Feasibility of e-commerce pharmacy provision and acceptability of levonorgestrel 1.5 mg for pericoital use in urban and peri-urban settings in Kenya: a prospective cohort study. Issue 1 (2nd November 2022)

• Record Type: Journal Article
• Authors: Odwe, George; McCann, Brent; Liambila, Wilson; Vandermark, Jessica; Mwanga, Daniel; Anab, Edna; Wanami, Moses; Ramarao, Saumya
• Is Part Of: BMJ sexual & reproductive health. Volume 49:Issue 1(2023)
• Page Start: 35
• Page End: 42
• Publication Date: 2022-11-02
• Subjects: contraception behavior -- contraceptives, oral -- contraceptives, postcoital -- Contraceptive Effectiveness; Reproductive health -- Periodicals; Sexual health -- Periodicals; Birth control -- Periodicals; Contraception -- Periodicals; 613.905
• DOI: 10.1136/bmjsrh-2022-201653
• Languages: English
• ISSNs: 2515-1991

Abstract

Abstract : Introduction: An 'on-demand' contraceptive pill may suit women having infrequent sex. We assessed the feasibility of e-commerce pharmacy provision and acceptability of levonorgestrel (LNG) 1.5 mg for pericoital use in Kenya. Methods: A 12-month prospective, single-arm, open-label, interventional study conducted from August 2020 to August 2021. A total of 897 women aged 18–49 years at risk of pregnancy and having infrequent sex (ie, six times or fewer coital frequency/month) were screened and enrolled. We undertook univariate and bivariate analysis on multiple data points: enrolment dataset, bimonthly surveys, extended survey around 6-month follow-up, and e-commerce pharmacy sales log. Results: A total of 2291 pericoital LNG 1.5 mg pill doses were dispensed to 300 women over a 12-month period mainly via the USSD (Unstructured Supplementary Service Data) platform. Of the 266 women who obtained the pill and completed the survey, most (83%) were satisfied/very satisfied with e-commerce platform services, citing convenience and ease of use. The pill was also acceptable. Of the 266 women who used it at least once, 94% were satisfied/very satisfied, likely to continue using and would recommend it to others; 86% used it within 24 hours before/after sex as recommended and most of the time they had sex; and 147 (55%) experienced side effects, mainly nausea, headache, changes in menstrual pattern, cramps and dizziness that were mild and tolerable. Conclusions: E-commerce pharmacy provision of LNG 1.5 mg for pericoital use is feasible. In addition, a pericoital LNG 1.5 mg pill is acceptable among women having infrequent sex and could potentially address their unmet family planning needs.