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Studies of Emergency Contraception Web Sites Demonstrate Stark Need for On-line Reproductive Health Information



Two Journal Articles Analyze Questions Posed by Users of an English-language Site and Use of the First Arabic-language Emergency Contraception Web Site

Joint Press Release Issued by Ibis Reproductive Health, Princeton University Office of Population Research, and the Association of Reproductive Health Professionals

For Immediate Release
July 21,  2005

Contact:
Dr. Angel Foster
617-349-0045
afoster@ibisreproductivehealth.org
Dr. Lisa Wynn
609-258-5402
lisawynn@princeton.edu

July 21, 2005—Analyses of use of both the emergency contraception (EC) Web site—NOT-2-LATE.com— and its Arabic-language version demonstrate that women need more information about contraception and other reproductive health issues, according to two articles published in Contraception: An International Reproductive Health Journal.

Questions posted by users of the English-language EC Web site via e-mail point to the need for further research on EC-related issues that cannot be answered with the extant medical literature but are of concern to patients, such as bleeding after EC use and whether or not EC use will prevent pregnancy if additional intercourse occurs shortly after treatment.  Many writers referred to intercourse with a hormonal contraceptive but not a barrier contraceptive as “unprotected sex,” suggesting that patients and health professionals may be using the same terms but with far different meanings. Questions sent to the Web site also indicated that many young people lacked sufficient information about family planning, pointing to the need for better counseling and education about contraceptive methods and their efficacy.

Users of the Arabic-language version of the Web site are also concerned about bleeding after EC use. However, visitors to the Arabic EC Web site are also interested in different aspects of EC than English-language users and web pages that were specifically designed for an Arabic-speaking audience are particularly popular, emphasizing the importance of creating culturally specific content when adapting and translating health education materials. General reproductive health information not devoted specifically to EC is also highly popular, suggesting a need for more online Arabic-language health education resources.

The article on use of NOT-2-LATE.com, “The Morning After on the Internet: Usage of and Questions to the Emergency Contraception Web Site,” analyzed e-mail queries received over a five-year period. It appears in the July 2005 issue of Contraception: An International Reproductive Health Journal, and is available on-line. The publication is the official journal of the Association of Reproductive Health Professionals (AHRP), published by Elsevier.

The article on the Arabic-language version of the Web site, “Reproductive Health, the Arab World and the Internet: Usage Patterns of an Arabic-Language Emergency Contraception Web Site, appears in the August 2005 issue of Contraception: An International Reproductive Health Journal . It presents information about Web site user profiles and use patterns for 19 months from June 1, 2003, to December 31, 2004.

NOT-2-LATE.com was launched in 1994 and is jointly operated by the Office of Population Research (OPR) at Princeton University and ARHP. The Arabic-language version of the Web site was adapted from the English-language site and was launched in May 2003 by Ibis Reproductive Health and OPR and is the first Arabic-language website dedicated to EC. The site also has been translated into French and Spanish.

English-language EC Web site study

Co-authors Lisa Wynn, PhD, and James Trussell, PhD, point out that i n the United States, health care providers do not routinely counsel women in advance about EC. “Women are often reluctant to ask for advance prescriptions for EC pills, and doctors rarely offer them without being asked. When women do have a condom failure or fail to use contraception, they may not know about EC, and even if they do they may face a struggle finding a doctor who can prescribe EC pills and then filling that prescription,” said Dr. Wynn.  “Unprotected intercourse often occurs on weekends or holidays when access to medical providers is limited.” The Web site includes a searchable directory of clinicians willing to provide EC in the United States and parts of Canada and a searchable database of all known brands of oral contraceptive pills that can be used as EC in more than 200 countries.

The English-language Web site offers the option to submit questions via e-mail, which are personally answered by Dr. Trussell. “The questions e-mailed to the site demonstrate the importance of Web sites that provide accurate medical information, particularly for women and men who are reluctant or unable to articulate their questions to their healthcare providers, who receive incorrect information from their healthcare providers, or who do not have access to medical professionals,” the authors write. Internet sites dedicated to sexual and reproductive health appear particularly popular among individuals seeking information on issues related to sexually transmitted infections, contraception, and pregnancy.

Arabic-language EC Web site study

Angel M. Foster, DPhil, of Ibis Reproductive Health, and co-authors of the article on use of the Arabic-language Web site, write that e mergency contraception may help to reduce the incidence of unintended pregnancy in the Middle East and North Africa. “Since the legality of abortion varies considerably throughout the Arab world,” Dr. Foster said, “the prevention of unintended pregnancy has the potential to reduce both the unintended birth rate and the number of unsafe and/or clandestine abortions.” However, the authors note, few resources dedicated to EC have been developed for Arabic-speaking populations. “The results of this study leave no doubt that there is interest in Arabic-language materials dedicated to EC and other forms of contraception,” Dr. Foster said. Even in the absence of a specific advertising campaign, the Web site received 39,217 visits and over 78,000 page requests in the first 19 months. 

The first dedicated EC pill became available in the Arab world in 2001 and dedicated EC products are now registered in Algeria, Egypt, Lebanon, Libya, Tunisia, and Yemen, as well as Israel.  However, Dr. Foster noted that the majority of the Arab world users accessed the site from countries in which a dedicated EC product is not registered, including Saudi Arabia, Syria, and Morocco. This finding suggests that there is a role for increased coordination among the various organizations working on EC-related issues in the region. 

“Creating on-line health information resources should be considered just one part of a multimodal effort to provide accurate health information to both providers and EC users,” the authors said. “The expansion of additional online reproductive health resources has the potential to provide Arabic–speaking populations with a confidential method of accessing health information. The importance of developing medically accurate and accessible educational resources cannot be underestimated.”

“The morning after on the Internet: usage of and questions to the emergency contraception web site,” Lisa Wynn and James Trussell (Contraception: An International Reproductive Health Journal, July 2005). To request a copy of this article, please contact: Dr. Lisa Wynn, 609-258-5402, lisawynn@princeton.edu.

 “Reproductive health, the Arab world and the internet: usage patterns of an Arabic-language emergency contraception web site,”

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The Association of Reproductive Health Professionals (ARHP) is the leading source for trusted medical education and information on reproductive and sexual health. ARHP educates health care providers, informs consumers, and helps shape public policy. ARHP is a non-profit membership association composed of highly qualified and committed experts in reproductive health. ARHP members are health professionals in clinical practice, education, research, and advocacy and they include physicians, nurse practitioners, physician assistants, nurse midwives, researchers, educators, pharmacists, and other professionals in reproductive health. To learn more, visit: http://www.arhp.org.