Postcoital contraception, commonly known as emergency contraception (EC), is a method of preventing pregnancy used after unprotected sexual intercourse or in cases where regular contraception has failed. It works primarily by preventing or delaying ovulation through the use of hormonal agents (1). EC is available in two forms: hormonal emergency contraceptive pills (ECPs) and copper intrauterine devices (IUDs). The effectiveness of EC depends on the active substance and the timing of administration. Levonorgestrel (LNG) can prevent up to 85% of pregnancies, while ulipristal acetate (UPA) can be effective in up to 97% of cases if taken before ovulation and within 24 h after unprotected intercourse (2). In Poland, since 2017, both LNG and UPA have been available by prescription (3). LNG may remain effective beyond the approved 72-h window, while UPA can be used for up to 120 h after intercourse (2, 4). Both methods share the same primary mechanism of action but are ineffective if ovulation has already occurred (2, 5).

Although studies show a high demand for modern birth control methods, according to the Contraception Policy Atlas 2025, Poland has had the lowest access to contraception in Europe for years (33.2%), far below the European average and rates observed in other countries in the region, including Hungary (40%) and Cyprus (42.1%). In contrast, access to contraception in Western Europe exceeds 90% (6). Experts have noted ongoing gaps in contraceptive counselling, particularly regarding methods, effectiveness, and availability. In Poland, the main barriers include limited access to gynaecologists, especially in smaller towns and rural areas; the prescription requirement for EC; insufficient sexual education; and persistent taboos around sexuality, reinforced by religion and conservative norms (7). Additionally, contraception is not reimbursed, and minors require guardian consent to obtain a prescription, which may further limit access for some groups, including adolescents (7).

Despite recent policy initiatives, public awareness and perceptions of EC in Poland remain limited. In 2024, the Polish Minister of Health introduced a pilot programme enabling pharmacists to provide selected reproductive health services, including consultations and the issuance of prescriptions for ulipristal acetate (UPA) (8). Under this initiative, pharmacists may conduct consultations and provide patient education, and, where appropriate, issue prescriptions (9). The programme remains in the pilot phase and is intended to evaluate the feasibility and outcomes of this approach before wider implementation.

Although awareness of emergency contraception in Poland is increasing, it remains limited, and misconceptions as well as unresolved concerns persist. A 2015 Centre for Public Opinion Research report found that 49% of respondents believed that EC was harmful to women’s health, 45% equated it with abortion, and 57% feared that easier access would encourage sexual promiscuity and irresponsibility in intimate relationships, while 56% believed it would promote earlier sexual initiation among youth (10). Such misconceptions are more common among individuals with lower levels of education, conservative political views, residents of smaller towns, and those who are highly religious (10). Left unchallenged, misinformation may reduce acceptance of EC and encourage unsafe alternatives. In response, reproductive health experts, including gynaecologists and pharmacists, are increasingly engaged in efforts to dispel myths and reduce the stigma surrounding EC.

Educational campaigns such as “Morning AFTER” (11), projects like “Contraception.PL” (12), and the NFZ pilot programme (8) have aimed to increase public awareness of EC and expand pharmacists’ involvement in patient consultations. According to the Ministry of Health, over 1,300 pharmacies have joined (13), and pharmacist-issued prescriptions for EC rose by more than 9% in the first quarter of 2025 compared with the last quarter of 2024 (14). Recent data indicate that EC is most commonly used by women aged 31–40 and 19–25 years (14). Public support for making EC available without prescription to individuals aged 15 and over has also risen by 7% (15).

While these data illustrate the recent outcomes of educational and advisory initiatives, there is still a lack of Polish representative studies among pharmacists and pharmacy students regarding their knowledge and attitudes towards EC, including their concerns about prescribing to minors without parental consent. There is also limited evidence on pharmacists’ perceptions of their educational role in this area. Meanwhile, previous studies conducted in various countries reveal that both pharmacy students and practising pharmacists demonstrate only partial and often inconsistent knowledge of EC. Although most are aware of EC and its clinical use, a detailed understanding of its mechanism of action and effectiveness is often limited, and misconceptions, such as confusing EC with abortion, remain widespread (16, 17). Studies with pharmacy professionals further suggest that while knowledge of dosing and side effects is generally adequate, awareness of the precise mechanisms and safety profile is weaker (18, 19). Among students, the picture is similarly mixed: only a minority achieves adequate knowledge, with gaps most evident around ulipristal acetate and the timing of levonorgestrel (20). Levels of knowledge are influenced by factors such as professional experience and educational exposure, with younger or less experienced practitioners typically performing worse (21, 22). Collectively, these findings indicate inconsistencies in EC-related knowledge, underscoring the importance of standardized education in pharmacy training and continuing professional development.

