Advance Provision Of Emergency Contraception Research Articles

Advance provision of emergency contraception to young men: An exploratory study in a clinic setting

PurposeTo explore the acceptability of advance provision of emergency contraceptive pills (ECPs) to young men seeking health care. MethodsFor this exploratory study in a clinic setting, we approached young men aged 16–35 to participate in a survey eliciting socio-demographics, sexual and contraceptive history, and knowledge about ECPs. We offered young men advance provision of ECPs and compared characteristics of 126 young men who did and did not accept the ECPs. ResultsMost (76%) of the participants accepted advance provision and left with an ECP pack, with even higher proportions among males whose sexual histories were suggestive of increased risk of involvement in an unintended pregnancy. ConclusionsThis study holds promise to inform scale up of advance provision of ECPs among young men.

Systematic review and narrative synthesis of the effectiveness of contraceptive service interventions for young people, delivered in health care settings

A systematic review and narrative synthesis to determine the effectiveness of contraception service interventions for young people delivered in health care premises was undertaken. We searched 12 key health and medical databases, reference lists of included papers and systematic reviews and cited reference searches on included articles. All retrieved literature was screened at title and abstract levels, and relevant articles were taken through to full paper appraisal. Data relating to study design, outcomes and quality were extracted by one reviewer and independently checked by a second reviewer. We included interventions that consisted of contraceptive service provision for young people, and also interventions to encourage young people to use existing contraceptive services. The searches identified 23 studies that met the inclusion criteria. The papers focused on: new adolescent services, outreach to existing services, advanced provision of emergency contraception, condom/contraceptive provision and advice and repeat pregnancy prevention. The literature in general is not well developed in terms of good quality effectiveness studies and key outcome measures. However, it is possible to make recommendations in terms of outreach versus targeted young people's services in health care settings, advanced provision of emergency contraception and long-acting reversible contraception to prevent repeat adolescent pregnancy.

Advance Provision of Emergency Contraception in an Urban Pediatric Emergency Department

Study Objective To assess whether a policy and educational intervention in an urban, pediatric emergency department (ED) increases advance provision of emergency contraception (EC) to patients. Design/Setting/Participants A pre- and post-intervention, retrospective chart review was conducted in an urban, pediatric ED assessing provider care of sexually active female adolescents and young adults. Intervention/Main Outcome Measures A policy was instituted recommending that ED providers prescribe EC and provide an educational handout to all sexually active female adolescents and young adults. ED providers were educated about EC and this policy. Charts, subsequently reviewed, included sexually active female patients, age 13–21 years, presenting to the ED status post sexual assault, seeking EC, or with an abdominal, gynecologic, or urologic complaint. Student’s t-tests, Pearson’s chi-square and Fisher’s Exact tests compared pre- and post-intervention provider and patient characteristics and outcomes. Results The mean age of the patient sample was 18.8 years (SD=1.7), 83% were Black or Hispanic, 43% were previously pregnant, 25% reported not using birth control. Last unprotected sexual intercourse was not documented for 87% of patients presenting with medical complaints. There was no difference in the advance prescribing of EC or the provision of the educational handout to patients pre- (3.3%) or post- (5.6%) intervention ( P = 0.73). Conclusions Despite a policy and an educational intervention for providers, little change occurred in advance EC prescribing in an urban, pediatric ED. Additionally, many providers were not documenting last unprotected sexual intercourse, potentially missing an opportunity to treat patients with EC at the time of their visit.

Advance provision of emergency contraception for pregnancy prevention

This article discusses whether advance provision of emergency contraception is more effective than standard provision of the medication in preventing unintended pregnancy. It also touches on the question of whether advance provision impacts other sexual and contraceptive behaviors.

