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Emma Jane Armstrong Harcourt University of Otago The Affect of Language on Attitudes Towards Levonorgestrel-based Emergency Contraception Myths and Misconceptions Emma Jane Armstrong Harcourt A thesis submitted in partial fulfilment of the requirements for the Degree of Master of Science Communication Centre for Science Communication, University of Otago, Dunedin, New Zealand March 2017 i ii Abstract Globally, there is at least one registered form of emergency or post-coital contraception registered in 146 countries, with a further 22 countries importing emergency contraceptive products. By far the most commonly accessed emergency contraceptive, levonorgestrel-based emergency contraception (LNG- EC) features in the essential medicines list (EML) of 62 countries, out of a total of 118 countries with publicly available EMLs. LNG-EC is a safe and effective way of preventing an unintended pregnancy after unprotected sexual intercourse has occurred. The current consensus is that LNG-EC works primarily through the suppression of ovulation and thus prevents the fusion of sperm and ovum (fertilisation). It is unlikely that LNG-EC acts after fertilisation and it cannot harm an established pregnancy. However, the information presented to the public frequently implies that LNG-EC can impair the implantation process, wherein a blastocyst attaches to the wall of the uterus. This post-fertilisation action is morally unacceptable to many. My work concerns how the language used to describe how LNG-EC prevents a pregnancy effects attitudes towards the medication. There are prevalent misconceptions of how the medication acts and the effect that access to LNG-EC has on sexual behaviour, such as that it may harm an early embryo or that access to the medication encourages riskier sexual practices. I conducted a small pilot study and an experiment to examine how the language used to describe the i mechanism through which LNG-EC acts to prevent pregnancy influences attitudes towards the medications. I found that, although the priming text did not influence attitudes towards LNG- EC, frequency of religious service attendance was very strongly correlated with both attitudes towards the medication and with support for access to the medication. Specifically, that more frequent religious service attendance was positively correlated with negative attitudes towards LNG-EC and negatively correlated with support for access to LNG-EC. The second half of this manuscript fulfils the creative component requirement for the Master’s of Science Communication degree and takes the form of a creative non-fiction novella. While the academic thesis is intended as a serious scientific argument and contribution to the literature surrounding emergency contraception, the creative half of the manuscript is intended as a humorous work to be read for enjoyment as well as enlightenment. Although the creative component was undoubtedly more fun to research and write, it required just as much hard work and diligence as the academic component did. And, although the tone is light-hearted and funny, purpose of the creative component was the same as that of the academic thesis: to dispel myths and shed light upon murky areas of knowledge. ii Acknowledgements I want to thank my supervisor, Jesse Bering, and my colleagues in the Centre for Science Communication, Sue Harvey, Steve Ting, Emma Curtin, and Jean Fletcher, for being incredibly generous with their time and energy. All of these individuals provided me with invaluable support and encouragement while I conducted my experiment and prepared my thesis. I also wish to thank my classmates, housemates, family, and the Family Planning Association for the essential roles they have played over the last 15 months. In particular, I want to thank Guy Frederick, Vibhuti Patel, Emma Schranz, Elise Provis, Sam Fraser-Baxter, and Siana Fitzjohn for being tolerant while I watched bull electro-ejaculation videos in our shared office and constantly distracted them with lurid stories of sex-related mayhem like lethal nipple clamp hijinks. iii Table of Contents Abstract .................................................................................................................................. i Acknowledgements ......................................................................................................... iii List of Tables and Figures .............................................................................................. vi Introduction ........................................................................................................................ 1 Literature Review .............................................................................................................. 3 Mechanisms of action. ........................................................................................................................... 3 Action on Sperm Transport and Function. ................................................................................... 7 Action on Follicular Development and Ovulation. .................................................................... 8 Action on the Endometrium and Endometrial Receptivity to Implantation. .............. 12 Conclusion. .............................................................................................................................................. 16 Barriers to Access and Use of LNG-EC ...................................................................... 17 Lack of Risk Awareness. .................................................................................................................... 18 Lack Of Emergency Contraceptive Knowledge. ....................................................................... 21 Global Perspective. ............................................................................................................................... 22 Knowledge of LNG-EC in Africa. ..................................................................................................... 23 Knowledge of LNG-EC in Asia. ......................................................................................................... 24 Knowledge of LNG-EC in Americas. .............................................................................................. 26 Knowledge of LNG-EC in Europe. .................................................................................................. 29 Role of Education in EC Knowledge. ............................................................................................. 31 Role of the media in EC Knowledge. ............................................................................................. 31 Confusion between EC and Abortion. .......................................................................................... 33 Institutional Barriers to LNG-EC Use. .......................................................................................... 34 Company Policy Restricting LNG-EC Access. ............................................................................ 36 Medical refusal to dispense or prescribe. .................................................................................. 39 The Experiment ............................................................................................................... 45 Introduction ............................................................................................................................................ 45 Aims ............................................................................................................................................................ 45 Methods .................................................................................................................................................... 46 Priming Texts. ........................................................................................................................................ 47 The Survey Tool. ................................................................................................................................... 48 Recruitment Method. .......................................................................................................................... 54 Selection Criteria. ................................................................................................................................. 54 Limitations of the Recruitment Method and Criteria. ........................................................... 55 Results and Discussion ................................................................................................. 56 Data Collection Period ........................................................................................................................ 56 Data Analysis .......................................................................................................................................... 56 Participants. ............................................................................................................................................ 58 Text group assignment. ...................................................................................................................... 61 Role of religion on attitudes towards LNG-EC. ........................................................................ 63 Discussion ................................................................................................................................................ 69 Limitations. .............................................................................................................................................
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