Teens face obstacles when obtaining EC
The adolescent in your exam room just told you she had unprotected sex over the weekend. When you ask her if she used emergency contraception (EC), she says she didn’t know where to get a prescription because the clinic was closed.
When it comes to accessing emergency contraceptive pills (ECPs), teens face many barriers. To address these obstacles, a recent web conference sponsored by the Washington, DC-based American College of Preventive Medicine (ACPM) featured an overview of the newest indications, contraindications, mechanisms of action, efficacy, and safety of ECPs for teens. (See resources at the end of this article.)
While the word may be getting out about EC, many teens still do not know about it, says Melanie Gold, DO, associate professor of pediatrics at the University of Pittsburgh School of Medicine and associate professor at the University of Pittsburgh Graduate School of Public Health. A 2003 national survey supports Gold’s observation. While two-thirds of women ages 18-44 surveyed said they were aware that there is something a woman can do to prevent pregnancy in the few days following sexual intercourse, only 6% of them reported ever using EC.1
Gold, who presented at the ACPM web conference, says she talks about EC with all teens as part of contraceptive counseling. She uses the following strategy:
- Discuss what a teen’s future plan is for contraception, then provide a scenario that is tailored to the individual, based on his or her particular plan.
- Follow up with a scenario in which the plan fails, then ask, "What would you do if you didn’t want to get pregnant?"
- If the teen does not have a plan, ask, "Can I tell something you could do?" (Teens always say yes to this question, says Gold, because they don’t want to get pregnant.)
- Ask, "Do you know anything about emergency contraception?"
- If the teen answers in the affirmative, say, "Tell me what you know about EC."
Teens who do know about EC usually have fairly good information on the method, but they are not clear on the effectiveness window of the drug. Gold uses this opportunity to discuss that while EC is most effective when it is taken as soon as possible, new data indicate EC may prevent pregnancy for up to five days (120 hours) after unprotected intercourse.2,3,4
- Ask, "How do you get EC?"
Gold offers advance provision of EC, but to help prepare teens should they need a refill, she also explains what they should ask for if they need to call for a refill. She tells teens that when they call the clinic, they will be speaking to the receptionist, so they must communicate the urgency of their need. While the staff at Gold’s clinic are trained to ask such questions as "Did you have unprotected sex?" and "Do you need emergency contraception?" teens may not always encounter such questions when they make the call. She also makes sure that teens understand that while EC may prevent unintended pregnancy, it does not provide protection against sexually transmitted diseases (STDs).
What if EC goes OTC?
How will providers’ roles change if the Food and Drug Administration (FDA) approves the move of the levonorgestrel-only ECP Plan B (Barr Laboratories, Pomona, NY) to OTC?
Don Downing, RPh, a clinical associate professor in the Seattle-based University of Washington’s School of Pharmacy, who presented at the ACPM conference, suggests the following steps for pharmacists:
- Place EC near the pharmacy counter to help facilitate conversations between pharmacists and clients.
- Place handouts near EC products to aid in providing clients with information on referrals, ongoing contraception, STDs, and other important information.
- Place posters in pharmacies to let women know that the pharmacy’s pharmacists are educated about EC and would be pleased to talk with them about EC and related services. (See resources at the end of this article for EC promotional materials.)
Health care providers still have a very important role in educating teens about emergency contraception, even if it does go over the counter, says Gold. Providers will need to reinforce the importance of returning for STD screenings as well as obtaining a regular method of contraception, even if teens can obtain EC at the local pharmacy.
"Health care providers will have an important role to ask patients, What do you know about emergency contraception?’ and Where could you get it if you needed it?’" she says.
References
- Kaiser Family Foundation/SELF magazine. National Survey of Women on their Sexual Health. New York City; June 2003.
- Von Hertzen H, Piaggio G, Ding J, et al. Low-dose mifepristone and two regimens of levonorgestrel for emergency contraception: A WHO multicentre randomized trial. Lancet 2002; 360:1,803-1,810.
- Ellertson C, Evans M, Ferden S, et al. Extending the time limit for starting the Yuzpe regimen of emergency contraception to 120 hours. Obstet Gynecol 2003; 101:1,168-1,171.
- Rodrigues I, Grou F, Joly J. Effectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse. Am J Obstet Gynecol 2001; 184:531-537.
Resources
- To view an archive of the web-based conference on teens and emergency contraception presented by the American College of Preventive Medicine, go to www.medscape.com, register and log in as a free Medscape user. Search the continuing medical education (CME) Public Health and Prevention section for "emergency contraception" click on "Emergency Contraceptive Pills and Adolescents."
- For states with EC pharmacy access programs, look at the resources available on the Oakland, CA-based Pharmacy Access Partnership. The web site has a variety of promotional materials, including an 8-by-11 inch pharmacy poster. Many are available for free reproduction in Adobe Acrobat PDF Go to the site, www.pharmacyaccess.org; click on "Pharmacist Resources," "Emergency Contraception," and "Promoting Your EC Services."