Young women who have an advance provision of emergency contraception are more likely to use it when they need it, but its availability does not appear to increase risky sexual behavior, according to a new study by University of California, San Francisco researchers.
Emergency contraception, also known as oral post-coital contraception and often called the morning-after pill, prevents pregnancy after unprotected intercourse. The treatment regimen consists of a series of elevated doses of oral contraceptive pills (levonorgestrel) taken within 72 hours of intercourse. The UCSF study followed 213 young women between the ages of 16 and 24 who were considered at very high-risk for unintended pregnancy and who were patients at a publicly funded family planning clinic in the Mission District of San Francisco.
Study participants were assigned to one of two groups: those receiving educational information about emergency contraception along with advance provision of a single treatment dose and those receiving only information. Researchers compared behavior patterns in the two groups over a four-month period.
This type of data had not been collected previously in the U.S. or in such a high-risk population, according to lead investigator Tina Raine, MD, MPH, an assistant professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences who treats patients at San Francisco General Hospital Medical Center and the New Generation Health Center, a clinic affiliated with UCSF and SFGHMC.
Study findings are reported in last month's issue of the journal Obstetrics and Gynecology. Senior study investigator is Philip Darney, MD, MSc, UCSF professor and chief of the Department of Ob/Gyn at SFGHMC.
The study found that women who had emergency contraception on-hand were three times more likely to use it than women who only had received information about it, and they did not have more unprotected sex or use condoms less.
Women in the advance provision group were more likely to report using a less effective method of birth control-such as condoms-instead of oral contraceptives, which are more effective. Twenty-eight percent of women in the advance provision group reported using less effective methods at the end of the study compared to the time of enrollment, versus 17 percent in the information-only group.
"The implications of this finding are unclear since consistency of condom and contraceptive use improved overall in both study groups from enrollment to the end of the study. For example, if a woman uses oral contraceptives inconsistently and switches to condoms but uses them more consistently or with emergency contraception as a back-up method, this may have a positive impact on unintended pregnancy rates. Future studies need to be done to determine the impact of increased emergency contraceptive use on STDs and unintended pregnancy rates," Raine said.
The key clinical implications from the study concern the role of the provider, according to Raine. "Providers need to present information about emergency contraception within the context of education about other forms of contraception, and to give their clients advance provision so they will have this important method of contraception in hand when needed," she said. "Many of the potential barriers to using emergency contraception are removed when an individual has it at home in advance."
The researchers noted that these barriers range from awareness that an emergency contraceptive method exists to specific knowledge about how and where to obtain it and the correct time of its administration. While most women ages 18-44 (66 percent) report that they have heard of emergency contraception, only 1-2 percent report having used it, according to the research team. Most health care providers consider it safe and effective, yet few routinely discuss it with patients or prescribe it, they said.
Study co-investigators were Cynthia Harper, PhD, and Kathleen Leon, of the UCSF Department of Ob/Gyn and Reproductive Sciences.
The study was supported in part by grants from the Compton Foundation, of Menlo Park, Calif., and the Fred Gellert Family Foundation, of San Francisco.
Journal
Obstetrics and Gynecology