Emergency Contraception Products Research Articles

Missing opportunities for preventing unwanted pregnancy: a qualitative study of emergency contraception

Background and methodologyHigh levels of unplanned pregnancy among young people are a huge public health problem in South Africa. However, use of emergency contraception (EC) remains low. Studies suggest that...

Ulipristal acetate for emergency contraception

Ulipristal acetate is a progesterone receptor modulator. As an emergency contraceptive, a 30-mg micronized formulation is effective for use up to 120 h from unprotected sexual intercourse. Ulipristal acetate acts as an antagonist of the progesterone receptor at the transcriptional level and a competitive antagonist of glucocorticoid receptor function. In contrast to other contraceptives, it has little effect on sex hormone-binding globulin. Although a single small study demonstrated some potential endometrial effects after ulipristal acetate administration, the clinical relevance of these findings is unclear. The incidence of adverse events in clinical trials for emergency contraception has typically been minimal, with one study showing a higher than expected incidence of nausea upon ulipristal acetate use. Ulipristal acetate, like other emergency contraceptive products, can lengthen the time to the next expected menstruation. Ulipristal acetate may have several advantages over currently approved emergency contraceptives. When compared to levonorgestrel, ulipristal acetate maintains its efficacy for a full 120 h, whereas levonorgestrel formulations have declining efficacy over that time frame. Moreover, although the copper intrauterine device (IUD) is highly effective as an emergency contraceptive, accessibility is an issue since the IUD requires a skilled provider for insertion.

Pharmacy Students' Knowledge, Attitudes, and Behaviors Regarding Emergency Contraception

To determine pharmacy students' knowledge, attitudes, and behaviors regarding emergency contraception. A cross-sectional survey was conducted among a convenience sample of students prior to a regular class period. The 16-item survey instrument included both multiple-choice and true/false questions to assess knowledge and Likert-type scale questions regarding attitudes and behaviors. Frequency and descriptive statistics were calculated for all variables. Three hundred one pharmacy students were surveyed. Eighty-seven percent knew that Plan B had been approved by the Food and Drug Administration (FDA) for nonprescription use, yet 33% believed that it worked by disrupting a newly implanted ovum. On a scale from 1-5 on which 5 = strongly agree, the mean item score was 1.5 for whether nonprescription emergency contraception should be available without counseling by a pharmacist, yet only 26.7% believed they were competent instructing patients on the use of emergency contraception. Additional education is needed to prepare pharmacy students to provide informed pharmaceutical care to patients seeking emergency contraception, especially given the passage of legislation making the pharmacy the point of access for some emergency contraception products.

Pregnancy outcome after levonorgestrel-only emergency contraception failure: a prospective cohort study

Levonorgestrel (LNG), as a dedicated emergency contraception (EC) product, has been available over-the-counter in China for 10 years. Until now, only a small number of deliveries after LNG-EC failure have been documented. This study was a prospective comparative cohort study. A group of 332 pregnant women who had used LNG-EC during the conception cycle was recruited, and matched to a group of 332 pregnant women without the exposure to LNG. Congenital malformations, perinatal complications and delivery circumstances were investigated in this study. There were 31 pregnant women in the study group and 28 in the comparison group miscarried within 14 weeks of gestation. In the study and comparison groups, four malformations were found in each group. In the study group, both birthweight (3416 versus 3345 g, P = 0.040) and the sex ratio of birth (boys/girls, 1.14 versus 0.90, P = 0.153) were higher than in the comparison group. There were no statistically significant differences in the incidence of miscarriage or malformation or in the neonatal outcome between the two groups. There was no association between the use of LNG-EC pills and the risk of major congenital malformations, pregnancy complications or any other adverse pregnancy outcomes in our study.

Comprehension of a prototype emergency contraception package label by female adolescents

Background We evaluated female adolescents' comprehension of a prototype over-the-counter package label for an emergency contraceptive pill product. Study Design Volunteers aged 12–17 years who could read English were recruited at malls and clinics in six United States metropolitan areas. After completing a literacy assessment, subjects examined the prototype package and answered 20 questions that assessed understanding of six key concepts related to appropriate use of the product. Results The analysis population included 335 subjects, 54 to 59 of each year of age between 12 and 17 years. When asked what the product is used for, 264 respondents (79%) specifically indicated contraception. The six key concepts were each understood by 83–96% of subjects. In all 24 population subgroups examined, each key concept was understood by at least 72% of subjects. Conclusion Female adolescents aged 17 years and younger understand the prototype package label well enough to enable safe and effective use without assistance from a clinician.

