Table 2 Theme emerged during the semi-structured in-depth interview

Knowledge and attitudes toward sex

Sex talk is still related to shyness

(P8) People, mostly teenagers, are shy about sex. This is because of communication. We fail to let them know that having sex is normal. Sexually transmitted infection is also another reason for making people shy to talk about it

Sex should become normalized

(P9) We cannot prohibit people from having sex. We have an environment that promotes people to have sex more than we ever had

(P10) Parents should accept that sex is normal in teenagers. Their kids have changed. The world has changed. Parents should invest more in sex education. Make them understand. Do not scold them

Knowledge and attitudes toward contraception

There are false beliefs among pharmacists about contraception

(P8) Most of my patients do not know how to monitor their menstrual cycle, so they do not know or are not confident in using the fertility-awareness method. When I tell my patient that they do not need the EOCs, since they are in the “safe period”, they do not believe me. They risk taking EOCs instead of using the fertility-awareness method

Unintentional pregnancy is taboo

(P10) Males should also know about contraception, but they do not care. They should not let their girls frequently have morning-after pills, since the pills are bad. If the girls are pregnant, that is the males’ fault. Becoming pregnant not at the proper time can lead you to get expelled from school or work. This leads to excessive guilt and depression like they committed hideous sin. Pregnant women with undesired pregnancies may commit suicide or abortion

Knowledge and attitude toward emergency oral contraceptives (EOCs)

There are false beliefs among pharmacists about EOCs

(P1) High hormone levels in the morning after pills can cause severe side effects, such as ovary cancer, or uterine cancer. This should be announced to the public

(P3) Levonorgestrel should not be used in overweight and obese people, since it lacks efficacy

(P4) If pharmacists gave EOCs to their patients without thinking, it could put their patients at risk for cancer

(P5) I do not like people who use EOCs frequently. It is stupid. It is unresponsible to themselves and their unborn child, since the efficacy of EOCs is reduced after two doses

(P9) Using EOCs every day decreases their efficacy. Are you ok if the efficacy of ECOs is tenfold lower than combined oral contraceptives (COCs)?

Knowledge of EOCs should be promoted

(P1) People do not have education about sex like how we have, so it is our job to educate them. Google is full of knowledge and garbage. I think EOCs should be taught in schools

(P2) Sex education should be compulsory and provided to all Thai people. The content does not have to be in-depth but covers all the necessities. The more the people know, the fewer the problems

(P6) I agree with having sex education since menarche

(P7) Sex education should be provided in high school. However, it is not provided in a lot of schools. It would be nice if the family teaches their kids about sex

Knowledge of the EOC mechanism of action affects whether pharmacists perceive EOCs as sinful

(P6) Using EOCs and sin? No, they are not related, even remotely. EOCs prevent fertilization and do not destroy lives. It is not the same as abortion

(P8) EOCs cause unsuitable conditions for the eggs. I do not think it is sinful. It is sinful in some religions, maybe because the religions want to increase the human population

Attitudes toward EOCs are negative

(P1) Only promiscuous people should have EOCs with them. Monogamous people do not need to

(P2) I would not allow my kid to use EOCs. It should not be used according to religion. However, I may have allowed it if she was raped or not ready

(P13) EOCs are not as dangerous as we use to think

(P14) In Thailand, attitudes toward EOCs are quite negative. Users are shy. Some pharmacists are not professionals. There is also a lot of misunderstanding

(P16) Those who use EOCs are promiscuous. In case guys buy EOCs, their female partner might not be fully willing to have sex

EOCs are related to protection during sex

(P2) EOCs may lead to unprotected sex

(P10) Using EOCs is already the protection (against pregnancy)

Factors affecting EOC use

Access

(P9) There are a lot of drug stores in the cities, so access is very easy. This is not the case in rural areas

Parents

(P3) If my kids used EOCs, I might have not been that open-minded. I would feel bad. I would think why did they not use other methods?

(P8) What is the cause for not knowing EOCs? Parents. They should also teach their children. They should not see sex as a bad habit. They should not scold their kids but educate them

(P9) Parents do not want their children to use EOCs. I think parents are disappointed about their kids having sex more than about their kids using EOCs. The parents are afraid of unwanted pregnancy. Thai people are not that open-minded about this issue. Teenagers should take a long time to see each other before having sex

Partner

(P6) The male partner has a lot of impact on whether a girl would use EOCs. The male partner may not want to use a condom or prefer to have unprotected sex. The female partner may not have a say in the way they have sex

(P10) The male partner does not want to use a condom. The female partner does not want to use COCs. Both are lazy

(P16) Some guys think that they are couples. Why do they need to use condoms? Using condoms means untrust or despisal for them. Some girls who are blindly in love agree not to use condoms and use EOCs instead

Religion

(P2) Islam prohibits sex in people who are not married, even if they are in a serious relationship. Therefore, EOCs can be used only after medical consideration

(P3) Education makes people believe that EOCs should not be used. People think that sex is bad. The elderly say that using EOCs is sinful but I think that it is normal

(P4) Using EOCs does not concern religions. We are far from that point. Well, maybe except for a few religions though

Social norm

(P4) Thai culture does not open to sex

(P9) The norm is very strict about sex. I once wanted to conduct a research project (about EOC use in teenagers), but it was not allowed by the ethics committee. We are not that open. I would be so glad if a high schooler come and buy EOCs from me. We cannot force them to abstain from sex. Sex education is a better option

Responsibility

Using EOCs shows responsibility

(P1) Parents should not scold their kids when they use EOCs, since nothing is wrong. It is good that they are responsible for what they have done. I am ok with high schoolers who buy EOCs. They are responsible for themselves

(P3) Do not want to be pregnant and do something about is already responsible

(P7) Taking EOCs is protecting oneself. It is better than letting a child be born without love and support

(P12) Using EOCs shows self-care but it would be better if condoms or COCs are used, since condoms and COCs show that the sex is planned

Pharmacists are responsible for providing EOC knowledge

(P1) It is our job to let them know that EOCs cannot be used for abortion

(P4) EOCs should be sold by pharmacists. Sellers should know and give buyers the knowledge

(P11) If pharmacists take the patient history and think that they should not use EOCs, that is ok. But I have a very negative opinion of those who refuse to dispense EOCs for personal reasons. We have the responsibility. We are educated and obligated to use our knowledge with our patients

Refusing EOC dispensing is not acceptable

(P12) I think that pharmacists who refuse to dispense EOCs must be very old and conservative. Such a pity