Emergency contraception is gaining momentum from local to national levels
Agency sees fivefold increase in EC use through educational efforts
Emergency contraception (EC) may once have been "the nation’s best-kept secret," but a continued commitment to increasing public awareness is about to change its status.
The Washington, DC-based American College of Obstetricians and Gynecologists (ACOG) is moving to put emergency contraceptive pills in the medicine cabinets of every U.S. woman. In a letter directed mailed in March 2002 to the group’s 40,000 member physicians, ACOG president Thomas Purdon, MD, urged advance prescription for the method. Sample letters also were issued at the same time to help members request that local pharmacies stock EC.1
On Capitol Hill, Sen. Patty Murray (D-WA) and Rep. Louise McIntosh Slaughter (D-NY) have introduced the Emergency Contraception Education Act to educate health care providers and the public about EC. The legislation is part of a growing effort to make sure women and health care providers know that there is a backup birth control method available in the United States.
At Contraceptive Technology Update press time, EC advocates were poised to kick off a national "Back Up Your Birth Control" campaign to increase awareness about EC. (Read more about the campaign in the February 2002 issue, p. 18, in the article, "Make EC the focus during March campaign" also visit the campaign web site, www.backupyourbirthcontrol.org and click on "For Providers/Pharmacists" to download a patient information brochure, fact sheet, and poster on EC.)
"If we want to reduce unintended pregnancies, we need to get serious about giving women options — and that includes emergency contraception," states Kirsten Moore, president of the Washington, DC-based Reproductive Health Technologies Project, which is coordinating the "Back Up" campaign. "Too many women don’t know that they can get a dose of EC and keep it in their medicine cabinets just in case."
Commitment to education is what it takes to increase EC access, agrees Sally Ward, RN, clinical services director of the St. Paul, MN-based Planned Parenthood of Minnesota/South Dakota. She credits in-house patient education as an important facet of the campaign behind a fivefold increase in the use of EC pills in the last three years at the Planned Parenthood affiliate’s clinics.2
Why the push for EC? Experts estimate that widespread use of the method could prevent as many as half of the 3 million unintended pregnancies in the United States each year.
The Emergency Contraception web site, www.not-2-late.com, touts its effectiveness. On average, if 100 women have unprotected intercourse once during the second or third week of their cycle, eight will become pregnant. Following treatment with combined emergency contraceptive pills (ECPs), two will become pregnant, representing a 75% reduction in the risk of pregnancy. When progestin-only ECPs are used, one will become pregnant, representing an 89% reduction in the risk of pregnancy.3,4
Open avenues of access
How can your clinic boost access to EC services? Take a look at how Planned Parenthood of Minnesota/South Dakota achieved its results, and look at avenues of access in your community:
• Give advance prescriptions.
The EC program is part of Planned Parenthood of Minnesota/South Dakota’s comprehensive and limited services to women, says Ward. Clinicians provide a refillable EC prescription for all female patients who want it, with the prescriptions good for up to one year.
Prescriptions are filled in-house in the clinics, says Ward. While clinicians would be willing to write prescriptions to outlying pharmacies, the limited availability of dedicated EC product in Minnesota and South Dakota makes filling outside clinic walls problematic, she notes. Until more pharmacies stock EC products, the clinics will continue to fill the prescriptions, says Ward.
• Get the word out.
Use every available moment to educate patients about EC. Planned Parenthood of Minnesota/South Dakota uses its automated telephone hold and after-hours messages to educate about EC. When patients check in at any of the affiliate’s clinic front desks, they receive an information sheet on emergency contraception, says Ward. A comprehensive women’s health brochure, also distributed to all patients, covers EC in addition to such issues as contraception, breast self-exams, and sexually transmitted diseases. Posters on EC are displayed in each of the affiliate’s 24 clinics.
To date, Planned Parenthood of Minnesota/ South Dakota has not used paid advertising to promote its EC services. How has it been so effective in getting the word out? Ward credits the clinic’s internal marketing and patient education efforts.
"We know from our patient evaluation of services that the majority of patients hear about us from friends or families, so educating our patients tends to educate our communities as well," she says. "I think whereas it is not always the same person coming back, the word has gotten out from us talking with the women as they present to the clinics."
• Make EC available.
Many of Planned Parenthood of Minnesota/ South Dakota’s clinics are open on Saturday, so Sunday is the only day patients do not have EC access, says Ward. The clinic’s telephone after-hours message reminds patients that they have up to 72 hours from the act of unprotected intercourse to use EC and instructs them to call back on Monday. Patients are getting the message; a clinic usually fields 15-20 EC requests on a Monday morning, says Ward.
• Look outside the clinic.
Do you know if EC is available outside your clinic walls, such as in hospital emergency departments? A 2001 survey of 137 Minnesota hospitals conducted by the St. Paul-based Minnesota National Abortion Rights Action League (NARAL) found that fewer than half of the hospitals surveyed would provide EC to survivors of rape.5 (CTU reported on emergency department EC access in November 2001, p. 129, "Is EC available in your local emergency room?")
Since that time, the NARAL affiliate has worked with Minnesota Sen. Deanna Weiner (DFL) to hammer out a nonlegislative compromise with the Minnesota Hospital and Healthcare Partnership to ensure that the facts about EC are given to every sexual assault survivor who presents at a hospital emergency department, says Timothy Stanley, MPA, executive director of Minnesota NARAL.
Working with Planned Parenthood of Minnesota/South Dakota and the Minnesota Coalition Against Sexual Assault, Minnesota NARAL is putting together an EC information sheet that will be placed inside "rape kits" that are given to each sexual assault survivor, says Stanley. The kits are given to women to use after receiving medical treatment and include items such as sweat clothes and toiletries.
"The timeline is a little sketchy, but I think it is reasonable to assume that the EC info should be in the kits before spring," reports Stanley. "Also, the Minnesota Hospital and Health Care Partnership said they would work with all of us to provide training to hospital staff and allow us to test the efficacy of this agreement with some kind of random site visits."
References
1. Parker-Pope T. New push tries to put the morning-after pill in every woman’s hand. The Wall Street Journal; March 1, 2002: B1.
2. Marcotty J. Morning-after pill use is increasing. Minneapolis Star Tribune; Feb. 11, 2002.
3. Task Force on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel vs. the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet 1998; 352:428-433.
4. Trussell J, Rodriguez G, Ellertson C. Updated estimates of the effectiveness of the Yuzpe regimen of emergency contraception. Contraception 1999; 59:147-151.
5. Minnesota National Abortion Rights Action League. Access in Crisis: The Continuing Decline of Hospital-Based Reproductive Health Services in Minnesota. St. Paul; 2001.
Resources
For more information on the Planned Parenthood of Minnesota/South Dakota emergency contraception program, contact Sally Ward, RN, at [email protected].
The Planned Parenthood of Minnesota/South Dakota Resource Center offers a brochure, Emergency Contraception, product No. PMOR019. Standard unit price is 40 cents; if more than 200 units, 35 cents; if more than 500 units, 32 cents. Add 15% for shipping and handling; orders under $25 must be prepaid with a check or credit card. Order from the affiliate’s web site, www.ppmsd.org; click on "Online Store." Orders also may made by contacting:
• The Resource Center, 1200 Lagoon Ave., Department 300, Minneapolis, MN 55408. Telephone: (612) 823-6568. Fax: (612) 825-3522.
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