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“What information do Italian people get when looking for advice on EMERGENCY CONTRACEPTION?” THE MORNING-AFTER PILL IN ITALY

PROJECT BY: Viviana Ferro Ilaria Pagin Sara Pandini Federica Sciuto Elisa Zamarian




_Introduction _Hot topic _The Italian Situation _General scheme _Levels visualization

5 6 7 8 9

Chapter 1: _Google queries _Navicrawler analysis _Categories _Gephi analysis _Single gephi analysis

11 12 13 14 15 16 / 25

Chapter 2:


_Overlap categories _Main Links

28 29

Chapter 3:


_AlchemyAPI analysis _Entities scheme

32 33

Chapter 4:


_Opinion leaders names _H-index scheme

36 37




family planning socio economic implications the infographic woman condition


why emergency pill? focus on the effects of family planning google trends: international situation about emergency pill


the morning-after pill in Italy: data and factions of thought

GENERAL SCHEME all steps of our work

LEVELS VISUALIZATION and their colours

ICPD 1995 programme of action startup


TOTAL FUNDS for population activities (millions of current US $)



70.000 60.000 50.000 40.000 30.000

Our project presents Socioeconomic family planning implications as main theme and in the first part of research, the work focused on the reason why family planning has been established. The International Conference on Population and Development held in Cairo in 1994 deemed family planning as one of the essential means to meet the Millennium Development Goals: Reduce widespread poverty, hunger, disease and gender inequality by 2015. As the end of the ICPD Programme of Action approaches, it has been interesting to analyse how the reached level of funds actually influenced the Countries in which these funds were invested.

20.000 10.000 5.000 0

FAMILY PLANNING funds (millions of current US $)








India Sub-saharan Africa

500 0




8% 7% 6% 5% 4% 3% 2% 1% 0% -1.5% -2.5%




2.8% 2.6% 2.4% 2.2% 2%


1.8% 1.6% 1.4% 1.2% 1% 0.8%

In the topside of the poster, the system map was represented with the metaphor of Newton’s Cradle: The funds, coming from different institutions, are sent to developing and least developed countries to be invested in different activities, which have an effect on society, population and economics. These effects spring back directly through all the stakeholders, reaching again the international level that decides future actions. To understand the quality of these invest-

0.6% 0.4% 0.2% 0%







ments, the second part of the infographic was showing a comparison between average trends of the world and of LDC, trying to find a possible relation between quantity of funds, population growth and economic evolution.

The last part then concentrates on the conditions of women, the improvement of which is at the basis of a global change: the areas taken into consideration are India, first country to apply FP programmes, and Sub-Saharan Africa, region coping with the greatest difficulties in the world. In a second moment, the focus moved to the health topic, as contraceptives is a hot topic, especially recently, and comprehends both economical resources, because of farmaceutical industry, and ethic problems, as one of the main controversy about family planning is about its rightness from a religious point of view. The morning-after pill is considered an emergency contraceptive, Italy is the only country in which a prescription is needed. Moreover, some doctors refuse to give consent to the prescription and we thought this could be an interesting focus for the project.




100 80 60 40 20 2005








Education Women emancipation Mother and infant mortality Abortion number Fertility




Religion Local beliefs Families Urbanisation Price

Demography Labour force Health



Local socio-economic conditions Community-level characteristics Literacy rate State machinery Efficiency of related services Media F.P. Clinics Pharmaceutical industries Hospitals Education in schools Media

Delivery methods

Before starting our research and deciding which would have been our main question, we analyzed the topic with Google Trends. It’s evident that the controversy is increasing, especially because there is a discussion about the funcioning of the morning-after pill: is it abortive or not? Does it interfere with the implantation of a fertilized egg? Often, from an ethical point of view, the pill is considered abortive and then conscentious objectors refuse to prescribe it, even if the the law doesn’t refers to medicines but only to the practice of surgery for abortion.

