Emergency contraception: methods, efficacy, and clinical considerations

Emergency Contraception

The availability of emergency contraception pills (ECP) has raised concerns on the part of the public and medical personnel as to whether this form of avoiding pregnancy in youthful females (ages 16-24) might constitute a serious health risk. The ramifications of providing ECP to young women is addressed in this study, with consideration as to whether its use and availability had secondary effects on regular contraception use.

Past research show overwhelming indications that emergency contraception has proven safe and effective for women to take, following unprotected intercourse. Planned Parenthood (2006) defines unprotected intercourse as intercourse where: (1) the condom broke or slipped off and ejaculation occurred inside the vagina, (2) the woman forgot to take her birth control pills, insert her IUD, ring, or apply her patch, (3) the diaphragm, cap, or shield slipped out of place, and ejaculation occurred inside the vagina, (4) There was a miscalculation of "safe" days, (5) There was a late withdrawal and ejaculation occurred inside the vagina, (6) There was a lack of use of any birth control, or (7) the male forced the woman to have unprotected vaginal sex. (Johnsen)

The above causes were some of the reasons unwanted pregnancies reached record levels among young adults in prior decades. However, recently, since the availability of ECP, some claim that the use of ECP has prevented 51,000 abortions in during this century. (Hatcher, et al. 2004)

America's Children in Brief: Key National Indicators of Well-Being (2006) gives us good news about the recent state of affairs. The data in this year's report shows that adolescent birth rates continued to decline to the lowest ever recorded, immunization rates were at record highs, more young children were being read to daily by a family member, average mathematics scores of 4th- and 8th-graders reached an all-time high, and teen smoking was at the lowest rate since data collection began.

On the other hand, there are good indications that the proportion of births to unmarried women continued to rise, the rate of infants born with low or very low birthweight continued to increase, the trend of overweight children also rose, and the percentage of children living in families with incomes below poverty levels remained at 17%. Births to unmarried women constituted 36% of all births in 2004, reaching a record high of nearly 1.5 million births.

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In 1995, the Institute of Medicine reported in its publication, "The Best Intentions," that there are immense consequences associated with unwanted pregnancies. Decreasing the incidence of unplanned pregnancies by any method creates better public health. When pregnancies are reduced, so are abortion rates and, for those who choose to continue their pregnancies, lower rates of preterm and intrauterine growth retarded infants. (Henderson 1) Unplanned pregnancies not only affect the health of the teen mother, but the health and well-being of the children produced from these pregnancies. (See Exhibit a)

Routinely providing ECP, along with education, to adolescent and young females was done for this study, because teens are considered to the prime population for this type of activity. The CDC's National Vital Statistics reported that national teen pregnancy rates are 34.3% for girls age 15-17, and 65.7% for girls age 18-19 (Hamilton, Martin & Ventura, 2004). But Planned Parenthood claims that, with the use of ECP, only two out of 100 will become pregnant. This is a drastic drop in the incidence of unwanted pregnancies. (Johnsen)

Statement of the Purpose

The purpose of this study is to compare the control group's statistics with those of the group given ECP in advance to determine if there are side effects, to determine if there is any decline in unintended pregnancies with ready use of ECP, and to see if there were any differences in use of ECP between the groups. Other findings might be whether there were any differences in use of other birth control methods or increased sexual risk behavior among these young adults.

Discussion of Significance

Trussell and Wynn (OPR.Princeton.edu) examined questions to not-2-late.com (an ECP call-in and internet hotline) to analyze users concerns and reactions to ECP. They analyzed e-mails sent to the Emergency Contraception Website over five years, from July 1999-June 2004, and determined how many viewed the informational pages using Microsoft Site Server Analysis:

Of the 7,022 e-mails received, 29% did not contain questions about EC. The remaining e-mails reveal that EC users are concerned with how to use EC (23%), side effects (21%), pregnancy (17%), whether EC is needed in a given situation (14%), EC access (8%), EC effectiveness (4%) and how EC works (3%).

Visitors to the site were mainly interested in how to use EC and how to interpret bleeding after EC use. These e-mails point to the need for further research on EC-related questions that are of concern to patients, such as bleeding after EC use and effects on sex that occurs shortly after taking ECPs. Writers also use language that referred to sex with a hormonal contraceptive but not a barrier contraceptive as "unprotected sex," suggesting that patients may be using language that does not mean what medical professionals might think. The e-mails also demonstrated the importance of pointing patients who do not have medical care or are unable to discuss these subjects with their providers to alternative resources that provide accurate medical information. This study indicates that language education is needed when dealing with the age group used in the study, in order for them to utilize ECPs effectively.

Another significance of use of ECPs is that ECPs not only have the potential to reduce the incidence of unintended pregnancy and the consequent need for abortion, but also may reduce medical care costs significantly.