Easy access to EC increases teenagers' use, but does not lead to risky behavior.

Adolescent clinic clients who were given packs of emergency contraceptive pills to have on hand had a higher rate of use of the method during a six-month follow-up period than did their counterparts who had to go to a clinic to obtain it (44% vs. 29%), but the groups did not differ in their routine use of contraceptives or levels of risky sexual behavior. (1) These patterns did not differ from those observed among young adult women, and patterns of use among adolescents younger than age 16 were similar to those among older adolescents.

Researchers studied participants in a 2001-2003 trial among young women using clinics in the San Francisco Bay area who were not pregnant, did not wish to become pregnant and were using oral contraceptives, barrier methods or no method of contraception. Participants were randomly assigned to one of three groups: a pharmacy group, who were given instructions on how to get emergency contraceptive pills directly from a pharmacy without a prescription and free of charge; an advance provision group, who were given three packs of the pills in advance; and a clinic access group, who were told to return to the clinic if they needed emergency contraception, and who served as controls. At baseline and again six months later, participants were questioned about their contraceptive use and sexual behavior, and were tested for pregnancy and for chlamydia and herpes simplex virus type 2.

Analyses compared 964 adolescent women (15-19-year-olds) with 1,153 young adults (aged 20-24). In addition, comparisons were made among three groups of adolescents--youngest (age 15), middle (16-17) and oldest (18-19). Nine percent of adolescents were in the youngest group, 41% were in the middle group and 50% were in the oldest group.

Adolescents were racially and ethnically diverse. One-fifth had used emergency contraception in the past six months. On average, they had been 15 years old at first intercourse, and one-quarter had been pregnant. Twenty-four percent had had an STD or had chlamydia or herpes diagnosed at enrollment. Although 37% strongly wanted to avoid pregnancy, 52% had had unprotected sex in the past six months. Overall, 59% of adolescents used condoms as their only method of contraception, and 8% did not use any method; for both measures, the proportion was highest among the youngest group.

In all, 36% of adolescents used emergency contraception during the six-month study period; the proportion was 44% for the advance provision group, 30% for those given pharmacy access and 29% for the clinic access group. The level of use among adolescents given advance supplies of pills was significantly higher than the level among their counterparts given clinic access; use by the pharmacy access group did not differ from that of either the advance provision group or controls. The level of use was similar across adolescent age-groups: 33-38%.

Measures of routine contraceptive use and sexual risk-taking did not differ by ease of access to emergency contraception. During the study period, nearly equal proportions of adolescent women in all three access groups had unprotected intercourse, consistently used condoms, were pressured into having sex, had more than one sexual partner, acquired an STD and became pregnant.

The proportion of adult women who used emergency contraception (24%) was somewhat smaller than that among adolescents. However, as was the case among adolescents, the level of use was significantly higher in the advance provision group than in the clinic access group (32% vs. 14%), while the level did not differ between the pharmacy access and clinic access groups.

Among all women using emergency contraception, the proportions using it only once were similar among adolescents and adults (62% and 65%, respectively). In addition, nearly all users took the pills correctly (93% of adolescents and 94% of young adults); the level of correct use was especially high among the youngest adolescents (97%).

In logistic regression analyses, women given advance supplies of emergency contraception were significantly more likely than those with clinic access to use the method (odds ratio, 2.3); the only difference among access groups in risk-related behavior was that women with pharmacy access had reduced odds of unprotected intercourse (0.7). Adolescents in different age-groups did not differ with respect to use of emergency contraception or with respect to measures of routine contraceptive use and sexual risk-taking Compared with 16-17-yearolds, young adults were less likely to use emergency contraception, to have unprotected intercourse, to use condoms consistently and to become pregnant (0.5-0.6). Results of interaction analyses indicated that when given advance access to emergency contraception, 15-year-olds were no more likely than 16-19-year-olds to use it. Moreover, when given advance access, the youngest adolescents had a reduced likelihood of acquiring an STD (0.1).

The researchers note that the U.S. Food and Drug Administration specifically cited a lack of data among women younger than 16 when it decided not to make emergency contraception available over the counter. This study, they assert, provides such data and refutes many of the concerns about easing access to this method for adolescents, particularly young adolescents. They contend that the finding that adolescents are more willing than older women to use the method when needed "suggests that a policy change toward greater access to [emergency contraception] could be of particular benefit to this age group."

REFERENCE

(1.) Harper CC et al., The effect of increased access to emergency contraception among young adolescents, Obstetrics & Gynecology, 2005, 106(3):483-491.