Morning-after pill % Usage


Lombardia: 20,4% Veneto: 17,9% Toscana: 20,3% Molise: 9,4% Lazio: 16,3% Calabria: 9,3%

THE MORNING-AFTER PILL IN ITALY: DATA AND FACTIONS OF THOUGHT In Italy emergency contraception is available in pharmacies and hospitals, but a medical prescription is needed to buy it, so first of all, it is necessary to find a willing doctor, that’s not an easy task, and often results in a lot of hours spent in different hospital lounges. The effectiveness of the pill is higher the sooner you take it after an intercourse, so the time to obtain it should be minimized, eliminating the obstacles. At first aid points, the morning-after pill can be prescribed to people, including minors, as they’re deemed by the law 194/78 “sexually released” by the age of 16. The Catholic Church has raised many objections to the use of the emergency pill, claiming that its presence in the market is wrong, as it has the explicit aim to abort. Consequently, all the doctors are firmly incited to practice moral objection and to refuse to prescribe the pill. However, conscientious objection only refers to abortion surgery and it’s not available for medicines also, so the morning-after pill falls within the normal jurisdiction of the doctor-patient relationship: the first one cannot deny the treatment required by the second one only on the basis of his own moral beliefs.

370 thousand sold packages

55% sold to teenagers between 14 and 19

of which



In italy the prescription is a

Conscientious objection

vailable for underage people also

prevent the prescription

Medicine prescription is considered emergency service, so it can prevent ulterior risks

Italian medical research confirms that the pill is not abortive, because it inhibit ovulation.

Catholic Church considers the consumption of the pill as aiming to abortion

Because of religious controversies, Italy is the only country where a prescription is required

GENERAL SCHEME ALL THE STEPS OF OUR WORK Google Queries 200 starting links

The research protocol starts from 200 links, which are analyzed with Navicrawler, then the useless or irrelevant links, as advertising, are cutted off. This step leads to a total of 1588 links, that are visualized thanks to Gephi, and from which are extracted the main entities with AlchemyAPI. Afterwards all the links are divided into 6 categories, which are pointed out graphically in the gephi results. The entities are also divided in categories and the final outcome should be scientific characters such as doctor or authors, who are researched in Google Scholar to understand who they are, what they wrote and what weigh in the medical world they have.

NAVICRAWLER FILTER_cut out irrilevant links 1588 link


ALCHEMYapi tagging





opinion leader names GOOGLE SCHOLAR

LEVELS VISUALIZATION AND THEIR COLORS This kind of research can be visualized as levels put one on the other, as the kind of information we get is more and more specific: starting from the 200 links analyzed and visualized with Navicrawler and Gephi, the categories and overlaps are identified, then a further step consists in the detection of the most recurrent words (entities) and names. The passage is thus from something general as the links, to something specific as the single person, like a doctor or author, passing through the category to which a link belongs. We assigned a color to every level, that will be a chapter of our report. Those colors helped us to subdivide the work more clearly.

ENTITIES AND KEY WORDS With AlchemyAPI we found the main words that can be read in the links and their relevance. So we evidenced the leading terms. OPINION LEADER NAMES In the file achived with AlchemyAPI we extract the name most relevants. We found the relevance of each one with Google Scholar, eliciting the h-index value.



After the generation of 5 queries, we made the network of the links come out. With Gephi we created a scheme to visualize those connections.



NETWORK OF THE QUERIES Gephi / Navicrawler

The second step of our work was to underline the overlap of the links of each query. So we made some visualization that can show what links are in common between queries.



CATEGORIES and icons

examples and icons


the network visualized in a complete scheme



The first step is the identification the queries that are to be searched in; there are 5 different queries, whose aim is to obtain an higher number of results, with links belonging to different categories: a query like “levonorgestrel or norlevo” will conduct to scientific links in an easier way, while “aborto del giorno dopo” aims to find religious blogs or moral controversies. For each query, the first hundred links were taken into consideration and gradually put in an excel file, so they could be prepared to the analysis with Navicrawler. The double links or irrelevant links were eliminated from the excel files.


After eliminating the unproductive links from the results of the five queries, there has been the analysis with Navicrawler to detect the first connections between links. We got a total of 5240 links, from which there has been eliminated non funcioning links, advertising and links with only one connection (leaves).