Advance Provision of Emergency Contraception among Adolescent and Young Adult Women: A Systematic Review of Literature

Objective The purpose of this review is to summarize the findings of randomized controlled trials assessing the advance provision of emergency contraception (EC) to women 24 years of age or younger. Design We conducted a comprehensive search of the PubMed database from 1950 to November 11, 2009. This review includes seven studies that randomly assigned women aged 24 and younger to advance provision of EC or a control group. Results All studies reviewed found that women assigned to advance provision were more likely to use EC, though not all reached statistical significance. Furthermore, studies assessing time to EC use (N = 4) found that those with advance provision used EC sooner following intercourse. Most studies found that women assigned to advance provision of EC did not engage in more sexual risk taking behaviors (assessed by reported number of sexual partners, number of episodes of unprotected intercourse, and acquisition of sexually transmitted infections) or switch to less reliable contraceptive methods. Despite increased use and decreased time to use, women who were provided EC in advance did not report significantly lower pregnancy rates. Conclusions The existing literature suggests that among women 24 years of age or younger, advance provision has a positive impact on use and time to use of EC. Most findings indicate that increased use of EC does not have significant negative effects for ongoing contraceptive use or sexual risk taking behaviors. Despite increased use, advanced provision of EC has not been associated with a significant corresponding decrease in pregnancy.

Advance Provision of Emergency Contraception in an Urban Pediatric Emergency Department

Study Objective: To assess whether a policy and educational intervention in an urban, pediatric emergency department (ED) increases advance provision of emergency contraception (EC) to patients. Design/Setting/Participants: A pre- and post-intervention, retrospective chart review was conducted in an urban, pediatric ED assessing provider care of sexually active female adolescents and young adults. Intervention/Main Outcome Measures: A policy was instituted recommending that ED providers prescribe EC and provide an educational handout to all sexually active female adolescents and young adults. ED providers were educated about EC and this policy. Charts, subsequently reviewed, included sexually active female patients, age 13e21 years, presenting to the ED status post sexual assault, seeking EC, or with an abdominal, gynecologic, or urologic complaint. Student’s t-tests, Pearson’s chi-square and Fisher’s Exact tests compared preand post-intervention provider and patient characteristics and outcomes. Results: The mean age of the patient sample was 18.8 years (SD51.7), 83% were Black or Hispanic, 43% were previously pregnant, 25% reported not using birth control. Last unprotected sexual intercourse was not documented for 87% of patients presenting with medical complaints. There was no difference in the advance prescribing of EC or the provision of the educational handout to patients pre- (3.3%) or post- (5.6%) intervention (P 5 0.73). Conclusions: Despite a policy and an educational intervention for providers, little change occurred in advance EC prescribing in an urban, pediatric ED. Additionally, many providers were not documenting last unprotected sexual intercourse, potentially missing an opportunity to treat patients with EC at the time of their visit.

Emergency contraceptive use as a marker of future risky sex, pregnancy, and sexually transmitted infection

The objective of the study was to examine whether emergency contraceptive use predicts future sex at risk for pregnancy, pregnancy, or sexually transmitted infection among young women. A secondary analysis of control group participants (n = 718) from a recent trial of advanced provision of emergency contraception was conducted. We found no association between use of emergency contraception and either pregnancy or infection. Recent use predicted decreased occurrence of subsequent sex at risk for pregnancy among women with a history of sexually transmitted infection (relative risk [RR], 0.39; 95% confidence interval [CI], 0.15-0.97), whereas ever having used predicted increased occurrence among women who either were highly effective method users (RR, 1.45; 95% CI, 1.05-2.01) or had no history of sexually transmitted infection (RR, 1.31; 95% CI, 1.04-1.65). Information about prior emergency contraceptive use was not a useful predictor of subsequent pregnancy, infection, or sex at risk for pregnancy among these young women.

