Emergency Contraception Use in School-Based Health Centers: A Qualitative Study

Study Objective: To understand contraceptive behaviors and decision-making in school-based health center (SBHC) female patients who have used emergency contraception (EC). Design: Qualitative interviews and questionnaires. Setting: SBHCs. Participants: Female adolescents, who self-reported EC use, were recruited from SBHCs. Interventions: Interviews were conducted until thematic saturation was reached on the following themes: reasons for selecting EC, perceived EC efficacy, reasons for use, nonuse, or inconsistent use of nonemergent contraception (NEC), and beliefs surrounding pregnancy risk. Main Outcome Measures: The team used a modified grounded theory approach and open coding technique to identify common themes. Participants completed a questionnaire to assess demographic information and EC knowledge. Results: Twenty-eight interviews were completed. Reasons for using EC include not using another contraceptive method, using another method incorrectly, or in combination with another method for added protection. Reasons for EC preference include ease of administration, ease of access, minimal side effects, perceived high efficacy, and because it can be used discreetly. Use of NEC was supported by identifying it as more effective, increased sexual experience and anticipation of sex, belief that excess EC decreases efficacy or is detrimental to health, and social interactions. Participants reported having used EC a mean of 3.5 times. Eighteen of 28 participants (65%) incorrectly believed that EC is 90%-99% effective, and 15 of 28 participants (53%) correctly identified ovulation inhibition as the mechanism of action. Conclusion: EC use is promoted by ease of access and administration, experiencing minimal side effects, and perceived high efficacy. Compliance issues with NEC and condoms and a desire for a discreet contraceptive method support EC use.