National statistics reveal that use of emergency contraception is growing
National statistics reveal that use of emergency contraception is growing
About 11% of women have used EC, compared to 4.2% in earlier stats
New national statistics show that about one in nine (11% or 5.8 million) women ages 15 to 44 had ever used emergency contraception (EC) in 2006-2010, up from 4.2% in 2002.1 Young adult women ages 20-24 were the most likely to have ever used EC — about one in four (23%) indicated they had utilized the method.
The new report on emergency contraception describes trends and variation in the use of the method and reasons for its use among sexually experienced women ages 15-44 using the 2006–2010 National Survey of Family Growth. The survey gathers information on family life, marriage and divorce, pregnancy, infertility, use of contraception, and men’s and women’s health in the United States.
According to the report, most women who had ever used emergency contraception had done so once (59%) or twice (24%).1 Almost one in five never-married women (19%), one in seven cohabiting women (14%), and one in 20 currently or formerly married women (5.7%) had ever used the method. About one in two women reported using emergency contraception because of fear of method failure (45%), and about one in two reported use because they had unprotected sex (49%).
Although insertion of a copper intrauterine device (ParaGard IUD, Teva North America, North Wales, PA) can be used for emergency contraception, the report focuses only on emergency contraceptive pills. While emergency contraceptive pills are more common, the copper intrauterine device is the most effective form of emergency contraception, states a recent committee opinion by the American College of Obstetricians and Gynecologists (ACOG).2 (See “Hope versus reality — Access to EC pills doesn’t work,” Contraceptive Technology Update, January 2013, p. 8.)
“Since the failure rate of post-coital IUD insertion is one-tenth of emergency contraceptive pills — only 12 failures in more than 12,000 postcoital insertions of copper IUDs — programs wanting to get the most out of emergency contraception should switch from ECPs to postcoital insertions of ParaGard IUDs,”3 says Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta.
Push for access
Progestin-only emergency contraceptive pills, such as Plan B One-Step (Teva Pharmaceuticals, Woodcliff Lake, NJ), Next Choice One Dose (Watson Pharmaceuticals, Parsippany, NJ), Next Choice (Watson Pharmaceuticals) and Levonorgestrel Tablets (Perrigo, Allergan, MI) can be sold only at the pharmacy counter. Because emergency contraceptives have a “dual label” in the United States, they remain behind the counter for consumers age 17 and older and are available only by prescription to women under 17.
It is good news that so many women have been able to access emergency contraception, says Susannah Baruch, interim president and chief executive officer of the Washington, DC-based Reproductive Health Technologies Project, a reproductive health advocacy group. But there is evidence that women, couples, men, boyfriends, and teens have received misinformation or been wrongfully turned away by pharmacists in their pursuit of the method. A recent Boston University study of 943 pharmacies in five major cities revealed when callers posed as 17-year-olds seeking EC, one in five were incorrectly told they could not purchase EC under any circumstances.4 (See “Is EC easily found? Evidence says no,” CTU, March 2012, p. 29.)
Reproductive health activists continue to press onward to remove the age restriction to over-the-counter access to EC. In February 2011, Plan B One-Step’s manufacturer, Teva Pharmaceuticals, filed a supplemental new drug application to the Food Drug Administration (FDA) to allow unrestricted over-the-counter sale of its product. In December 2011, the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius overruled the FDA and continued restricting Plan B One Step emergency contraception to its behind-the-pharmacy-counter status for women 17 and older. (See “OTC access to EC blocked — What’s next?” February 2012, p. 15.)
“There is no reason for this safe and easy-to-use back-up method of birth control to be behind the pharmacy walls,” says Baruch. “FDA’s recommendation to make it available to all without a prescription was overturned by HHS, and it is time to put science before politics.”
Write advance prescriptions for emergency contraception, particularly for females younger than age 17, to increase awareness and reduce barriers to immediate access, the 2012 ACOG committee opinion advocates.2
Teen access important
A 2012 policy statement by the American Academy of Pediatrics focuses on the use of emergency contraception and how it can reduce the risk of unintended pregnancy in adolescents.5 Studies have shown that adolescents are more likely to use emergency contraception if it has been prescribed in advance of need.6 However, most practicing pediatricians and pediatric residents don’t routinely counsel patients about emergency contraception and haven’t prescribed it.7-10
Many teens continue to engage in unprotected sexual intercourse, the statement notes. Rates of sexual assault among teens and young adults are higher than in any other group.11 Nearly 80% of pregnancies in adolescents are unintended and result from contraceptive failure or nonuse.12
According to the new policy statement, clinicians can play an important role in counseling patients and providing prescriptions for teens in need of emergency contraception for preventing pregnancy. Be sure to counsel that emergency contraception does not protect against sexually transmitted infections (STIs). Providers should discuss the importance of STI testing, or treatment if needed, the statement states. Also, providers are encouraged to advocate for better insurance coverage and increased access to emergency contraception for teens, regardless of age.
References
1. Daniels K, Jones J, Abma J. Use of emergency contraception among women aged 15-44: United States, 2006-2010. NCHS Data Brief. 2013; No. 112.
2. Access to emergency contraception. Obstet Gynecol 2012; 120(5):1,250-1,253.
3. Trussell J, Schwarz EB. Emergency contraception. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 20th revised edition. New York: Ardent Media; 2011.
4. Wilkinson TA, Fahey N, Shields C, et al. Pharmacy communication to adolescents and their physicians regarding access to emergency contraception. Pediatrics 2012; 129(4):624-629.
5. Committee On Adolescence. Emergency contraception. Pediatrics 2012; 130(6):1,174-1,182.
6. Meyer JL, Gold MA, Haggerty CL. Advance provision of emergency contraception among adolescent and young adult women: a systematic review of literature. J Pediatr Adolesc Gynecol 2011; 24(1):2-9.
7. Sills MR, Chamberlain JM, Teach SJ. The associations among pediatricians’ knowledge, attitudes, and practices regarding emergency contraception. Pediatrics 2000; 105(4 pt 2):954-956.
8. Golden NH, Seigel WM, Fisher M, et al. Emergency contraception: pediatricians’ knowledge, attitudes, and opinions. Pediatrics 2001; 107(2):287-292.
9. Lim SW, Iheagwara KN, Legano L, et al. Emergency contraception: are pediatric residents counseling and prescribing to teens? J Pediatr Adolesc Gynecol 2008; 21(3):129-134.
10. Upadhya KK, Trent ME, Ellen JM. Impact of individual values on adherence to emergency contraception practice guidelines among pediatric residents: implications for training. Arch Pediatr Adolesc Med 2009; 163(10):944-948.
11. U.S. Department of Justice. Questions and answers: domestic violence, sexual assault, teen dating violence, and stalking. Accessed at http://1.usa.gov/16oXF4O.
12. 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.
New national statistics show that about one in nine (11% or 5.8 million) women ages 15 to 44 had ever used emergency contraception (EC) in 2006-2010, up from 4.2% in 2002.1 Young adult women ages 20-24 were the most likely to have ever used EC about one in four (23%) indicated they had utilized the method.Subscribe Now for Access
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