This study aims to fill this gap by comparing community pharmacists and pharmacy students in terms of: (1) their knowledge and opinions regarding EC, and (2) the factors influencing their attitudes toward EC. Understanding these differences may provide insight into how pharmacy education and professional training relate to practice realities and communication with patients, including minors, thereby informing future educational research in reproductive healthcare.

The sample was predominantly female (71.6%), with males accounting for 28.4% (Table 1). More than half of the respondents (58.7%) were students, while 41.3% were pharmacists. Half of the respondents lived in cities with over 500,000 inhabitants (50%), whereas 16.3% lived in small towns of up to 10,000 inhabitants; the remaining respondents were distributed across medium-sized localities.

Respondents’ ages ranged from 21 to 64 years (M = 30.2 ± 10.8). Scores on the Religious Commitment Inventory-10 ranged from 10 to 50 (M = 22.7, 95% CI: 21.6–23.8; SD = 10.6; median = 21.5). The majority of respondents (79.3%) reported using contraception, whereas 20.5% reported not using any.

Figure 1 shows that community pharmacists scored higher on the Knowledge Index (median = 15, IQR: 11–17) compared with pharmacy students (median = 13, IQR: 10–16), with the difference being statistically significant (Mann–Whitney p = 0.0035).

Table 2 summarizes the attitudes of community pharmacists and pharmacy students towards EC. The majority of respondents supported the use of EC (84.5% answered “rather yes” or “definitely yes”), while most opposed the idea of its legal prohibition (92.6% answered “definitely not” or “rather not”). Opinions were divided regarding over-the-counter availability, with 40.2% in favor and 52.9% against. Views on access for minors without parental consent were similarly split, with 40.8% supporting and 48.9% opposing. More than half of respondents (47.4%) agreed that EC should be reimbursed by the National Health Fund, while a large majority (83.9%) considered access to information about EC in Poland insufficient. Almost all respondents endorsed discussing EC in educational settings (95.8%) and involving pharmacists in related education (90%). Finally, 75.5% agreed that access to EC should form part of national health policy.

Table 3 presents the results of logistic regression analyses evaluating community pharmacists’ and pharmacy students’ attitudes toward emergency contraception (EC), focusing on four outcomes: support for EC use, belief that EC should be legally prohibited, support for EC availability without a prescription, and support for minors obtaining EC without parental consent.

Significant predictors include age (OR = 1.066, 95% CI: 1.029–1.104, p < 0.001) for supporting EC use, and the RCI-10 index, which is significant across all models (e.g., OR = 0.865, 95% CI: 0.827–0.904, p < 0.001 for EC support; OR = 1.152, 95% CI: 1.082–1.226, p < 0.001 for EC prohibition; OR = 0.916, 95% CI: 0.893–0.940, p < 0.001 for over-the-counter availability; OR = 0.909, 95% CI: 0.885–0.933, p < 0.001 for minors’ access).

Pharmacy students show greater support than pharmacists for EC use (OR = 2.869, 95% CI: 1.134–7.257, p < 0.05) and for minors’ access to EC without parental consent (OR = 3.282, 95% CI: 1.523–7.074, p < 0.01). Individuals with personal contraception experience are more likely to support EC use (OR = 4.586, 95% CI: 1.764–11.923, p < 0.01) and less likely to support its prohibition (OR = 0.236, 95% CI: 0.069–0.814, p < 0.05).

Respondents residing in municipalities with 10,000–50,000 inhabitants (OR = 0.281, 95% CI: 0.111–0.717, p < 0.01) or more than 500,000 inhabitants (OR = 0.374, 95% CI: 0.189–0.739, p < 0.01) are less likely to support EC use compared with those living in municipalities of ≤10,000 residents. Nagelkerke R² values range from 0.223 to 0.468, with the highest explanatory power observed for EC support (R² = 0.468), and overall model p-values (0.002–0.038) indicate statistical significance.

Table 4 presents the results of logistic regression analyses evaluating community pharmacists’ and pharmacy students’ attitudes toward emergency contraception (EC), focusing on five outcomes: (1) support for EC reimbursement by the National Health Fund, (2) perception of sufficient access to EC information in Poland, (3) belief that EC use should be discussed within education, (4) support for including EC access in national health policy, and (5) support for pharmacists’ involvement in EC education.

The table reports odds ratios (OR) with 95% confidence intervals (CI), along with Nagelkerke R² and model p-values to assess model fit. Significant predictors include the RCI-10 index, which remains significant across most models (e.g., OR = 0.967, 95% CI: 0.948–0.987, p < 0.01 for reimbursement; OR = 1.037, 95% CI: 1.006–1.070, p < 0.05 for information access; OR = 0.915, 95% CI: 0.859–0.975, p < 0.01 for education discussion; OR = 0.904, 95% CI: 0.872–0.938, p < 0.001 for national health policy).

