of whom approximately 90% are practicing Roman Catholics, is reflected in the studies made by Nowakowska and Korzeniewska (22). According to the published findings of these authors, 39.2% of women claimed that the main obstacle to the use of any means of contraception whatever was in fact the position of the Roman Catholic Church on this matter. Since 1989, when the country underwent a constitutional transformation and became fully democratic, there has been an open clash of views, upon which a wide range of public opinion is brought to bear, involving the protection of life at conception and birth control. Matters of sexual life and family planning have, however, remained unresolved problems for Polish women.

    The majority of young women in Poland (51% aged 19) are sexually active, the average age of initiation of the population as a whole being 19.1 (23). No information is provided in the available literature on the use either of levonorgestrel or of any other method of EC, even by women aged 18–25, the characteristic age bracket for unsafe sexual behavior and the age group into which as many as 70% of those who use EC fall, according to non-Polish sources (24). The situation of young women in Poland is amply demonstrated by data from GUS (the Central Office of Statistics for Poland) for 2004, when, of 356,131 live births, 5.8% were to girls under the age of 19 and 27.6% were to women between the ages of 20 and 24 (25), and by the results of the survey conducted by us. This highlights the low percentage of women, only amounting to 14.9%, who use EC in the form of the levonorgestrel-only tablet. In countries in which this is available over the counter the percentage is yet higher, from 27% in Sweden (26) to 36.4% in France (27), while in Scotland, where women have received a supply of emergency contraceptives for use at home whenever needed, the proportion using this method has been extremely high, reaching approximately 50% (17). The age of the participants in the present study who used EC fell within the 19–28 age bracket, with a mean age of 22.4±1.99. In similar surveys conducted in Italy, Finland, and Spain the average age of women using EC was 24.6, 23.4, and 23 respectively (24), (28), (29). Research conducted by Tyden et al. (30) among Swedish women has confirmed that it is used most often by young women; in this study 86% of the respondents were women under 24 years of age.

    The main reason given by young Polish women for using EC was condom breakage (39.6%) and lack of contraceptive precautions of any kind during sexual intercourse (22.5%). At the same time nearly a third (32.1%) of young women were unable to supply a precise reason for using EC. Bastianelli et al. (24) report that the most frequent reason for using EC was breakage or discarding of condoms (64%) and unprotected sexual intercourse (28%). A similar percentage of condom failure has been reported by Finnish (29) and Spanish (31) authors, who give figures of 65% and 69.2% respectively. Swedish authors, however, put unprotected sexual intercourse in first place (54%). The high proportion of Polish women who are unable to give an explicit reason for using EC probably conceals a failure to apply any form of contraception, which would bring the results obtained in this survey in line with those of Swedish studies (32).

    In studies made of Swedish teenagers, Aneblom et al. (33) found no fundamental difference between those who used EC and those who did not. In studies conducted in Denmark (18), in which women aged between 26 and 45 were analyzed, it has been demonstrated that users of EC were distinctly different from non-users in that they were older and better educated women, who were especially motivated to use EC as a contraceptive “add-on”.

    The profile of the sexual activity of young Polish women who have used EC indicates that they have had a number of sexual partners, have had unprotected sexual intercourse fairly frequently, and are still using inefficient methods of contraception such as coitus interruptus. Those who have not used this form of contraception, however, have had fewer sexual partners and admit to having had unprotected intercourse less frequently. Furthermore, analysis of the mean ages of sexual initiation has shown that the users of EC studied had embarked on sexual activity when in the same age bracket as the non-users, but had been active for longer. These observations are confirmation of the opinion expressed by Falk et al. (32), who state that the young women who use EC are a group who run a high risk of unplanned pregnancy. However, as Raine et al. (34) report, it is not the case that the use of EC is an inducement to more risky sexual behavior, but that this form of contraception is chosen most frequently by the most sexually active women. It suggests, furthermore, that a longer period of sexual activity constitutes a greater opportunity for risky sexual behavior.

    On the other hand, it was a characteristic feature of the women who had taken EC in the past (true of over half of them), that they had most often used the most reliable method of contraception, namely the oral contraceptive pill. The frequency with which condoms were used fell from 68.5% at the time of initiation to a current 47.7%. The cause of this was probably the high rate of condom failure as a reason for using EC. However, from analysis of the methods used by women who had not employed EC it became apparent that these women were not using the most effective methods of contraception. They were the most likely to use condoms and only a third of them were taking the oral contraceptive pill, condoms remaining their favorite method of contraception. On the other hand, at the time of their first intercourse slightly more of the young women in this subgroup had used the oral contraceptive pill and in the past they had less often had unprotected sexual intercourse. This may suggest that young women forced to resort to EC in particular situations are conscious of why this has happened and choose more effective methods of contraception, whereas those who have not used EC abide by their first choice of less effective methods. Confirmation of this may be seen in the fact that the women who have used postcoital contraception declare that they have less confidence in condoms and natural methods.

    Knowledge of EC was rather low in all groups of women examined. It is true that a clear majority of young Polish women (81%) are aware, as are Swedish teenagers (82.3%) (35), young French women (89.5%) (27), and young women in the USA (84%) (36), that it exists. However, barely half the respondents were able to give the correct time within which EC should be taken, a situation similar to that in other countries (35), (36). Moreover, almost three quarters of Polish women regarded it as a means of early termination of pregnancy, a misgiving that divides women in other countries, although to a lesser extent, with 21% cited by Larsson et al. (26) and 37% by Sorhaindo et al. (36). It should be emphasized that the majority of the young women questioned stated that EC should be used in exceptional circumstances, which indicates, therefore, that they were aware that the preparation should not be used in place of a regular method of contraception, but only to supplement it. In fact the study did not take into account the opinion that this preparation might be taken repeatedly, but it did indicate that over 28% of women had used EC at least twice.

    A further factor which may discourage young women from using EC is that of the possible side effects of taking it. In a retrospective analysis of young Polish women such effects were reported by fewer than half the participants. Similar results have been seen in other European countries (37). Nausea and vomiting, which Falk et al. (32) referred to as the most frequent and the most burdensome side effects, was put in fifth place by our respondents.

    One of the factors curbing the use of EC is, as reported by Free et al. (38), difficulty in gaining access to it. It is therefore a matter of unease that in Poland one in six young women who had made use of emergency contraceptives had encountered problems in obtaining them. Postcoital contraceptive tablets are not available over the counter, and so the main channels for bringing about an increase in their use are gynecologists and family doctors.

    The study described here has brought to light the multifactorial nature of the use of EC by young women. Moreau et al. (27), who carried out a survey of women seeking an abortion as a result of unplanned pregnancy, showed that there are two main obstacles to the use of EC. The first is lack of basic information about the drug. According to Moreau et al. (27), 19.9% of women did not think of using this method of contraception, while in 22.4% too long an interval was thought to have elapsed between sexual intercourse and taking the contraceptive. The second obstacle, not, however, investigated here, is the woman's perception of the risk of becoming pregnant, as almost half the women studied by Moreau et al. (27) underestimated the risk of pregnancy. Thus there is a need for thorough and comprehensive sexual education that covers EC and other contraceptive issues affecting young Polish women.