ABSTRACT
OBJECTIVES: Pharmacists play a key role in contraceptive service delivery in Albania. This qualitative study explores the availability and accessibility of different contraceptive methods in Tirana, Albania, as well as the knowledge, opinions, and provision practices of retail pharmacists in the county. METHODS: In 2016, we conducted 16 in-person interviews with retail pharmacists in Tirana county, Albania. We also observed practices and dynamics in the pharmacies. We analyzed our data using descriptive statistics and for content and themes using inductive and deductive techniques. RESULTS: Our findings suggest that although a number of contraceptive methods are available in pharmacies, there are numerous barriers to access. Pharmacists were both uninformed and misinformed about reproductive health technologies, in general, and hormonal contraceptives, in particular. Pharmacists reported that the lack of awareness, fear of judgment, and embarrassment among women are some of the biggest obstacles for women seeking contraceptives from pharmacies. Yet few pharmacists reflected on their own lack of knowledge and the role that health service provider misinformation and judgment plays in contraceptive service delivery. CONCLUSION: Supporting continuing education efforts for pharmacists and pharmacists in training in Albania appears warranted. Improving pharmacists' knowledge of reproductive health technologies and fostering values clarification and transformation could address current barriers to access. IMPLICATIONS: Our findings shed light on the barriers to contraceptive access in Albanian pharmacies. Developing strategies to raise awareness about contraception, training pharmacists to provide medically accurate counselling, and improving knowledge within the community through culturally and linguistically resonant education campaigns appear warranted.
Subject(s)
Contraception/methods , Health Knowledge, Attitudes, Practice , Health Services Accessibility , Pharmacies/organization & administration , Adult , Albania , Family Planning Services/education , Female , Humans , Interviews as Topic , Male , Middle Aged , Needs Assessment , Qualitative Research , Reproductive Health/educationABSTRACT
OBJECTIVES: Contraceptive prevalence is relatively low in Albania, and abortion is the mainstay of family planning. Although levonorgestrel-only emergency contraceptive pills are available, uptake of this method is minimal. Emergency contraception (EC) could play a significant role in addressing women's need for an effective and discreet pregnancy prevention method. However, information about the dynamics surrounding EC is limited. STUDY DESIGN: In 2016-2017, we conducted a multimethods qualitative study that aimed to explore awareness, knowledge, attitudes and practices toward EC in Albania. This project comprised four components: a community-based survey with 115 respondents, six focus group discussions with women of reproductive age, 19 semistructured key informant interviews, and 16 structured interviews with retail pharmacists. We analyzed our data using descriptive statistics and for content and themes. RESULTS: Our findings suggest that EC is widely available in pharmacies in Albania. However, a quarter of our survey participants did not know whether EC was available, and more than a third did not think EC was safe to use. Women face numerous barriers to accessing this form of contraception. Misconceptions about hormonal contraceptives, in general, and about progestin-only EC in particular, lack of training among providers, and stigma and fear of judgment were common obstacles identified by participants. CONCLUSIONS: Misinformation and lack of knowledge about EC among women and providers in Albania appears common. Training health service providers, raising awareness among women, and developing linguistically and culturally resonant materials for distribution could be keys to improving access to and use of EC. IMPLICATIONS: Although the availability of progestin-only EC is widespread in Albania, our findings suggest that more work needs to be done to align national regulatory policies with international standards, facilitate evidence-based service delivery, and increase access to medically accurate information in Albanian.
ABSTRACT
INTRODUCTION: After years of complex regulatory changes, levonorgestrel (LNG) emergency contraception (EC) is now approved for unrestricted sale in the United States. Timely access to EC pills is critical because they are more likely to work the sooner they are taken. This study assesses whether LNG EC is sold in accordance with current Food and Drug Administration regulations. METHODS: We distributed an online questionnaire through an EC-focused listserv for reproductive health professionals, asking data collectors to visit local stores and document product names, price, over-the-counter shelf availability, and misinformation about age restrictions. We used χ2 analysis to assess bivariate associations and t tests and Wilcoxon rank-sum tests to determine differences in means. RESULTS: We collected information about 220 stores. The majority (65%) stocked EC on over-the-counter shelves, although only 22% of these displayed it without a locked security enclosure. Chain pharmacies were more likely to shelf-stock EC than independent pharmacies (77% vs. 5%; p = .000), but variation existed among stores within the same chain. Among stores that were asked, 40% incorrectly reported an age restriction for non-prescription purchase of LNG EC, whereas 95% correctly reported that men can buy LNG EC. The average price of branded and generic LNG EC was $49.64 and $40.05, respectively. CONCLUSIONS: Changes in the regulatory status of LNG EC have resulted in widespread confusion about how EC can be sold, and its high price contributes to access barriers. Retailers should ensure that consumers can access LNG EC quickly and easily by stocking the product on over-the-counter shelves and educating staff about current regulations.