From pilot to mainstream: a decade of working in partnerships to expand access to emergency contraception in Mexico

Emergency contraception (EC) is used post-coitally and offers women an important second chance to prevent pregnancy. Approximately 10 years ago, Mexico became one of the earliest countries working to expand EC access. Partners came together to pursue a synergistic four-pronged strategy, including product registration, health care provider training and orientation, awareness raising among the general public, and policy change. By 2006, five EC products were registered and sold in Mexico, EC was widely available through pharmacies and included in the public sector contraceptive options, and knowledge of the method had increased substantially.

Emergency contraception in South Africa: A literature review

Objectives Since emergency contraception (EC) products became available over the counter in South Africa in 2000 a number of studies have emerged. This paper reviews the growing body of literature on EC in that country.Methods Standard computer database searches identified published articles and reports on EC in South Africa.Results The level of awareness of EC is fairly low, especially among public sector clients. Most studies suggest that very few people have even heard of it. Several studies also indicate that provider knowledge of and attitude towards EC vary greatly. While many providers are aware of the indications and efficacy of the method, not all health care professionals are sufficiently knowledgeable and misperceptions persist. The limited knowledge of EC among health professionals may, in turn, prevent them from discussing it with clients.Conclusion The existing literature suggests that the greater availability of EC is not sufficient to increase uptake and that interventions are needed to ensure that women become aware of this option.

OTC Product: Plan B Emergency Contraception

This article provides the key information for the over the counter (OTC) emergency contraception product Plan B. It includes information regarding: manufacturer active ingredient indication availability safety efficacy mechanism of action and patient information.

Expanding access to emergency contraception through state systems: the Washington State experience.

Access to family planning and reduction of unintended pregnancy are long-standing priorities for Washington States Department of Health (DOH) and Department of Social and Health Services (DSHS). Working together to ensure that all pregnancies are intended (consciously and clearly desired at the time of conception) the two agencies provide family planning counseling and a broad choice of contraceptive methods through a range of health and social service programs. When a dedicated product for emergency contraception became available in 1998 widespread integration of relevant information and services became one more strategy the agencies used to realize the goal of reducing unintended pregnancy in the state. Since 1997 the Program for Appropriate Technology in Health (PATH) has collaborated with state colleagues to increase access to emergency contraception. In a series of interviews conducted in December 2003 PATH asked administrators managers and others who were involved in the initial process to describe the experience. The story that emerged described here is one of strong high-level support for family planning services that created an ideal platform for expanding emergency contraception services establishing collaborations between relevant agencies and increasing the number of state programs and the range of service providers offering emergency contraception services. The result was an innovative approach to service delivery that made it possible to reach underserved and low-income populations including those not served by Title X--funded clinics. Our objective in sharing Washington States experience is to stimulate further state-level innovation for expanding access to emergency contraception. (excerpt)

Expanding Access to Emergency Contraception Through State Systems: The Washington State Experience

Access to family planning and reduction of unintended pregnancy are long-standing priorities for Washington States Department of Health (DOH) and Department of Social and Health Services (DSHS). Working together to ensure that all pregnancies are intended (consciously and clearly desired at the time of conception) the two agencies provide family planning counseling and a broad choice of contraceptive methods through a range of health and social service programs. When a dedicated product for emergency contraception became available in 1998 widespread integration of relevant information and services became one more strategy the agencies used to realize the goal of reducing unintended pregnancy in the state. Since 1997 the Program for Appropriate Technology in Health (PATH) has collaborated with state colleagues to increase access to emergency contraception. In a series of interviews conducted in December 2003 PATH asked administrators managers and others who were involved in the initial process to describe the experience. The story that emerged described here is one of strong high-level support for family planning services that created an ideal platform for expanding emergency contraception services establishing collaborations between relevant agencies and increasing the number of state programs and the range of service providers offering emergency contraception services. The result was an innovative approach to service delivery that made it possible to reach underserved and low-income populations including those not served by Title X--funded clinics. Our objective in sharing Washington States experience is to stimulate further state-level innovation for expanding access to emergency contraception. (excerpt)

Current Issues in Emergency Contraception: An Overview for Providers

Emergency contraception has the potential to greatly reduce the number of unintended pregnancies occurring each year in the United States. Emergency contraception is a safe and effective intervention to which all women should have easy access in the event of an act of unprotected intercourse. Methods of emergency contraception include combined hormone oral contraceptive pills, progestin-only oral contraceptive pills, a dedicated progestin-only emergency contraceptive product, and insertion of a copper intrauterine device. Barriers exist to the increased use of emergency contraception, including the prescription-only status of all of the methods and lack of accurate knowledge on the part of health care providers and consumers. This article provides an overview of the clinical management of emergency contraception.