The Knowledge Index is also a significant predictor for EC inclusion in national health policy (OR = 1.227, 95% CI: 1.057–1.425, p < 0.01) and pharmacists’ involvement in EC education (OR = 1.191, 95% CI: 1.061–1.338, p < 0.01). Pharmacy students are less likely than pharmacists to believe that access to EC information in Poland is sufficient (OR = 0.424, 95% CI: 0.208–0.865, p < 0.05), yet more likely to support pharmacists’ involvement in EC education (OR = 10.484, 95% CI: 2.646–41.554, p < 0.001). Individuals with personal contraception experience are more likely to support the inclusion of EC in national health policy (OR = 4.541, 95% CI: 2.029–10.162, p < 0.001). No significant effects were observed for municipality size, age, or gender across any of the models. Nagelkerke R² values range from 0.042 to 0.340, with the highest explanatory power observed for EC inclusion in national health policy (R² = 0.340). Overall model p-values (<0.001 to 0.020) indicate statistical significance across all models.

The results of this study reveal notable differences in attitudes toward EC between community pharmacists and pharmacy students. This variation may reflect differences in knowledge levels, professional experience, and social context within these groups. While pharmacists achieved higher scores on the knowledge index, students expressed more permissive views regarding EC use and its availability to minors without parental consent. These findings suggest that higher factual knowledge does not necessarily translate into more supportive attitudes toward EC access, highlighting the complex relationship between knowledge, ethical reasoning, and professional decision-making. Similar inconsistencies between pharmacists’ knowledge, attitudes, and professional practice have also been reported in other settings, particularly in relation to ethical standards and codes of professional conduct (26).

The discrepancies observed in this study are consistent with previous research on EC. In a U.S. study conducted among pharmacy students, researchers reported inconsistencies between knowledge, attitudes, and dispensing practices: while 32% of respondents admitted limited understanding of EC’s mechanism of action and only 26.7% felt competent to provide counselling, 42.8% declared willingness to dispense EC (27). These findings indicate that supportive attitudes toward EC access do not necessarily correspond with adequate theoretical knowledge or counselling competence, underscoring the role of both cognitive and contextual factors. Similarly, a Polish study found that only 51.6% of pharmacy personnel provided patients with at least basic information about EC, with counselling quality varying by education level and workplace setting. Substantial knowledge gaps were also identified: 63% of respondents lacked full knowledge of all EC methods, and only 43% correctly recognized that EC is not abortifacient (28). Insufficient knowledge regarding emergency contraception has been documented across multiple international settings. Studies conducted in Nigeria (21), Nepal (19), Jamaica (29), and South Africa (30) indicate persistent misconceptions among healthcare professionals, including beliefs that EC may act as an abortifacient, harm fetal development, or pose significant health risks when used repeatedly. Taken together, these findings suggest that pharmacists’ knowledge, similar to that of other healthcare professionals, often remains partial. Persistent gaps regarding EC mechanisms, available methods, and safety profiles may adversely affect the quality of patient counselling and influence individuals’ decisions about EC use.

A second key conclusion concerns the regulatory framework governing EC and the implementation of pharmacy-based services. While the vast majority of respondents opposed a legal ban on EC, opinions remained divided regarding over-the-counter availability and minors’ access without parental consent, indicating persistent regulatory and ethical uncertainty. Pharmacists’ more cautious attitudes, despite higher knowledge levels, may reflect greater awareness of legal responsibilities and the potential professional consequences of EC provision.

Previous studies conducted in Poland indicate that, although many pharmacists oppose refusing to dispense emergency contraception, the expansion of over-the-counter availability remains controversial (31–33). Merks et al. identified two principal sources of this controversy. First, ethical concerns play a central role, particularly differing interpretations of the beginning of human life. It should therefore be emphasized that emergency contraception, including ulipristal acetate and levonorgestrel, is not abortifacient and does not prevent implantation, as its mechanism of action consists of preventing or delaying ovulation (33–36). Second, legal considerations further contribute to the debate, particularly uncertainty surrounding the conscience clause, which allows healthcare professionals to refuse procedures that conflict with their moral or religious beliefs (33, 37). Studies suggest that many healthcare professionals perceive existing legislation as insufficiently clear regarding the scope and application of this clause, including its potential relevance to pharmacists (31).

These findings should also be interpreted in light of broader cultural and systemic determinants. Previous Polish research indicates that religiosity and moral norms rooted in Catholic teaching significantly shape healthcare professionals’ attitudes toward ethically sensitive services, including reproductive health care and conscientious clause (37–39). Moreover, studies conducted in broader European and international contexts demonstrate that religion, conscience-based reasoning, and institutional arrangements within healthcare systems play a critical role in shaping professionals’ responses to controversial clinical practices, particularly in areas related to reproductive health (40–42). Ambiguity surrounding the legal scope of the conscience clause and its uneven institutional implementation has been shown to generate ethical tension and uncertainty among medical professionals, further influencing their decision-making in practice (38, 43).

