Use of emergency contraceptive pill by 15-year-old girls: Results from the international Health Behaviour in School-aged Children (HBSC) study

Objective To describe emergency contraceptive pill (ECP) use and variation across countriesregions; and to explore personal and contextual factors associated with ECP use and differences across countriesregions. Design Data were obtained from 11 countriesregions in the 2006 Health Behaviour in School-aged Children cross-sectional study. Setting Data were collected by self-report questionnaire in school classrooms. Population The analysis is based on 2118 sexually active 15-year-old girls. Methods Contraceptive behaviours were compared across countriesregions by chi-square tests. Individual factors related to ECP use were investigated with separate logistic regression models. Multilevel random-intercept models allowed the investigation of individual and contextual effects, by partitioning the variance into student, school and countryregion levels. Main outcome measures ECP use at last sexual intercourse. Results ECP use rate varied significantly across countriesregions. Poor communication with at least one adult (odds ratio [OR] 1.62 [1.12-2.36], P = 0.011) and daily smoking (OR 1.46 [1.00-2.11], P = 0.048) were independently associated with ECP use in comparison with condom andor birth-control pill use. Sexual initiation at 14 years or later (OR 2.02 [1.04-3.93], P = 0.039), good perceived academic achievement (OR 1.69 [1.04-2.75], P = 0.035) and daily smoking (OR 1.63 [1.01-2.64], P = 0.045) were associated with higher levels of ECP use in comparison with unprotected girls. The country-level variance remained significant in both comparisons. Conclusions These data document the large heterogeneity in rates of ECP use between countriesregions. These differences could not be explained by individual or contextual factors, and raise further questions in relation to ECP access for adolescents and their education in its appropriate use.