Emergency Contraception Provision Barriers Among Emergency Medicine Residents

Abstract

INTRODUCTION: Emergency medicine physicians can decrease the risk of unintended pregnancy in at-risk women presenting to the emergency department through consistent emergency contraception provision. We assessed emergency medicine residents' practice patterns and emergency contraception provision barriers to better understand emergency medicine resident training on emergency contraception. METHODS: An online survey was e-mailed to U.S.-based emergency medicine residency program directors for resident distribution. Current residents caring for reproductive-aged women were eligible. Survey questions assessed demographics, prescription and counseling patterns, and provision barriers. RESULTS: Three hundred forty-five participants met inclusion criteria and represented all training years and U.S. regions. Mean age was 29.9 years, and 50.3% were female. Most participants reported an academic (74.8%) and nonreligious (88.6%) hospital affiliation. A total of 24.7% of respondents prescribed emergency contraception over the last 6 months. Although 71.2% reported always offering emergency contraception after sexual assault, only 19.5% always offered emergency contraception after unprotected consensual sex. The most common emergency contraception provision barriers were lack of knowledge (37.5%) and lack of follow-up (39.1%). Respondents were more likely to prescribe emergency contraception if it was on formulary (odds ratio [OR] 18.8, 95% confidence interval [CI] 8.3-42.4) or a protocol for sexual assault victims included emergency contraception (OR 5.9, 95% CI 2.3-11.0). Participants were less likely to prescribe emergency contraception if they were first-year residents (OR 3.0, 95% CI 1.6-4.7) or if they reported lack of sufficient knowledge (OR 2.3, 95% CI 1.3-4.2). CONCLUSIONS: Emergency medicine residents often care for women at risk of unintended pregnancy yet have low emergency contraception prescription rates. Emergency department changes and improved education may increase emergency contraception provision to eligible women. Language: en