200 starting links

NAVICRAWLER FILTER_cut out irrilevant links

1588 links






















CATEGORIES AND ICONS To make a useful division of the kind of information that a user can find while searching news about emergency contraceptive, there has been established 6 categories. the first one is “information”, that encloses all the links that give neutral report of effects and funcioning of the morning-after pill; “religion” includes all the blogs, websites and discussion about the morning-after pill being abortive or not from an ethical point of view; “news” for online magazines and articles; “medicine” includes those websites that are or refer to scientific papers, “sale” for online clinics or shops; “opinion” encloses blogs and user experiences, selfbased information websites, such as the description of the steps in a hospital to obtain the prescription of the emergency pill. Here are some examples of the links we found and categorized.




This website is administrated by the government, the information are available to the citizens, they’re given according to the law and in the most complete and neutral form.

MEDICINE This website contains many kind of information: it has a magazine part for the news, a section in which making questions to a doctor aggiungere is possible and other parts in which information are mostly scientific.

This acronym uccr means “unione cristiani cattolici razionali” and it’s a website created by some students to talk about religious matters in relation with the everyday life.




This website is connected to an association and gives information and news about the main trends to improve the health and how to behave in case of difficulty.

This is an online private clinic. It’s possible to buy medicines and get informations about health. In some cases it’s possible to get medicines recipes by answering a brief questonnaire.


This website was founded by 2 friends to talk about their experiences as parents. In the websites there are news, advices, stories, people who ask questions and opinions.


To gain a visual result that would have made what kind of relations lie between the found links more clear, we used Gephi: it’s a program that uses a force atlas 2 algorithm and it’s a way to visualize how links are connected to each other. In this way it was also possible to identify a hierarchy between links, to eliminate the leaves and keep all the links with an higher number of connections.



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Writing in the searchbar “contraccezione d’emergenza”, it is possible to find every kind of link, belonging to all the categories. The results of the research were various and different from each other, neverthless the category with the highest number of link is information: is one of the main websites and it appears in other queries, moreover it’s linked basically to other information (wikipedia) or medicine websites. At last, there are the categories of news and sale, even if religion didn’t have a big part in the graphic from Gephi, either. Observing the connections between websites, we could see that is connected only to medicine websites, while to the opinion blog are linked websites from almost every category.

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As expected by searcing the name of the active principle of the morning-after pill and it’s market name, the main links belong to 2 categories: medicine and information. Sale and religion are almost absent, but the second one is linked to an opinion website, and this in not unusual: religion blogs are often linked to opinion websites. As it can be seen in the graphic on the left, there are 2 kind of links: primary links (circles with number) and secondary links (simple circles). The principal links belongs mainly to the information category, followed by medicine, news, opinion, sale and religion. It was exactly as expected, since we tried to search this kind of keywords to obtain scientific websites.

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om r.c de in pl .s ta vi rla it it .it pe c. c. to du du uc ad ita .a .a m he ine it e. co og nl c. ion .it it w. .dr so du az uc .uk c. rg it r t o d u o o a i . ww ww w.s tlc. mig a.a c.c .ad uc. om gs b. w w w. im atu .bb nto .ad .it ot.c oblo tawe w . il s e p a ww ww w.d ew lam enzeaduc logs ud.n og.k w w .n ar ert re. .b a-s .bl m w ww .p vv sti -on o- ini co ot. w ww w.a ve ay ism per g w w .in -m in lip .or logsp et w ww .on mm na lce .b .n w w fe da do me am ww ww. .lore ntro dino sterd .it w ww .rie ra am duc w ww .chia mm li.a w ww ma ina ical h w w. am ad .c a m m t r wwww.s adio uspd t w ww.r vss- .sn sco vita.i w ww.s orum oricre ritae w ww.f enit atove w ww.g omit t t w .c c.i uc.i w ww ww rldma .it ww w.wo nuova rg ww w.citta zym.o m .it ww .kora blica wwww.latimca.repubnet ww w.ricer idiario. ww w.ilsuss g ww .zenit.or .it www .avvenire www zaroman www.i orrisponden www.cvulcanostatal www. emi.repubblic www.t www.w ostatale.blo www.vulcan www.cittadinolex.k www.europaquotidian www.roma.repubblic www.roma.corri www.natu www.wa www.j www. ournals.elsevi www. www. www newnotizie. it www www ww .qn.qu ww w.medscotidiano ww w.mpv. ww w.ilme org ww w.libe ssagg ww ww w.vit repub ww w.pi adido blica.i w w.d ane nna.o t ta w ww w.q iregio donn rg w w.t uotid vani. w ww.a echn iano tv w ww.f nsa orati.csanit w ww.c om w ww. hie lia w ww rad sa.e cris w ww .vulc icali spr tian w ww .ho an rom ess w ww .ch lyqu ost a.c w ww .m rist ee atale om pubb lica w ww .al arc usv n.a .b .it w ww .va lea oda eri lter log w w .f ti nz vi tas vis spo w c a o a w ww .t co an ca no .alt ta.o w w .b otu lar .va ttoli .wor ervis rg ca dp ta w w w.l lo st e. .or res .or w w w. ib gc uu org g s.c g w w w. ve ert att s.b om ww ww w.fecomritae aep olic iz w. .sc de ita vit erso ce ie rvi tov a.b na ogs sn nz ta er lo .o po ur aev pie ita gsp rg t.c .o it m ev ot om r a o g . or nte ita.d .com g .i o t cv ita .c om