Young women's perceptions of pregnancy risk and use of emergency contraception: findings from a qualitative study

Background Advance provision of emergency contraception (EC) has increased use but not impacted on pregnancy or abortion rates. Here we describe young women's EC use and experiences of unprotected sex to explore why this difference occurs. Methods In-depth interviews with twenty 20-year-old women from eastern Scotland. Results The majority (16) had used EC; 10 reported some experience of unprotected sex. EC use followed contraceptive failure and unexpected or unplanned, but not frequent, unprotected sex. Acknowledging the need for EC requires recognition of pregnancy risk. Those reporting frequent unprotected sex misperceived their pregnancy risk and did not use EC. This group was from socially disadvantaged backgrounds, and all became pregnant. Conclusions EC remains an important “backup” contraceptive and should continue to be widely available. With high levels of unprotected sex, nonuse of EC and unintended pregnancies, further efforts are required to improve the sexual and reproductive health outcomes of disadvantaged young women.

Implementing an Advance Emergency Contraception Policy: What Happens in the Real World?

Advance provision of emergency contraception increases the likelihood of its use, yet little is known about the factors that influence successful implementation of an advance provision policy in publicly funded family planning clinics. Data on knowledge of, attitudes toward and use of emergency contraception were collected from 211 patients attending four Title X-funded clinics in Pennsylvania in 2001-2002. In addition, 22 staff from the four clinics were interviewed regarding barriers to and facilitators of advance provision in 2004-2005, and 111 staff from 46 clinics completed related surveys in 2005. Qualitative data underwent content analysis, and frequencies and bivariate associations between variables were calculated for the survey data. Most patients said they would use emergency contraception (80%) and believed it should be easy to obtain (93%), although 46% thought it is a form of abortion. Patients' familiarity with the method, attitudes toward it and self-efficacy regarding its use were not associated with most demographic or reproductive health characteristics. While nearly all interviewed staff endorsed routine advance provision, only about half of survey respondents offered it "very often" at patients' initial or annual visits. Barriers to advance provision included staff prejudgment of patients' needs and ability to use the method, time constraints and inefficiencies in clinic procedures. Strategies that may facilitate advance provision of emergency contraception include emphasizing the need for staff to offer it during all patient visits, providing patient-friendly information and streamlining clinic procedures.

The Impact of Programs to Increase Contraceptive Use Among Adult Women: A Review of Experimental and Quasi‐Experimental Studies

Because rates of unintended pregnancy, abortion and unintended birth are very high among adult women in the United States, it is important to identify interventions that can increase contraceptive use in this population. PubMed, PsycINFO and POPLINE were searched for experimental or quasi-experimental studies published between 1990 and 2005 that evaluated policies or programs designed to increase contraceptive use or reduce pregnancy among adult women in the United States. In addition, relevant journals were searched, experts were asked to provide further citations and several subsequently published articles were included. Only 11 studies that assessed programs, and none that assessed policies, were found. The evaluated interventions offered pregnancy and STD prevention counseling (one study); provided contraceptives in settings other than family planning clinics (two studies); had women initiate contraceptive use during the medical visit (two studies); provided advance supplies of emergency contraception (four studies); or implemented systems to remind injectable contraceptive users about their next injection (two studies). The interventions generally had positive, albeit short-term, effects on contraceptive use; none reduced pregnancy rates. Programs that gave women a contraceptive during the visit were the most effective at increasing method use. Advance provision of emergency contraception increased the likelihood of its use and did not affect regular contraceptive use. Very few studies have evaluated interventions to increase contraceptive use among adult women. A research plan that rigorously assesses the impact of different approaches to increasing contraceptive use among adult women should be an integral part of any long-term effort to prevent unintended pregnancy in the United States.