Emergency Contraception: In Reply

In Reply.—The American Academy of Pediatrics (AAP) Committee on Adolescence welcomes Dr Gold's letter and the opportunity to correct the dose and product recommendations of readily available emergency contraceptive (EC) products. Although the position paper1 was current at the time it was written and approved by the AAP, she is correct in noting that the availability of products has changed.Drs Stanford and Mikolajczyk identify several additional references that selectively address the lack of evidence for reductions in abortion rates for populations for which EC is available. However, whether populations in Scotland and China are reasonably extrapolated to the United States is not clear; in addition, recent studies suggesting that EC is associated with responsible sexual behavior in Scotland were not reviewed in our article or in the letter.Their reading of the policy also somewhat misses the point. It is appropriate for primary care organizations to judge the available evidence and make recommendations for best clinical practices even when extensive efficacy data are not available. The AAP believes that “[e]mergency contraception has the potential to further decrease the rate of unintended teen pregnancies in the United States.”

Gravidez ectópica após uso de contracepção de emergência: relato de caso

Gravidez ectópica é a implantação e o desenvolvimento do ovo fora da cavidade uterina; impõe diagnóstico precoce e assistência de urgência. Gravidez ectópica com corpo lúteo contralateral presume ocorrência de transmigração do zigoto para a tuba uterina do lado oposto, o que pode ser responsável pela sua ocorrência. Em 1994, o levonorgestrel teve sua eficácia comprovada como superior à dos outros métodos para contracepção de emergência. É relatado caso de paciente de 27 anos que apresentou gravidez ectópica, de localização tubária, com corpo lúteo contralateral, após uso de contracepção de emergência por falha do método anticoncepcional de escolha (preservativo masculino). Foi realizado tratamento cirúrgico conservador por videolaparoscopia, com boa evolução após a cirurgia.

Competency Assessment of Pharmacists Providing Emergency Contraception

Emergency contraceptive pills (ECPs; levonorgestrel or combination oral contraceptives) are used in unique regimens soon after failed contraception or unprotected intercourse to prevent pregnancy. Prompt access to these products is important, as efficacy diminishes with time since intercourse. The availability of EC from pharmacists (either as prescribed Schedule F products or via a rescheduling to Schedule II pharmacist-supervised sale) would greatly increase access. In Saskatchewan, pharmacists have received independent prescribing authority for ECPs. This article describes the process for assessing competency to prescribe EC in that province. A faculty of pharmacy developed a workshop to educate pharmacists about emergency contraceptive products, their mechanism of action, the necessary assessment and documentation processes, ethical issues related to emergency contraception, and counselling techniques. It also offered participants an opportunity to explore a variety of clinical cases in small groups. Participants completed a test before and after the training and were required to attain a score of 80% or greater on the latter test to become certified to prescribe. The average scores on the pre- and post-training tests were 14.4/25 (57.6%) and 22.1/26 (85.0%), respectively ( p < 0.05). Over a series of three workshops, 17.2% of Saskatchewan's 1182 pharmacists became certified to prescribe ECPs. The workshop was offered again in June and September 2003, in anticipation of the September 1, 2003, legislative changes.

Emergency contraception: pharmacy access in Albuquerque, New Mexico

Objective Emergency contraception could reduce the approximately 3 million unintended pregnancies that occur annually in the United States. Dedicated emergency contraception products may be particularly useful because instructions are easy to understand and simple to follow. However, they must be available within a few days to women who have had unprotected intercourse. The goal of this study was to investigate whether women presenting to pharmacies in a moderately sized metropolitan area with a prescription for Plan B or Preven could get it filled. Methods Two research assistants posed as women needing emergency contraception. They visited 89 pharmacies in Albuquerque, New Mexico, presenting a prescription for either Plan B or Preven. The assistants recorded the availability of the products in the pharmacies. When the product was not in stock, the research assistants asked pharmacy providers why the products were not carried. Fisher exact test was performed to compare categoric data. Results Plan B and Preven were in stock at only 19 visits (11%). Of the pharmacies that did not stock the products, 53% reported they could obtain Plan B or Preven within 24 hours. The most common reason cited by pharmacy providers for not stocking Plan B or Preven was the lack of prescriptions received for them (65%). Conclusion Plan B and Preven were not in stock at the majority of pharmacies in a moderately sized metropolitan area. Lack of availability at the pharmacy constitutes a major barrier to emergency contraception access.

