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the NEWS

Women’s Access to Contraception

Groups advocate for greater access to oral and emergency

annually—two groups oral contraceptives because of

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issued new recommen­ their personal beliefs, ACOG

dations in December notes that these concerns would
2012. The American need to be addressed in any plan
Congress of Obstetri­ to improve access to birth con­
cians and Gynecolo­ trol. (For the full ACOG state­
gists (ACOG) proposed ment, go to
Photo by Mark Thomas / Science Photo Library.

that oral contraceptives Increased use of both contracep­

be made available over tion and abstinence by teens has
the counter, and the contributed to a decrease in preg­
American Academy of nancies since the 1990s—and the
Pediatrics (AAP) has AAP notes that those approaches
recommended emer­ remain the best ways to avoid
gency contraception, pregnancy. But large numbers of
such as Plan B, as one teens are still having unprotected
part of an overall pub­ intercourse, using contraceptive
lic health strategy to methods inconsistently, or having
reduce teen pregnancy. sex against their will (approxi­
ACOG argues that mately 10% report sexual assault).

bout half of all pregnan­ although oral contraceptives have And in those cases, emergency
cies in the United States some rare possible adverse effects contraception—used as soon as
each year are unintended. (chiefly, venous thromboembo­ possible after intercourse but as
Although birth rates among U.S. lism), they are as safe as many late as 120 hours afterward—is a
teens are declining, they are still over­the­counter medications. safe and fairly reliable backup.
significantly higher than rates Further, there is good evidence The AAP stresses the impor-
among teens in other industrial­ that women can effectively screen tance of counseling teens about
ized nations. themselves for contraindications the use and availability of emer­
In an effort to address this stag­ using a checklist. And although gency contraception and provid­
gering and expensive problem— issues of cost and reimbursement ing prescriptions in advance so
which was recently estimated to exist, as does the possibility of they can use it as soon as possi­
cost U.S. taxpayers $11.1 billion pharmacists refusing to dispense ble when needed—making sure
they follow up with their pri­
mary care practitioners later to
be tested for sexually transmitted
NewsCAP diseases.
Many health care providers
Longer shifts increase nurse burnout and patient dissatisfaction. Nurses who work have to grapple with their own
shifts of 12 hours or longer experience more job burnout, and their patients are more dis- underlying beliefs when it comes
satisfied with their care, report researchers in the November 2012 Health Affairs. The study to counseling teens about sex,
involved 22,275 nurses, 65% of whom worked 12-to-13-hour shifts. Patients whose nurses pregnancy, and contraception, but
worked longer shifts reported poorer communication, pain control, and responses to according to the AAP policy state­
help calls from nurses. They also gave hospitals lower ratings and were less likely to rec- ment, failing to educate patients
ommend them. Nurses working 10-hour shifts or longer were 2.5 times more likely to regarding legally available treat­
experience burnout and job dissatisfaction than peers working eight to nine hours. The ments like emergency contracep­
authors suggest restricting the number of consecutive hours worked, respecting days off tion (or failing to refer patients to
and vacation time, and allowing nurses to leave a shift promptly or refuse overtime work someone who will) is a violation
without retribution. (Read a related AJN blog post at: of a provider’s duty to her or his
patients.—Laura Wallis ▼
18 AJN ▼ February 2013 ▼ Vol. 113, No. 2