Impact of emergency contraception status on unintended pregnancy: observational data from a women’s health practice
Main Article Content
Keywords
Contraception, Postcoital, Behind-the-Counter Drugs, Health Knowledge, Attitudes, Practice, United States
Abstract
Objective: This study aimed to determine if non-prescription emergency contraception (EC) availability impacted self-reported unintended pregnancy rates and to assess women’s knowledge and awareness of EC prior to and after non-prescription availability.
Methods: A survey regarding contraception use and knowledge was verbally administered to a cross-sectional, convenience sample of 272 pregnant women receiving prenatal care at a large urban community women’s clinic between August 2003 and October 2008. Statistical analyses determined the differences between two groups (before [BA] and after, [AA] non-prescription EC availability in the U.S. drug market) in terms of self-reported unintended pregnancy rates, knowledge and awareness of EC.
Results: The AA group reported higher incidence of unintended pregnancy when compared to the BA group (90.7% vs. 72.7%, P = 0.0172). The majority of both groups reported that they were not using any contraception at the time of conception (BA-84.4%; AA-83.3%). There was no significant difference in the participants’ awareness of EC between the two groups (BA-46.8% vs. AA-43.0%) nor was there a significant difference between the two groups in the self-reported willingness to use EC in the future (BA-53.1% vs. AA-63.4%). However, among participants who were unaware of EC, 61% reported they would consider using it in the future after receiving brief EC counseling from a pharmacist or student pharmacist. Neither age nor pregnancy intention was associated with self-reported EC awareness but there was an association with income (P = 0.0410) and education (P = 0.0021).
Conclusion: The change from prescription-only to non-prescription status of EC in the U.S. drug market did not impact the unintended pregnancy rate in this patient population. Lack of knowledge and awareness is still a major barrier to widespread EC use.
References
2. Santelli J, Rochat R, Hatfield-Timajchy K, Gilbert BC, Curtis K, Cabral R, Hirsch JS, Schieve L; Unintended Pregnancy Working Group. The measurement and meaning of unintended pregnancy. Perspect Sex Reprod Health. 2003;35(2):94-101.
3. Henshaw SK. Unintended pregnancy in the United States. Fam Plann Perspect. 1998;30(1):24-9, 46.
4. Trussell J, Ellertson C, Stewart F, Raymond EG, Shochet T. The role of emergency contraception. Am J Obstet Gynecol. 2004;190(4 Suppl):S30-S38.
5. Steinbrook R. Waiting for Plan B -- The FDA and Nonprescription Use of Emergency Contraception. N Engl J Med. 2004;350(23):2327-2329.
6. Kuroki LM, Allsworth JE, Redding CA, Blume JD, Peipert JF. Is a previous unplanned pregnancy a risk factor for a subsequent unplanned pregnancy? Am J Obstet Gynecol. 2008;199(5):517.
7. Phipps MG, Matteson KA, Fernandez GE, Chiaverini L, Weitzen S. Characteristics of women who seek emergency contraception and family planning services. Am J Obstet Gynecol. 2008;199(2):111-115.
8. The Guttmacher Institute. Contraception counts: Arkansas. http://www guttmacher org/pubs/state_data/states/arkansas html 2006 March. Accessed September 28, 2009.
9. Brown S, Eisenberg L. The best intentions: unintended pregnancy and the well-being of children and families. Washington (DC): National Academy Press; 1995.
10. Westhoff C. Emergency Contraception. N Engl J Med. 2003;349(19):1830-1835.
11. Amaral G, Foster DG, Biggs MA, Jasik CB, Judd S, Brindis CD. Public savings from the prevention of unintended pregnancy: a cost analysis of family planning services in California. Health Serv Res. 2007;42(5):1960-1980.
12. Weisberg E, Fraser IS. Rights to emergency contraception. Int J Gynaecol Obstet. 2009;106(2):160-163.
13. Yuzpe AA, Thurlow HJ, Ramzy I, Leyshon JI. Post coital contraception--A pilot study. J Reprod Med. 1974;13(2):53-58.
14. Task Force on Postovulatory Methods of Fertility Regulation. Randomized controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet. 1998;352(9126):428-433.
15. Raymond E, Taylor D, Trussell J, Steiner MJ. Minimum effectiveness of the levonorgestrel regimen of emergency contraception. Contraception. 2004;69(1):79-81.
16. Ho PC, Kwan MS. A prospective randomized comparison of levonorgestrel with the Yuzpe regimen in post-coital contraception. Hum Reprod. 1993;8(3):389-392.
