BACKGROUND The recent focus on increasing access to long-acting reversible contraceptive methods has often overlooked the diverse reasons why women may choose less effective methods even when significant access barriers have been removed. While the copper intrauterine device (IUD) is considered an acceptable alternative to emergency contraception pills (ECPs), it is unclear to what extent low rates of provision and use are due to patient preferences versus structural access barriers. This study explores factors that influence patients' choice between ECPs and the copper IUD as EC, including prior experiences with contraception and attitudes toward EC methods, in settings where both options are available at no cost. METHODS We telephone-interviewed 17 patients seeking EC from three San Francisco Bay Area youth-serving clinics that offered the IUD as EC and ECPs as standard practice, regarding their experiences choosing an EC method. We thematically coded all interview transcripts, then summarized the themes related to reasons for choosing ECPs or the IUD as EC. RESULTS Ten participants left their EC visit with ECPs and seven with the IUD as EC option. Women chose ECPs because they were familiar and easily accessible. Reasons for not adopting the copper IUD included having had prior negative experiences with the IUD, concerns about its side effects and the placement procedure, and lack of awareness about the copper IUD. Women who chose the IUD as EC did so primarily because of its long-term efficacy, invisibility, lack of hormones, longer window of post-coital utility, and a desire to not rely on ECPs. Women who chose the IUD as EC had not had prior negative experiences with the IUD, had already been interested in the IUD, and were ready and able to have it placed that day. CONCLUSIONS This study highlights that women have varied and well-considered reasons for choosing each EC method. Both ECPs and the copper IUD are important and acceptable EC options, each with their own features offering benefits to patients. Efforts to destigmatize repeated use of ECPs and validate women's choice of either EC method are needed to support women in their EC method decision-making.

中文翻译：

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探索美国年轻女性采用宫内或口服紧急避孕药的原因：一项定性研究。

背景最近对增加长效可逆避孕方法的获得的关注常常忽视了即使在显着的获得障碍已被消除的情况下妇女仍可能选择效果较差的方法的多种原因。虽然含铜宫内节育器 (IUD) 被认为是紧急避孕药 (ECP) 的可接受替代品，但尚不清楚供应和使用率低在何种程度上是由于患者偏好与结构性访问障碍造成的。本研究探讨了影响患者选择 ECP 和铜宫内节育器作为 EC 的因素，包括之前的避孕经验和对 EC 方法的态度，以及在免费提供这两种选择的情况下。方法 我们对来自旧金山湾区三个青年服务诊所寻求 EC 的 17 名患者进行了电话采访，这些诊所提供 IUD 作为 EC 和 ECP 作为标准做法，了解他们选择 EC 方法的经验。我们对所有采访记录进行了主题编码，然后总结了与选择 ECP 或 IUD 作为 EC 的原因相关的主题。结果 10 名参与者在结束 EC 访视时使用了 ECP，7 名参与者选择了宫内节育器 (IUD) 作为 EC 选项。女性选择 ECP 是因为它们熟悉且易于获取。不采用含铜宫内节育器的原因包括之前曾有过使用宫内节育器的负面经历、担心其副作用和放置程序以及对含铜宫内节育器缺乏认识。选择宫内节育器作为避孕药的女性主要是因为其长期疗效、隐形性、不含激素、性交后效期较长以及不依赖避孕药的愿望。选择宫内节育器作为 EC 的女性之前没有使用宫内节育器的负面经历，已经对宫内节育器感兴趣，并且准备好并且能够在当天放置它。结论 这项研究强调，女性选择每种 EC 方法有多种且经过深思熟虑的原因。ECP 和铜宫内节育器都是重要且可接受的 EC 选择，两者都有自己的特点，可为患者带来好处。需要努力消除重复使用 ECP 的污名并验证妇女对任一 EC 方法的选择，以支持妇女做出 EC 方法决策。