Dr.Firman Abdullah,Sp.OG / OBGYN .BLOG: Advance provision of emergency contraception for pregnancy prevention

[Intervention Review]
Advance provision of emergency contraception for pregnancy prevention

Chelsea B. Polis¹, David A Grimes², Kate Schaffer³, Kelly Blanchard⁴, Anna Glasier⁵, Cynthia Harper⁶

¹Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ²Behavioral and Biomedical Research, Family Health International, Research Triangle Park, North Carolina, USA. ³Pathfinder International, Watertown, Massachusetts, USA. ⁴Ibis Reproductive Health, Cambridge, Massachusetts, USA. ⁵Family Planning and Well Women Services, Lothian Primary Care NHS Trust, Edinburgh, UK. ⁶Dept. of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, San Franscisco, California, USA

Contact address: Chelsea B. Polis, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA.cpolis@jhsph.edu.

Editorial group: Cochrane Fertility Regulation Group.
Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 3, 2010.
Review content assessed as up-to-date: 9 November 2009.

Citation: Polis CB, Grimes DA, Schaffer K, Blanchard K, Glasier A, Harper C. Advance provision of emergency contraception for pregnancy prevention. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005497. DOI: 10.1002/14651858.CD005497.pub2.

Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Abstract

Background

Emergency contraception can prevent pregnancy when taken after unprotected intercourse. Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision could circumvent some obstacles to timely use.

Objectives

To summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors.

Search strategy

In November 2009, we searched CENTRAL, EMBASE, POPLINE, MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials.

Selection criteria

We included randomized controlled trials comparing advance provision and standard access (i.e., counseling which may or may not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy).

Data collection and analysis

Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 5.0.23.

Main results

Eleven randomized controlled trials met our criteria for inclusion, representing 7695 patients in the United States, China, India and Sweden. Advance provision did not decrease pregnancy rates (odds ratio (OR) 0.98, 95% confidence interval (CI) 0.76 to 1.25 in studies for which we included twelve-month follow-up data; OR 0.48, 95% CI 0.18 to 1.29 in a study with seven-month follow-up data; OR 0.92, 95% CI 0.70 to 1.20 in studies for which we included six-month follow-up data; OR 0.49, 95% CI 0.09 to 2.74 in a study with three-month follow-up data), despite reported increased use (single use: OR 2.47, 95% CI 1.80 to 3.40; multiple use: OR 4.13, 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -12.98 hours, 95% CI -16.66 to -9.31 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 1.01, 95% CI 0.75 to 1.37), increased frequency of unprotected intercourse, or changes in contraceptive methods. Women who received emergency contraception in advance were equally likely to use condoms as other women.

Authors' conclusions

Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Results from primary analyses suggest that advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy. However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.

Plain language summary

Easier access to emergency contraception to help women prevent unwanted pregnancy
Emergency contraceptive pills can prevent unwanted pregnancy if taken soon after unprotected sex. Getting a prescription for emergency contraception can be difficult and time-consuming. Giving emergency contraception to women in advance could ensure that women have it on hand in case they need it. We searched for studies comparing women who got emergency contraception in advance to women who got it in standard ways. We examined whether these groups had different rates of pregnancy or sexually transmitted infections. We also studied how often and how quickly both groups used emergency contraception. Finally, we looked at whether advance provision of emergency contraception changed sexual behavior. Studies showed that the chance of pregnancy was similar regardless of whether or not women have emergency contraception on hand before unprotected sex. Women who had emergency contraception in advance were more likely to report use of the medication, and to use it sooner after sex. Having emergency contraception on hand did not change use of other kinds of contraception or change sexual behavior.