17. Cheng L, Gulmezoglu AM, Oel CJ, Piaggio G, Ezcurra E, Look PF. Interventions for emergency contraception. Cochrane Database Syst Rev. 2004;(3):CD001324.
18. Ranney ML, Gee EM, Merchant RC. Nonprescription availability of emergency contraception in the United States: current status, controversies, and impact on emergency medicine practice. Ann Emerg Med. 47[5], 461-471. 5-1-2006.
19. Espey E, Ogburn T, Fotieo D. Contraception: What Every Internist Should Know. Med Clin North Am. 2008;92(5):1037-1058.
20. U.S.Food and Drug Administration. FDA approves Plan B one-step emergency contraceptive; lowers age for obtaining two-dose Plan B emergency contraceptive without a prescription. http://www fda gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsand Providers/UCM109775 2009 July 16. Accessed September 28, 2009.
21. Trussell J, Koenig J, Ellertson C, Stewart F. Preventing unintended pregnancy: the cost-effectiveness of three methods of emergency contraception. Am J Public Health. 1997;87(6):932-937.
22. Trussell J, Stewart F, Guest F, Hatcher RA. Emergency contraceptive pills: a simple proposal to reduce unintended pregnancies. Fam Plann Perspect. 1992;24(6):269-273.
23. Rocca CH, Schwarz EB, Stweart FH, Darney PD, Raine TR, Harper CC. Beyond access: Acceptability, use and nonuse of emergency contraception among young women. Am J Obstet Gynecol. 2007;196(1):29.e1-6.
24. The Kaiser Family Foundation. Women's health care providers experiences with emergency contraception. 2003 Jun.
25. Baldwin SB, Solorio R, Washington DL, Yu H, Huang YC, Brown ER. Who is Using Emergency Contraception? Awareness and use of emergency contraception among California women and teens. Womens Health Issues. 2009;18(5):360-368.
26. Jackson RA, Schwarz EB, Freedman L, Darney P. Advance supply of emergency contraception: effect on use and usual contraception--a randomized trial. Obstet Gynecol. 2003;102(1):8-16.
27. Endres LK, Beshara M, Sondheimer S. Experience with self-administered emergency contraception in a low-income, inner-city family planning program. J Reprod Med. 2000;45(10):827-830.
28. Crosier A. Women's knowledge and awareness of emergency contraception. Br J Fam Plann. 2006;22(2):87-90.
29. Foster DG, Harper CC, Bley JJ, Mikanda JJ, Induni M, Saviano EC, Stewart FH. Knowledge of emergency contraception among women aged 18 to 44 in California. Am J Obstet Gynecol. 2004;191(1):150-156.
30. Merchant RC, Casadei K, Gee EM, Bock BC, Becker BM, Clark MA. Patients' Emergency Contraception Comprehension, Usage, and View of the Emergency Department Role for Emergency Contraception. J Emerg Med. 2007;33(4):367-375.
31. Cremer M, Holland E, Adams B, Klausner D, Nichols S, Ram RS, Alonzo TA. Adolescent comprehension of emergency contraception in New York City. Obstet Gynecol. 2009;113(4):840-844.
32. Falah-Hassani K, Kosunen E, Shiri R, Rimpelä A. Emergency contraception among Finnish adolescents: awareness, use and the effect of non-prescription status. BMC Public Health. 2007;7:201.
33. Hobbs M, Taft AJ, Amir LH. The emergency contraceptive pill rescheduled: a focus group study of women's knowledge, attitudes and experiences. J Fam Plann Reprod Health Care. 2009;35(2):87-91.
34. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006;38(2):90-96.
35. Black K, Anderson C, Kubba A, Wellings K. Involving pharmacists in sexual health research: experience from an emergency contraception study. J Fam Plann Reprod Health Care. 2009;35(1):41-43.
36. Monastersky N, Landau SC. Future of emergency contraception lies in pharmacists' hands. J Am Pharm Assoc (2003). 2006;46(1):84-88.
37. Hopkins D, West D. Arkansas pharmacists perceptions toward emergency contraception and nonprescription Plan B. Pharm Pract (Internet). 2008;6(2):98-102.
38. Landau S, Besinque K, Chung F, Dries-Daffner I, Maderas NM, McGhee BT, Foster DG. Pharmacist interest in and attitudes toward direct pharmacy access to hormonal contraception in the United States. J Am Pharm Assoc (2003). 2009;49(1):43-50.
39. Sutkin G, Grant B, Irons BK, Borders TF. Opinions of West Texas pharmacists about emergency contraception. Pharm Pract (Internet). 2006;4(4):151-155.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 Unported License.