Emergency contraception: Not a secret any more
October 1, 1998
Emergency contraception: Not a secret any more
65% will prescribe anytime
Emergency contraception, once called "the nation's best-kept secret," is becoming a well-known fact as more avenues of access are opening to American women.
Almost 65% of providers responding to the 1998 Contraceptive Technology Update annual survey say their facility will prescribe emergency contraceptive pills (ECPs) at any time, a 10% increase over 1997 figures. About 23% will prescribe in emergencies only, with 7% referring to another provider. Seven percent of readers said they don- or can't - discuss it. (See chart, p. 137.)
The Lyon County Health Department/Flint Hills Community Health Center in Emporia, KS, implemented EC use in January 1998, says Jan Noyes, RNC, ARNP, a women's health nurse practitioner at the site. Although there was no publicity campaign to announce the availability of the method, several telephone requests were received before the first prescription was written, Noyes reports.
The EC rate has increased greatly at one Alaskan public health facility in the two years since it has been put into practice, says a nurse practitioner at the site.
"We have been using it, mostly ECPs, and rarely IUDs due to cost/equipment/staff," she notes. "We have come up with fairly compact packaging and info on ECPs."
Emergency contraception is becoming quite well known at Health Quarters Reproductive Health Care Services in Beverly, MA, according to clinician Mary Anne Baker, CNM.
"We explain ECPs to everyone using a barrier method and usually to teens who opt for the pill," Baker notes. "We have signs and handouts, and we give a whole package of pills [because] our pills are discounted."
New pills on horizon
Look to Gynétics, a Belle Mead, NJ, firm, to supply the first prepackaged ECPs in the United States. There are 11 brands of oral contraceptives that can be used for emergency contraception in the United States, but none of them are specifically packaged and marketed for that purpose. (Check the Emergency Contraception Hotline's Web site - http://www.opr.princeton.edu/ec/ - for the most current listing of these OCs.) American clinicians currently employ the Yuzpe regimen for emergency contraception, which relies on the use of combined oral contraceptives for post-coital contraception.
A new company, Women's Capital Corp. of Washington, DC, plans to debut a progestin-only ECP in the United States and Canada. The privately held company is led by Sharon Camp, PhD, former coordinator of the Welcome, MD-based Consortium for Emergency Contraception. The consortium is an international collaboration to promote EC as a standard part of reproductive health care.
The corporation plans to submit a new drug application in the next few months to the federal Food and Drug Administration for the progestin-only pill. The 0.75 mg levonorgestrel tablet, currently manufactured in Europe, is the first product developed specifically for use after unprotected sex.
Results from a multinational, double-blind, randomized trial of the method were published recently.1 The study was designed to confirm the results of a 1993 Hong Kong study of more than 800 women, which compared the Yuzpe regimen with the progestin-only method.2 In the new trial, half of the 1,998 women enrolled in the study were assigned to use the Yuzpe regimen, while the other group used the progestin-only pill.
Sponsored by several international organizations, including the World Health Organization and the World Bank, the study found that the levonor gestrel regimen was better tolerated and more effective than the Yuzpe method. (See the next issue of Contraceptive Technology Update for complete details on the progestin-only method.)
Raising EC awareness
While more providers are offering emergency contraception, many Americans - particularly teen-agers - are unaware of its availability. A national survey shows that only about one-fourth of teen-agers are aware that anything can be done after unprotected sex to prevent pregnancy.3 Once informed, teen-age girls reported being very interested in taking emergency contraceptive pills if needed.
Of the 1,510 teen-agers surveyed, only 28% had heard of 'morning-after pills' or ECPs. Of the 423 teen-agers who did know about ECPs, one-third were unaware that a prescription is necessary to obtain them, and 78% underestimated how long after unprotected intercourse the ECP regimen could be initiated.
After being told about the option of emergency contraceptive pills, 67% of teen-age girls said they would be likely to use emergency contraceptive pills. Such knowledge could play an important part in reducing the number of unplanned adolescent pregnancies, researchers conclude.
Getting the word out about emergency contraception is an important part of increasing its effectiveness, providers agree.
"With every abortion patient, we give them a little packet of information to take home," says Randall Whitney, MD, medical director of Family Planning, a private practice in Daytona Beach, FL. "We always have something in there about emergency contraception."
References
1. Task Force on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet 1998; 352:428-33.
2. Ho PC, Kwan MSW. A prospective randomized comparison of levonorgestrel with the Yuzpe regimen in post-coital contraception. Hum Reprod 1993; 8:389-392.
3. Delbanco SF, Parker ML, McIntosh, M, et al. Missed opportunities: teen-agers and emergency contraception. Arch Pediatr Adolesc Med 1998; 152:727-733.
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