Also this query got variegated results, as the keywords were simply an utility name as “pillola del giorno dopo or pdgd”. The interesting thing is that religion, news and opinion has almost the same number of websites in the less relevant links, while in the main junctions information got the first place, again, followed by religion. The strange thing is that one would expect that, in this query, the results for medicine and religion would have been even, while there’s no news in finding again information as the main category in both the primary and secondary links (cf. to the scheme on the left page). From a qualitative point of view, it’s interesting to notice how the religious websites are almost always linked to other religious websites, with a small variation of opinion or news.






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Looking at the graphic it is possible to notice that in this query most of the links belong to the religion category, that includes almost only religious website, with few exceptions. In this query we can also find the highest number of news websites. The opininion websites lead to medicine links, that are the few green circles in the query, almost never link to religious websites. Sale is the category with the least number of links: there are only two, one is a primary junction, the other is a secondary link. As almost all religious websites are against the emergency pill, there’s no news in seeing that there are few links for sales. Last but not least, information has always a huge percentage of links, even if this time the opinion category in the principal junctions appears more.

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Unexpectedly in this query there’s the lowest number of information an medicine links. The second category is often linked to news or opinion website, as expected, religious websites almost never relate to medicine or scientific links, as they are the counterpart. The principal junctions are mostly from religion and opinion category, and as we can see, religion category has the highest percentage of websites in the less relevant links. We can conclude that the trends the relationships between sites follow are always regular: religion leads to opinion and religion, almost never to information, while medicine mainly leads to medicine and information, rarely to opinion and sometimes to news or sales.




percentage stated by the starting links of every query


and the connection with the queries



While analyzing all the relations between links, it was clear that there are also relations between links from different categories, so we decided to produce a graphic with Gephi that includes all the links we found while analyzing the 5 queries, showing every



Contraccezione di emergenza

Levonorgestrel or Norlevo


“Pillola del giorno dopo” or PDGD

connection so that, at a second time, in the picture all the six categories can be underlined.The apllied criteria are the same as the single queries graphics, but in this way the aim is to show immediatly the overlaps between categories.



“Pillola del giorno dopo” aborto

Aborto del giorno dopo







2,5% 8%

4,8% 3,3% 10,5% 2,1%

17,1% 1,4% 14,8% 14,2% 15,1%

6,4% 0,5% 20% 18,1% 26,6%


285 links




375 links


350 links




332 links

200 links


2,8% 0,7% 23,5% 24,5% 30,1%








percentage and keywords



To understand and classify the main topics of the found links, it was used AlchemyAPI: this tool consented to extract from the links the main entities and keywords, so it could be made a table to explain the number of the words and the number of times they’re written. The percentage are referred to the totality of the words found thanks to AlchemyAPI and to which were deleted the entities with a value lower than 0,6; thus it is easier to under stand which category prevales on the others.