Advance Provision of Emergency Contraception for Pregnancy Prevention

Advance provision of emergency contraception can circumvent some obstacles to timely use. We performed a meta-analysis to summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. In August 2006, we searched CENTRAL, EMBASE, POPLINE, MEDLINE, a specialized emergency contraception article database, and contacted experts to identify published or unpublished trials. We included randomized controlled trials comparing advance provision to standard access, defined as any of the following: counseling (with or without information about emergency contraception) or provision of emergency contraception on request at a clinic or pharmacy. Two reviewers independently assessed study quality. We performed a meta-analysis using Review Manager software. Eight randomized controlled trials met inclusion criteria, representing 6,389 patients in the United States, China, and India. Advance provision did not decrease pregnancy rates, despite increased use (single use, odds ratio [OR] 2.52, 95% confidence interval [CI] 1.72-3.70; multiple use: OR 4.13, 95% CI 1.77-9.63) and faster use (weighted mean difference -14.6 hours, 95% CI -16.77 to -12.4 hours). Advance provision did not increase rates of sexually transmitted infections (OR 0.99, 95% CI 0.73-1.34), unprotected intercourse, or changes in contraceptive methods. Women who received emergency contraception in advance were as likely to use condoms as other women. Advance provision of emergency contraception did not reduce pregnancy rates and did not negatively affect sexual and reproductive health behaviors and outcomes compared with conventional provision. III.

Contraception

Contraception

Advance provision of emergency contraception for pregnancy prevention

Emergency contraception can prevent pregnancy when taken after unprotected intercourse. Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision, in which women receive a supply of emergency contraception before unprotected sex, could circumvent some obstacles to timely use. To summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. In August 2006, we searched CENTRAL, EMBASE, POPLINE, MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials. We included randomized controlled trials comparing advance provision and standard access, which was defined as any of the following: counseling which may or may not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy. We evaluated all identified titles and abstracts found for potential inclusion. Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 4.2.8. We calculated odds ratios with 95% confidence intervals for dichotomous data and weighted mean differences with 95% confidence intervals for continuous data. Eight randomized controlled trials met our criteria for inclusion, representing 6389 patients in the United States, China and India. Advance provision did not decrease pregnancy rates (OR 1.0; 95% CI: 0.78 to 1.29 in studies for which we included twelve month follow-up data; OR 0.91; 95% CI: 0.69 to 1.19 in studies for which we included six month follow-up data; OR 0.49; 95% CI: 0.09 to 2.74 in a study with three month follow up data), despite increased use (single use: OR 2.52; 95% CI 1.72 to 3.70; multiple use: OR 4.13; 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -14.6 hours; 95% CI -16.77 to -12.4 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 0.99; 95% CI 0.73 to 1.34), increased frequency of unprotected intercourse, nor changes in contraceptive methods. Women who received emergency contraception in advance were equally as likely to use condoms as other women. Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy. However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.

Advance Supply of Emergency Contraception: A Randomized Trial in Adolescent Mothers

Objective To examine whether the advanced provision of emergency contraception (AEC) to parenting youth would increase emergency contraception (EC) utilization, and whether AEC would impact the rates of unprotected sex and contraception use. Design Subjects were randomized to receive either information about EC or information and an actual supply of AEC. Subjects were interviewed at baseline, 6 and 12-month follow-up. Setting Urban non-medical case management office. Participants 160 adolescent mothers (ages 13 to 20) who were receiving case management services. Intervention Advance supply of emergency contraception. Main outcome measures Emergency contraception use, sexual activity, unprotected intercourse, contraceptive methods and use. Results Parenting teens who received AEC were much more likely to have used it than the control group at the 6-month interview (83% vs. 11%) and the 12-month interview (64% vs. 17%). Teens in the AEC treatment group were more likely to have unprotected sex at the 12-month follow-up interview (69% vs. 45%). There was no difference in condom use between the groups at either the 6-month, or the 12-month follow-up interviews. Conclusion Advance provision of emergency contraception in parenting teens increases the likelihood of its use, and does not affect the use of condoms, or hormonal methods of birth control. Parenting teens who receive AEC may be more likely to have unprotected sex.