Emergency contraception pills (ECPs): current trends in United States college health centers

Background Access to emergency contraception pills (ECPs) could drastically reduce the high rates of unintended pregnancies in college women. Methods In spring 2001, a survey was distributed to 139 US college health centers to assess availability of ECPs. Those that prescribed ECPs provided additional information about health center distribution policies and procedures, provider practice patterns, advertising and staff attitudes. Those that did not offer ECPs were asked to state reasons for not providing this service and whether FDA approval of dedicated emergency contraception products might promote availability. Results The majority of campuses (66.9%) prescribe ECPs; however, many barriers exist to access. Campuses not prescribing ECPs cited moral conviction (56.5%) as a main reason for not providing this service. Staff and administration attitudes appear to play a major role in whether campuses make ECPs available to their students. Interpretation Despite recent advances leading to increased availability of ECPs among college health centers, a number of campuses still do not prescribe ECPs.

Surfing on the morning after: analysis of an emergency contraception website

The introduction of widespread nonprescription delivery of hormonal emergency contraception (EC) calls for development of innovative tools to provide information to and gather feedback from EC users. Individuals seeking confidential information on sexual health and contraception are increasingly turning to the Internet as the resource of choice. This study employed analytical software and manual content analysis to examine the use of a website dedicated to an EC product (www.norlevo.com) over the course of 2 years. Frequency of visits to and pageviews of the site increased consistently over the 2-year time period, and the bulk of the visitors to the site were EC users seeking responses to frequently asked questions. The most common concern raised by users was the occurrence of spotting and menstrual bleeding following EC use. This analysis reveals that within the context of nonprescription access to hormonal EC, a website can constitute a potent educational tool for health professionals and EC users and provide a valuable source of post-marketing feedback on product use.

Information campaign and advocacy efforts to promote access to emergency contraception in Mexico

Emergency contraception (EC) has the potential to reduce unwanted pregnancy significantly, in Mexico as elsewhere. Recent years have seen tremendous growth in programs and research devoted to expanding access to emergency methods worldwide. In Mexico we developed a comprehensive model introduction effort that included four components: provider training, public information (through a dedicated hotline and website, free media, paid radio and TV spots, participation in talk shows, and alternative media channels), collaboration with the public sector to include EC in the official family planning norms, and assistance to partner with commercial firms to register a dedicated EC product. Ongoing efforts to combat misperceptions and overcome opposition are crucial to informing the public and ensuring greater access to the method.

Switching emergency contraception to over-the-counter status.

Hormonal emergency contraception is safe, effective, and available by prescription in the United States. This article explains why dropping the prescription requirement for emergency contraception would pose no risk to women and would improve public health by preventing unintended pregnancies. The author points out that over-the-counter sale of emergency contraceptive products is appropriate, because women are easily able to determine when and how to use them.

Comprehension of a Prototype Over-the-Counter Label for an Emergency Contraceptive Pill Product

In Brief OBJECTIVE This study was designed to evaluate comprehension of a prototype over-the-counter package label for an emergency contraceptive pill product. METHODS Interviews were conducted with 663 women in malls and family planning clinics in eight United States cities. The sample included many young and minority women and women of low literacy. After looking at the package, subjects were asked 30 questions that addressed 11 communication objectives about indications, contraindications, instructions, side effects, and management of serious complications. Most questions asked whether or not use of the product would be appropriate in a described situation. RESULTS Seven of the 11 communication objectives were each understood by more than 85% of subjects. Most women in the study understood the most important objectives: that the product is indicated for prevention of pregnancy after unprotected sex (93%), that the first pill should be taken within 72 hours or as soon as possible after intercourse (97%), that the product should not be used by women who are already pregnant (98%), and that the product does not prevent sexually transmitted diseases or human immunodeficiency virus/acquired immune deficiency syndrome (94%). More-literate women were more likely to understand the objectives than less-literate women. CONCLUSION These results indicate that by reading the prototype label, most women could understand key information necessary for safe and effective use of this product. A prototype over-the-counter label for an emergency contraceptive pill product was well understood by most women.