46 words




















servizi sociali

sclerosi multipla



nausea Norlevo

Ministero della Salute



ischemia cardiaca



gravidanza extrauterina




Giovanni Paolo II

Food and Drug Administration


farmacia notturna



emergency c.


ectopic pregnancy


dispositivo intrauterino



c. d'emergenza


Consiglio regionale

Chiesa cattolica

Centro Medico Santagostino




angina, emicrania
















Albert Yuzpe Alessandra Graziottin Amit Khutti Ann Aschengrau Levin Anna Pompili Baird DD Brache V Brown RW Bruna Rebagliati Bygdeman M Carlo Flamigni Carmen Cravioto Chen J Cheng W Chen-Mok Cochon L Cora Collette Breuner Corrado Melega D.A. Grimes Davidoff F. Dott. Ciro Iannone Dott. Bernard Nathanson Dott. Nicola Blasi dottor Sandro Spinsanti dr. Christophe Tieze dr. E.Blecheshmidt Dr. Emanuele Cosentino dr. Joe DeCook dr. Roy Hefferman Dr. Santo Angileri Dr. Vinand Nantulya dr. William Liley Durand M Eleanor Bimla Eliana Barcellona Emilio Arisi F.A. Davis Ferruccio Fazio Fuentes M.A. Gabrio Zacchè Gemzell-Danielsson K Gloria Dolciotti Gloria Polo Helena von Hertzen Isabel Rodrigues, MD J. Obstet J. Wang Jerome Lejeune Livio Zanoio Luigi Montevecchi Luigi Sacco Mauro Maccari Monica Bock Paola Bianchi Raymond EG Renzo Puccetti Rosa Maria Sabatel Serena Donati Silvio Viale Sir Liam Donaldson Tiziano Motta Umberto Veronesi van Hylckama Vlieg Vincenzo Spinelli Wilcox AJ Zhou L Ziebland S

firefox/chrome add-on, calculate the h-index for every character. After analyzing the entities with AlchemyAPI, all the found names were classified: politicians, bloggers, doctors, scientists, church people... Then all the doctors and authors of medical papers were selected and researched in

The last step of the research, consisted in passing from a general level, to a more specific one by inserting a selected number of names in Google Scholar and, thanks to a

OPINION LEADER NAMES Google scholar, writing in the search bar author:”name”, so that the results were only paper written by the author and not every file in which the researched name appeared. Morover, it has been made an additional research so that we could avoid the difficulties caused by the coincidences of names.

Ziebland S

Zhou L

Wilcox AJ

Vincenzo Spinelli

U. Veronesi

Tiziano Motta

Sir Liam j Donaldson

Jerome Lejeune Livio Zanoio Luigi Montevecchi Luigi Sacco M Chen-Mok Mauro Maccari ME Fuentes Monica Bock Paola Bianchi Raymond EG Rosa Maria Sabatel Serena Donati Silvio Viale

J. Wang

J. Obstet

I. Rodrigues, MD

Helena Von Hertzen

Gabrio Zacchè Gloria Dolciotti

Ferruccio Fazio

F.A. Davis

Dott. Ciro Iannone Dott. Nicola Blasi Dott. Renzo Puccetti dottor Sandro Spinsanti dr. Christophe Tieze dr. Roy Hefferman Dr. Vinand Nantulya dr. William Liley Durand M Eleanor Bimla Schwarz Eliana Barcellona Emilio Arisi

Davidoff F.

Danielsson K

D.A. Grimes

Carmen Cravioto Cochon L Cora Collette Breuner Corrado Melega

Carlo Flamigni

Bygdeman M

Bruna Rebagliati

Brown RW

Brache V

Bernard Nathanson

Baird DD

Anna Pompili

Alessandra Graziottin

A Yuzpe

A van Hylckama Vlieg













“What information do Italian people get when looking for advice on EMERGENCY CONTRACEPTION?� THE MORNING-AFTER PILL IN ITALY

The question behind the research aimed to discover what kind of information would find someone interested in knowing something more about the morning-after pill: there are medical websites, blogs, scientific reports or moral and ethical discussions. After the analysis of each category of website we managed to get a complex but complete

answer, to understand the doubts and the certainties a person can solve or create while making a research through google. We also managed to use different tools to expand the ray of knowledge and understanding of the matter.

PROJECT BY: Viviana Ferro Ilaria Pagin Sara Pandini Federica Sciuto Elisa Zamarian

The Morning After Pill in Italy