Computer-assisted advance provision of emergency contraception in an urgent care setting

Introduction: Advance provision of emergency contraception (EC) is the most effective means of increasing appropriate use of EC known. However, clinicians rarely counsel women about EC. We explored the acceptability of computer-assisted education about and advance provision of EC to women waiting for urgent care services. Materials and Methods: Seventy-eight women used a computer-based interactive educational module and evaluated the acceptability and usefulness of this educational program. The educational module used a ���video doctor��� to simulate a visit to an actual physician and provided information on the safety, efficacy and indications for use of EC. Results: One hundred percent of the women reported learning something from the computer-based educational program. Seventy-one percent of the women thought that they would use some of the information the video doctor shared with them and 91% would recommend use of this educational program to a friend. Ninety-seven percent of the women were interested in receiving a free sample of EC pills in case of future need. Discussion: Computer-assisted education about and advance provision of EC is feasible and acceptable to women seeking urgent care. Future work should demonstrate if advance provision of EC in urgent care settings increases appropriate use of EC. Conclusion: Computer-assisted advance provision of EC has the potential to increase access to EC in a variety of clinical settings.

Advanced provision of emergency contraception to postnatal women in China makes no difference in abortion rates: a randomized controlled trial

Emergency contraception (EC) prevents pregnancy, and it has been suggested that widespread use could reduce abortion rates; however, the use is limited. Providing EC in advance of need increases use, but there is no direct evidence that it reduces unintended pregnancy. In a randomized controlled trial of 2000 women after childbirth in Shanghai, all women not wishing to use hormonal contraception or an intrauterine device (IUD) were given a supply of condoms. Those in the intervention group also received three courses of mifepristone 10 mg with instructions for use as EC. Follow-up was by telephone at 16, 32 and 52 weeks. Over 88% of women in both groups completed 1 year of follow-up. Women with a supply of EC were more than twice as likely to use it, and to use it more than once (p<.001 for both) than women without a supply. There was no difference in pregnancy rates at 1 year (38/832 vs. 32/817). EC was not used in 89% of conception cycles, as women did not recognize the need for it. Increased use of EC may not reduce abortion rates.

Advance EC Provision: No Increase in Unprotected Sex

In this partially manufacturer-supported study, researchers examined the associations between advance provision of emergency contraception (EC) and the

Advanced provision of emergency contraception does not reduce abortion rates

A number of small studies have demonstrated increased use of emergency contraception (EC) when women have a supply available at home. It has been suggested that widespread use of EC could reduce abortion rates. We undertook a community intervention study designed to determine whether offering advanced supplies of EC to large numbers of women influenced abortion rates. All women aged between 16 and 29 years living in Lothian, Scotland, were offered, through health services, five courses of EC without cost to keep at home. Of a population of around 85,000 women in this age group, the study showed that an estimated 17,800 women took a supply of EC home and over 4500 of them gave at least one course to a friend. It was found that nearly half (45%) of women who had a supply used at least one course during the 28 months that the study lasted. In total, an estimated 8081 courses of EC were used. EC was used within 24 h after intercourse on 75% of occasions. Abortion rates in Lothian were compared with those from three other health board areas of Scotland. No effect on abortion rates was demonstrated with advanced provision of EC. The results of this study suggest that widespread distribution of advanced supplies of EC through health services may not be an effective way to reduce the incidence of unintended pregnancy in the UK.

Advanced provision of emergency contraception increased its use without affecting usual contraceptive practices

Advanced provision of emergency contraception increased its use without affecting usual contraceptive practices

Emergency contraception.

Knowledge and use of emergency contraception world-wide is extremely limited. Recent research has demonstrated that levonorgestrel alone is at least as effective as the Yuzpe regimen and is much better tolerated. Levonorgestrel is likely to become the method of choice in the early 21st century. Mifepristone is highly effective even at doses which are not abortifacient. Efficacy cannot be calculated precisely, but all presently available methods seem to prevent at least 74% of unwanted pregnancies. The Yuzpe regimen inhibits or delays ovulation, but there is no good evidence that it prevents implantation. There are no data on the mechanism of action of levonorgestrel alone and the mode of action of mifepristone depends on when in the reproductive cycle it is used. Accessibility to emergency contraception is limited by the requirement for it to be prescribed by a doctor. Advanced provision of emergency contraception may prevent a significant number of unwanted pregnancies.