Beyond the counter: Insights into knowledge, access, use, and stigma of emergency contraceptive pills among women in Kosovo

Background : Unintended pregnancy remains a major public health problem worldwide, and access to effective emergency contraception is essential for reducing unsafe abortion and maternal morbidity. Although the World Health Organization recommends emergency contraceptive pills (ECPs) for over-the-counter availability, evidence on women’s knowledge, attitudes, and use of ECPs in Kosovo is limited. Objective : To assess knowledge, attitudes, and practices regarding emergency contraceptive pill use among women in Kosovo and to analyze the influence of sociodemographic and social factors on access and utilization. Methods : A descriptive cross-sectional study was conducted in Kosovo from June to August 2025. A self-administered questionnaire was distributed online and in community pharmacies to women of reproductive age who had previously used emergency contraceptive pills. The survey collected data on demographics, usage patterns, sources of information, side effects, and attitudes toward ECP use. Participation was voluntary and anonymous. Results : Most participants were aged 18–30, highly educated, and living in urban areas. The majority used ECPs no more than once per month, and 77% obtained the pill without a prescription. No significant association was found between non-prescription access and frequent use ( p = 0.9181). Knowledge scores were significantly higher among women who received information from pharmacists (M = 6.02) and doctors or clinics (M = 5.86) than among those who relied on the Internet or Google (M = 3.33) or social media (M = 2.83) ( F = 90.91, p < 0.001). Rural residence was associated with higher odds of shame-related avoidance when requesting ECPs (OR = 2.60, 95% CI: 1.39–4.89) and with a stronger influence of cultural and family norms on ECP use (OR = 4.57, 95% CI: 2.20–9.49). Commonly reported side effects included menstrual irregularities, abdominal pain, headache, and nausea. Conclusion : Emergency contraceptive pills in Kosovo are generally used responsibly, even when accessed without a prescription. However, major knowledge gaps and social stigma persist, particularly among women in rural areas and those relying on unverified online sources for information. Strengthening professional counseling in pharmacies and clinics, establishing national OTC guidelines, and expanding sexual education programs are essential to improve the safe and informed use of emergency contraception.