Emergency contraception: a call to education.

A few years back I was on call for the outpatient clinic and received a call from one of my partner's patients stating she had just experienced a barrier contraception failure. The caller stated that this would be an ill-timed pregnancy and that she had heard from a friend that there was some type of pill available that would prevent pregnancy after unprotected sex. At that time, I knew of the product to which she was referring but did not know the name of it. I was aware that the same result could be accomplished with standard oral contraceptives, and after some discussion, we agreed to use that option.

It was clear that neither the patient nor I had much knowledge of emergency contraception. This is a common finding in the medical literature, as well as in the recent survey by Fagan et al. Despite awareness of contraceptives, the rate of unintended pregnancy remains near 50% in the United States. (1) This raises the question of whether we are failing this population of women and what is the best way to provide primary prevention on this issue. Should a discussion of emergency contraception be part of our routine screening examinations? Should patients have access in advance to emergency contraception?

Some have raised concerns that access to emergency contraception would promote unsafe sex and raise the rate of sexually transmitted diseases. Although this would seem a reasonable presumption, multiple studies have shown this fear to be unfounded. (1) Perhaps women should have access to emergency contraception without a visit or in advance of need or even without a prescription. Several studies have shown that providing emergency contraception in advance of need does not adversely affect women's contraceptive behaviors. (2) Most women in these studies were able to use it correctly and reduced their chance of unintended pregnancy to 1 to 2%.

Unintended pregnancy has many consequences, including medical, social, and public health issues. Unintended pregnancy has been associated with lack of prenatal care, infant mortality, low birthweight deliveries, newborns harmed by alcohol and tobacco, later child abuse, economic hardship, and other predictors of poor health. (3) The rate of unintended pregnancy could be lowered by primary prevention, beginning with educating ourselves, then providing counseling to our patients. A mechanism needs to be defined to provide easier access to emergency contraception to lower the rate further of unintended pregnancy and its potentially devastating consequences. Providing access in advance, as opposed to education alone, has been shown to increase the use of emergency contraception. (4) We as physicians have not just an opportunity but an obligation to educate our patients and ourselves regarding the use of emergency contraception.

References

1. Abbott J. Emergency contraception: what should our patients expect? Ann Emerg Med 2005;46:111-113.

2. Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998;339:1-4.

3. Brown SS, Eisenberg L, editors. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC, National Academy Press, 1995.

4. Weismiller DG. Emergency contraception. Am Fam Physician 2004;70:707-714.

Deborah A. Humphrey, DO, FACP 

From the University of South Florida, Division of Internal Medicine, Tampa, FL.

Reprint requests to Deborah A. Humphrey, DO, FACP, Assistant Professor, University of South Florida, Division of Internal Medicine, 4 Columbia Drive #630, Tampa, FL 33606. Email: [e-mail]

Accepted May 11, 2006.