However, in Poland, the conscience clause does not formally apply to pharmacists. Any unauthorized invocation of this regulation may therefore restrict patients’ access to guaranteed healthcare services and expose pharmacists to legal consequences, particularly given the limited window of effectiveness of emergency contraception (33).

The third key conclusion of this study concerns predictors influencing attitudes toward EC. Age, contraceptive experience, and place of residence emerged as significant factors, with younger respondents, individuals reporting contraceptive use, and residents of smaller towns expressing more supportive views toward EC availability, including over-the-counter access and access for minors without parental consent.

The over-the-counter availability of emergency contraception has long been a contentious issue in Poland. CBOS surveys indicate that public opinion has remained divided over time. In 2015, attitudes toward over-the-counter access were nearly evenly split, with comparable proportions of respondents supporting and opposing this policy, often expressing concern about unrestricted access for younger individuals (10). A follow-up survey conducted in 2024 showed a modest shift toward greater acceptance, with approximately half of respondents supporting over-the-counter availability of the “morning-after pill,” while a substantial proportion remained opposed (15). These findings suggest persistent social divisions in attitudes toward EC access, shaped by age, place of residence, education level, and broader worldview (10, 15).

The present study reflects these patterns while also indicating a growing openness toward over-the-counter EC among residents of smaller towns. Nevertheless, EC remains less available in rural pharmacies than in urban areas, pointing to ongoing disparities in service distribution (44, 45). Structural inequalities, including lower income levels, higher rates of underinsurance, and reduced access to specialist healthcare in rural areas, may further limit access to reproductive health services and reliable contraceptive information (7, 44, 45).

Beyond legal availability, access to information emerged as a key determinant of EC use. Evidence from several European countries, including Italy, Germany, the United Kingdom, France, and Spain, highlights the role of stigmatization, insufficient counselling, and communication barriers in shaping women’s experiences with EC and their healthcare decisions (46). Consistent with these findings, respondents in the present study perceived access to EC-related information as insufficient, while higher knowledge levels were associated with stronger support for including EC in national health policy and greater recognition of pharmacists’ educational role.

The final key conclusion concerns professional attitudes toward patient support and education. Pharmacy students more frequently emphasized the importance of nonjudgmental counselling and public education, whereas practising pharmacists’ attitudes appeared more constrained by ethical concerns, stereotypes, or perceived legal risks. Similar barriers have been documented in studies conducted in Nigeria, the United States, and Australia, where pharmacists’ personal beliefs and institutional practices influenced EC provision (21, 47–50).

A meta-analysis further indicates that willingness to dispense EC to men, partners, or other third parties remains limited across settings (5).

Overall, national and international evidence indicate that the provision of EC, in contexts where it is offered, requires adequate preparation of both pharmacy staff and facilities. Implementing extended-access services, such as pharmacist dispensing, would require improving pharmacists’ and students’ knowledge of EC availability, mechanisms of action, and relevant legal and ethical frameworks. Education in this area constitutes an important aspect of pharmacists’ professional competence, as many patients demonstrate limited knowledge about reproductive health and contraception.

Research from other contexts has examined the association between EC availability, pharmacist counselling, and outcomes such as reduced rates of unintended pregnancies and related health complications (51–53). Clear professional guidelines for dispensing EC may contribute to greater consistency and neutrality in patient interactions. Ultimately, strengthening pharmacists’ educational preparation and understanding of ethical and cultural contexts may contribute to more consistent reproductive healthcare practices.

This study revealed significant differences in knowledge and attitudes toward EC between pharmacists and pharmacy students. While pharmacists demonstrated higher factual knowledge, students expressed more supportive views regarding EC use and minors’ access without parental consent. Both groups exhibited knowledge gaps and uncertainty regarding legal regulations, indicating that professional experience alone does not ensure consistent understanding or attitudes. Age, religiosity, contraceptive experience, and place of residence emerged as key predictors shaping respondents’ views, highlighting the combined influence of cognitive and contextual factors on professional reasoning.

Although the majority of respondents opposed legal restrictions on EC, opinions remained divided regarding over-the-counter availability and minors’ independent access. These findings reflect persistent ethical, cultural, and regulatory tensions surrounding EC in Poland and underscore the need for clearer professional guidance and targeted educational interventions. Improving pharmacists’ knowledge and ethical competence may support more informed and consistent decision-making in pharmacy practice.

Based on these findings, several recommendations can be proposed to inform educational, professional, and policy initiatives aimed at strengthening pharmacists’ roles in reproductive healthcare: