Requesting Emergency Contraception Research Articles

Emergency contraception

Emergency contraception is an intervention aimed to prevent an unplanned or unintended pregnancy after unprotected sexual intercourse or where inadequate contraception has been used. It is only recommended for occasional use, and patients should be advised regarding regular and preferably long-term contraception if suitable. The request for emergency contraception is a frequent presentation in general practice. Around 40% of pregnancies worldwide are estimated to be unplanned, and a significant proportion of unplanned pregnancies result in termination, leading to avoidable distress. Therefore, it is paramount that healthcare professionals understand the available methods of emergency contraception. This article will cover the available methods, looking at their indications, use, efficacy, risks, and benefits.

Conscientious Objection to Emergency Contraception

Conscientious Objection to Emergency Contraception

Opportunities for improving provision of emergency contraception in California

ObjectivesTo assess emergency contraception (EC) service provision by California's family planning clinics. Study DesignWe made 2 scripted calls to a random sample of 309 family planning clinics. ResultsWe reached one hundred ninety-four clinics on 2 occasions, although only 183 (59%) could be reached with the information provided online by California's office of family planning. Of these 194 clinics, 27% responded that the clinic did not provide EC and 43% offered only levonorgestrel EC. Only 1 clinic asked about recent sexual assault and one other about their weight. ConclusionsPrompt access to effective EC remains challenging in California. Clinic staff responding to requests for EC should provide trauma-informed care.

Common questions on emergency and postcoital contraception

There are a number of key questions that must be asked when considering the method of emergency or postcoital contraception to use. Alison J Vaughan examines these when choosing from the three treatments available in the UK Copper IUD (CU-IUD), Levonorgestrel (LNG-EC), Ulipristal Acetate Emergency Contraception (UPA-EC) are the three methods of emergency contraception (EC) available in the UK. CU-IUD is the most effective method and must be offered to all women requesting emergency contraception and that offer documented in the record. UPA is more effective than LNG but the efficacy of UPA can be affected by on-going contraception, so is not always the ideal method for all women (see Figure 1 ). A consultation for EC offers the opportunity to discuss on going contraception and sexual health. Comprehensive evidence-led guidance can be found in the EC clinical guideline, published by the Clinical Effectiveness Committee of Faculty of Sexual and Reproductive Healthcare (FSRH) in 2017.

Response to requests for contraception in one direct-to-consumer telemedicine service

ObjectiveTo describe real-world care seeking and contraception provision in one direct to consumer telemedicine platform. Study designWe described encounters with reproductive age female patients between July 2016 and July 2018 seeking contraception on the American Well telemedicine platform. ResultsOf 126,712 total encounters with reproductive age women, 682 were with women seeking contraception, and 83% received it. The mean encounter length was 4.4 min versus 5.0 min for non-contraceptive visits. Insurance information was provided for 78% of contraceptive encounters versus 85% of non-contraceptive encounters, p < 0.001. Of the 27 encounters in which the patient requested emergency contraception, three did not result in such a prescription. ConclusionDirect to consumer telemedicine may increase access to contraceptives, yet overall use was uncommon. Most women seeking contraception via direct to consumer telemedicine on this platform received it. Three women who requested emergency contraception did not receive it, yet reasons for this are unknown.

Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset.

BackgroundEvidence of an association between exposure to domestic violence and abuse (DVA) and use of emergency contraception (EC) is lacking in the UK.AimTo quantify the association between exposure to DVA and consultations for EC in general practice.Design and settingNested case-control study in UK general practice.MethodUsing the Clinical Practice Research Datalink, the authors identified all women all women aged 15–49 years registered with a GP between 1 January 2011 and 31 December 2016. Cases with consultations for EC (n = 43 570) were each matched on age and GP against four controls with no consultations for EC (n = 174 280). The authors calculated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between exposure to DVA in the previous year and consultations for EC. Covariates included age, ethnicity, socioeconomic status, pregnancy, children, alcohol misuse, and depression.ResultsWomen exposed to DVA were 2.06 times more likely to have a consultation for EC than unexposed women (95% CI = 1.64 to 2.61). Women aged 25–39 years with exposure to DVA were 2.8 times more likely to have a consultation for EC, compared with unexposed women (95% CI = 2.08 to 3.75). The authors found some evidence of an independent effect of exposure to DVA on the number of consultations for EC (OR 1.48, 95% CI = 0.99 to 2.21).ConclusionA request for EC in general practice can indicate possible exposure to DVA. Primary care consultation for EC is a relevant context for identifying and responding to DVA as recommended by the World Health Organization and National Institute for Health and Care Excellence guidelines. DVA training for providers of EC should include this new evidence.

Use of emergency contraception among women with experience of domestic violence and abuse: a systematic review

BackgroundExposure to domestic violence and abuse (DVA) results in a reduction of women’s use of regular contraceptives. This evidence suggests that women exposed to DVA are more likely to have unprotected sexual intercourse and therefore may use more emergency contraception (EC) than those women who are not exposed to DVA. We aimed to test this hypothesis through evaluating the evidence for an association between exposure to DVA and use of EC.MethodsWe systematically searched eight electronic databases from inception until December 2017, checked references and citations, and contacted corresponding authors. Primary studies that evaluated the association between exposure to DVA and use of EC were included. Two reviewers were involved in screening, data extraction, quality assessment and analysis. We evaluated the quality of included studies with the adapted Newcastle-Ottawa Scale. We used tables and descriptive text to summarise and synthesise the data. Odds ratios (ORs) and 95% confidence intervals (CIs) for each estimate of the association between DVA and use of EC were plotted on a forest plot.ResultsOur search retrieved 1216 records of which six studies with 15,297 women were included. Five studies were observational; one study included intervention on the outcome (advance supply of EC). All studies were at high risk of bias. Four studies provided evidence of an association between DVA and EC use – ORs from 1.51 (95% CI 1.13, 2.02) to 6.50 (95% CI 4.15, 10.17). Two studies found no evidence of a such association – ORs 0.46 (95% CI 0.11, 1.96) and 0.76 (95% CI 0.29, 1.98). The latter differed by how the authors recruited participants, measured EC use and adjusted for confounders.ConclusionsThis systematic review provides some evidence of increased use of EC among women exposed to DVA. Request for EC can indicate possible exposure to DVA. Therefore, each consultation for EC could be an appropriate context for clinical enquiry about DVA and signposting/referral to specialist DVA services.Protocol registrationPROSPERO CRD42017058221.

Anxiety and attitudes towards sex in women requesting emergency contraception

We performed an observational descriptive study on 89 women who requested for emergency contraception (EC) at the emergency units of two hospitals, Virgen de la Victoria Hospital, and Regional University Hospital in Malaga between October 2016 and April 2017. Both hospitals are on the Andalusian Public Health System. We evaluated a group of socio-demographic variables and others related to the beliefs and the knowledge about EC and contraception in general, sexual behavior, Eysenck’s Inventory of Attitudes to Sex (satisfaction and promiscuity factors), and State-Trait Anxiety Inventory (STAI). RESULTS: State anxiety scores were low in 10.8% of the participants, middle in 25.7% and high in the 63.5%. On the other hand, the scores for trait anxiety were low in 13.5%, middle in 39.2% and high in 47.3%. The demand for EC resulted in a stressful situation for women, especially for youngest women. Also, married women with children and a history of pregnancy terminations showed higher anxiety scores. Regarding sexual attitudes, the highest levels of anxiety (state and trait) were found in women with less knowledge about EC, and in those who reported less satisfaction with their sex life. Best fit regression models for anxiety levels included beliefs that ECs are abortive, sexual dissatisfaction and women’s age as predictive variables for STAI scores. In conclusion, women who requested EC showed high scores in anxiety-state and -trait, with those of younger age presenting more intense emotions.

Unprotected intercourse in the 2 weeks prior to requesting emergency intrauterine contraception

Previous emergency contraception studies have excluded women who report >1 episode of unprotected or underprotected intercourse. Thus, clinical recommendations are based on exposure to a single episode of underprotected intercourse. We sought to assess the prevalence and timing of underprotected intercourse episodes among women requesting emergency contraception and to examine the probability of pregnancy following an emergency contraception regimen including placement of either a copper intrauterine device or a levonorgestrel intrauterine device with simultaneous administration of an oral levonorgestrel pill in women reporting multiple underprotected intercourse episodes, including episodes beyond the Food and Drug Administration-approved emergency contraception time frame (6-14days). Women seeking emergency contraception who had a negative pregnancy test and desired either a copper intrauterine device or levonorgestrel emergency contraception regimen enrolled in this prospective observational study. At enrollment, participants reported the number and timing of underprotected intercourse episodes in the previous 14 days. Two weeks later, participants reported the results of a self-administered home pregnancy test. Of the 176 women who presented for emergency contraception and received a same-day intrauterine device, 43% (n= 76) reported multiple underprotected intercourse episodes in the 14 days prior to presenting for emergency contraception. Women with multiple underprotected intercourse episodes reported a median of 3 events (range 2-20). Two-week pregnancy data were available for 172 (98%) participants. Only 1 participant had a positive pregnancy test. Pregnancy occurred in 0 of 97 (0%; 95% confidence interval, 0-3.7%) women with a single underprotected intercourse episode and 1 of 75 (1.3%; 95% confidence interval, 0-7.2%) women reporting multiple underprotected intercourse episodes; this includes 1 of 40 (2.5%; 95% confidence interval, 0-13.2%) women reporting underprotected intercourse 6-14 days prior to intrauterine device insertion. Women seeking emergency contraception from clinicscommonly reported multiple recent underprotected intercourse episodes,including episodes occurring beyond the Food and Drug Administration-approved emergency contraception time frame. However, the probability of pregnancy was low following same-day intrauterine device placement.

Sexual and Contraceptive Behaviors among Adolescents Requesting Emergency Contraception

Study Objective and DesignUnintended pregnancy rates in the United States remain high among adolescents. Emergency contraception (EC) provides the only option for pregnancy prevention after unprotected sex. To better define the population of adolescents who request and use EC pills, we performed a post hoc analysis of an over-the-counter simulation study of EC pills. SettingTeen reproductive health clinics in 5 cities. ParticipantsAdolescents between the ages of 13 and 17 years who requested EC. InterventionsSingle-tablet levonorgestrel 1.5 mg. Main Outcome MeasuresWe calculated the correlations between age and baseline sexual and contraceptive behaviors. χ2 Tests were used to compare behaviors of first-time and repeat EC users. ResultsOverall, the most commonly reported contraceptive methods ever used were condoms, oral contraceptives, none, and withdrawal; the most common method ever used in each age group was no method for 13- to 14-year-olds and condom for 15-, 16-, and 17-year-olds. The percentage of participants who had never used contraception before requesting EC decreased with age (53% [20/28] of 13- to 14-year-olds vs 15% [10/65] of 17-year-olds). First-time EC users were more likely to report no previous contraceptive use compared with repeat EC users (42% [88/208] vs 10% [13/135]; P < .001). Regardless of age, the most commonly reported reason for requesting EC was nonuse of any contraceptive method (ie, “unprotected sex”). ConclusionAdolescents who requested EC most commonly reported ever-use of contraceptive methods that rely on user adherence or no method at all, with younger adolescents more likely than older adolescents to have used no previous method. The provision of EC presents an opportunity to provide education and access to highly effective, long-term contraceptive methods.

S07.3 Facilitating sexual health: why do 12–16 year olds attend a rural sexual health clinic?

Introduction Chlamydia is the most commonly diagnosed bacterial STI in Australia and is asymptomatic in approximately 80% of people. If untreated, potential consequences include pelvic inflammatory disease, ectopic pregnancy and infertility. Those experiencing recurrent infections are more likely to experience these unwanted complications, and as such consideration must be given to those who are very young when first infected. Methods In 2014 we undertook a retrospective audit at a rural sexual health service to determine what proportion of patients attending the clinic were aged 12–16 years, tested for and infected with chlamydia and their reasons for attending the clinic. Results There were 595 consultations for patients aged 12–16 years during the study period, with a total of 111 individual patients attending the clinic, 104 (95%) were female. 194 chlamydia tests were conducted with the proportion of individual patients having at least one test per year being 100% in 2011, 81% in 2012, 72% in 2013 and 78% in 2014. There was no difference in the proportion tested by age over the study period (p = 0.59). 46 tests were positive for chlamydia (23.7%; 95% CI: 17.8%, 30.9%) with the proportion decreasing with increasing age from 46.7% (95% CI: 16.4%, 79.5%) in those aged 12 or 13 years to 15.5% (95% CI: 9.4%, 24.2%) in those age 16 years (p = 0.02). The reasons for attending the clinic when a chlamydia test was ordered included i) pregnancy testing, request for emergency contraception and/or termination of pregnancy (18.3%, 34/185), ii) symptoms of anything (16.7%, 31/185), iii) a request for STI screening or treatment (32.4%, 60/185) and presenting for contraception (32.4%, 60/185). Only 29.7% (33/111) of these patients would have tested for chlamydia if symptoms or requesting a screen were the only reasons a test was ordered. Conclusion Consideration should be given to amending the current chlamydia screening recommendation to annual screening of any sexually active person under 29 years. Conflict of interest None declared.

Contraceptive usage in women requesting emergency contraception in Swaziland

Background: The Kingdom of Swaziland, following the introduction of the National Family Planning Programme in 1973, has witnessed insufficient scientific publications on the contraceptive practices in the country despite documented high fertility rates and low contraceptive prevalence rates. This study was conducted to understand the practices and potential determinants of contraception among Swazi women who requested emergency contraception.Methods: The data were collected over a period of one month and analysed using simple descriptive analysis to summarise the data and bivariate analysis to determine relevant factors associated with the use of contraception.Results: The majority of participants (79%) use contraceptives. Reasons given for not using contraception previously ranged from medical conditions to not being sexually active. Widely used contraceptives are male condoms, injectable hormones and combined oral contraceptives while the least popular are implants, and post-coital pills. Knowledge of contraceptives came mainly from the health facilities, peers and mass media while parents are the least consulted sources. A high percentage (97%) are aware of sexually transmitted diseases (STDs) and that male and female condoms are the best forms of protection against STDs. Demographic and socio-economic variables are not significantly related to the use of contraceptives.Conclusion: The study established that the majority of the participants used some form of contraception and they also delayed their sexual debut up to the age of 18–20 years. The observed changes of increased contraceptive use and later age of sexual debut could be associated with increased levels of education of the participants and the predominant relaxed approach by Protestants and Zionists who are usually tolerant of contraception. The recommendations, based on the findings of this study, would assist with the planning and implementation of future family planning programmes for which this study serves as a foundation.

Contraceptive usage in women requesting emergency contraception in Swaziland

Background: The Kingdom of Swaziland, following the introduction of the National Family Planning Programme in 1973, has witnessed insufficient scientific publications on the contraceptive practices in the country despite documented high fertility rates and low contraceptive prevalence rates. This study was conducted to understand the practices and potential determinants of contraception among Swazi women who requested emergency contraception.Methods: The data were collected over a period of one month and analysed using simple descriptive analysis to summarise the data and bivariate analysis to determine relevant factors associated with the use of contraception.Results: The majority of participants (79%) use contraceptives. Reasons given for not using contraception previously ranged from medical conditions to not being sexually active. Widely used contraceptives are male condoms, injectable hormones and combined oral contraceptives while the least popular are implants, and post-coital pills. Knowledge of c...

Mifepristone 5 mg versus 10 mg for emergency contraception: double-blind randomized clinical trial.

PurposeTo estimate the efficacy and safety of 5 mg and 10 mg mifepristone for emergency contraception up to 144 hours after unprotected coitus.MethodsThis double-blind randomized clinical trial was carried out at Eusebio Hernandez Hospital (Havana, Cuba). A total of 2,418 women who requested emergency contraception after unprotected coitus received either 5 mg or 10 mg mifepristone. The variables for assessing efficacy were the pregnancies that occurred and the fraction of pregnancies that were prevented. Other variables assessed were the side effects of mifepristone, vaginal bleeding, and changes in the date of the following menstruation.ResultsThere were 15/1,206 (1.2%) and 9/1,212 (0.7%) pregnancies in the 5 mg and 10 mg group, respectively (P=0.107). There were 88% and 93% prevented pregnancies in the 5 mg and un ≥7 days was experienced by 4.9% and 11.0% of subjects in the 5 mg and 10 mg group, respectively (P=0.001). There was a significant high failure rate for women weighing >75 kg in the 5 mg group.ConclusionIt would be advisable to use the 10 mg dose of mifepristone for emergency contraception as there was a trend suggesting that the failure rate of the larger dose was lower.

Oops, we did it again! Unprotected intercourse in the 2 weeks prior to requesting emergency contraception

Oops, we did it again! Unprotected intercourse in the 2 weeks prior to requesting emergency contraception

Single-Dose 1.5 mg Levonorgestrel Emergency Contraceptive Safety in Young Women (Various Age Groups)

INTRODUCTION: A recent over-the-counter simulation study (Raine TR Ricciotti N Sokoloff A Brown BA Hummel A Harper CC. An over-the-counter simulation study of a single-tablet emergency contraceptive in young females. Obstet Gynecol 2012;119:772-9.) of a single-dose emergency contraceptive demonstrated young womens ability to appropriately select and correctly use the emergency contraceptive. This post hoc analysis examined the safety of the emergency contraceptive in various age subgroups. METHODS: This was a noncomparative case-series study of a single-dose 1.5 mg levonorgestrel emergency contraceptive. Eligible women were 11-17 years of age and presented to study sites requesting emergency contraception. Safety information (side effects and any medical problems) was collected by telephone or return clinic visit at approximately 1 4 and 8 weeks after the date the emergency contraceptive was dispensed. Safety data were retrospectively assessed in the following age subgroups: 13-14 15-16 and 17 years. RESULTS: There were 299 women included in the safety analysis (11-12 year olds n=0; 13 year olds n=2; 14 year olds n=30; 15 year olds n=87; 16 year olds n=123; 17 year olds n=57). The incidence of treatment-emergent adverse events were 13% (4/32) in 13-14 year olds 16% (34/210) in 15-16 year olds and 12% (7/57) in 17 year olds. The emergency contraceptive was well tolerated in all age subgroups. The most commonly reported treatment-emergent adverse event(s) in each age subgroup was as follows: in 13-14 year olds vaginal bleeding (6% [2/32]); in 15-16 year olds nausea and headache (each 3% [6/210]); in 17 year olds nausea and vulvovaginal mycotic infection (each 4% [2/57]). CONCLUSION: This post hoc analysis found a single-dose 1.5 mg levonorgestrel emergency contraceptive to be safe and well tolerated in young women of various ages ranging from 13 to 17 year olds.

A systematic review of effectiveness and safety of different regimens of levonorgestrel oral tablets for emergency contraception.

BackgroundUnintended pregnancy is a complex phenomenon which raise to take an emergency decision. Low contraceptive prevalence and high user failure rates are the leading causes of this unexpected situation. High user failure rates suggest the vital role of emergency contraception to prevent unplanned pregnancy. Levonorgestrel - a commonly used progestin for emergency contraception. However, little is known about its pharmacokinetics and optimal dose for use. Hence, there is a need to conduct a systematic review of the available evidences.MethodsRandomized, double-blind trials were sought, evaluating healthy women with regular menstrual cycles, who requested emergency contraception within 72 h of unprotected coitus, to one of three regimens: 1.5 mg single dose levonorgestrel, two doses of 0.75 mg levonorgestrel given 12 h apart or two doses of 0.75 mg levonorgestrel given 24 h apart. The primary outcome was unintended pregnancy; other outcomes were side-effects and timing of next menstruation.ResultsEvery trial under consideration successfully established the contraceptive effectiveness of levonorgestrel for preventing unintended pregnancy. Moreover, a single dose of levonorgestrel 1.5 mg for emergency contraception supports its safety and efficacy profile. If two doses of levonorgestrel 0.75 mg are intended for administration, the second dose can positively be taken 12–24 h after the first dose without compromising its contraceptive efficacy. The main side effect was frequent menstrual irregularities. No serious adverse events were reported.ConclusionsThe review shows that, emergency contraceptive regimen of single-dose levonorgestrel is not inferior in efficacy to the two-dose regimen. All the regimens studied were very efficacious for emergency contraception and prevented a high proportion of pregnancies if taken within 72 h of unprotected coitus. Single levonorgestrel dose (1.5 mg) can substitute two 0.75 mg doses 12 or 24 h apart. With either regimen, the earlier the treatment is given, the more effective it seems to be.

“I'll See What I Can Do”: What Adolescents Experience When Requesting Emergency Contraception

To understand the experiences of adolescent females when they try to obtain emergency contraception (EC) from pharmacies. Female callers, posing as 17-year-old adolescents, used standardized scripts to telephone 943 pharmacies in five United States cities. Two investigators independently coded qualitative data from these calls. Codes were discussed and a thematic analysis was conducted. Investigator, expert, and informant triangulation were used to ensure data credibility. Four major themes emerged. First, ethical terms (personal or religious) were used to explain institutional pharmacy policies on EC availability. Second, there was confusion about the dispensing regulations regarding EC, given recent changes in United States policies. Third, pharmacy staff often introduced false barriers to EC access. In some cases, pharmacy staff used these barriers as justification for refusing to dispense EC; however, in other cases, pharmacy staff helped the adolescents overcome these false barriers. Finally, the degree of confidentiality in providing EC was unpredictable, with some pharmacies guaranteeing strict confidentiality and others explicitly telling adolescents, incorrectly, that their parents had to be informed. Adolescents requesting EC from pharmacies are often explained pharmacy policies in ethics-laden terms, and confidentiality is not always guaranteed. They are told of false barriers to EC access, and there is confusion concerning the evolving policies regarding EC dispensing. It is important for clinicians, pharmacy staff and others to be aware of these experiences as they work to help improve adolescents' access to EC.

Twelve-month follow-up of advance provision of emergency contraception among teenage girls in Sweden—a randomized controlled trial

Objective. The objective of this study was to evaluate the effect of an intervention with advance provision of emergency contraceptive pills (ECP), condoms, and extended information to a targeted group of teenage girls, compared with a control group, 12 months after intervention.Material and methods. A randomized controlled trial among 420 girls, 15–19 years old, requesting emergency contraception at a youth clinic in Sweden was carried out. Data were collected by a questionnaire at the initial visit and structured telephone interviews 12 months after enrolment. Differences between the intervention group and the control group regarding ECP use, time interval from unprotected intercourse to ECP intake, contraceptive use, and sexual risk-taking were analysed.Results. One year after the intervention 62% of the girls could be reached for follow-up. The girls in the intervention group reported a shorter time interval (mean 15.3 hours) from unprotected intercourse to ECP intake compared to the control group (mean 25.8 hours) (p = 0.019), without any evidence of decreased use of contraceptives or increased sexual risk-taking.Conclusion. Even up to 12 months following the intervention, advance provision of ECP at one single occasion, to a specific target group of adolescent girls, shortens the time interval from unprotected intercourse to pill intake, without jeopardizing contraceptive use or increasing sexual risk-taking. Considering the clinical relevance of these results, we suggest that advance provision of ECP could be implemented as a routine preventive measure for this target group.

To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention in Australia

ObjectivesTo develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention called Emergency Contraception Mediated Pharmacy Access to Chlamydia Testing (ECOMPACT).DesignSelective, opportunistic and cross-sectional study targeting asymptomatic...