More providers are offering emergency contraception (EC), and more women are seeking prescriptions for it, say respondents to the 2002 Contraceptive Technology Update Contracep-tion Survey. Just more than 81% said their facility prescribes EC on site and provides emergency contraceptive pills (ECPs) at any time, a slight increase from 2001’s 80.6% number.
"Our numbers have definitely increased over the past year," reports Michele Van Vranken, MD, medical director of the Annex Teen Clinic and West Suburban Teen Clinic in Minneapolis. "Word gets out by clients talking to each other and by health educators giving talks about birth control options to schools and community groups."
Male patients have proven to be a valuable asset in spreading the word about EC, says Jane Newhard-Parks, FNP, MSN, a nurse practitioner at Student Health Services at California State University, Hayward. Information on the method is presented in talks to men, she notes. Posters on EC are displayed in the student health center, and handouts are distributed at every gynecological and sexually transmitted disease exam, she says.
What do you prescribe?
Two dedicated EC products are available in the United States: Plan B from Women’s Capital Corp. and Preven from Gynétics of Belle Mead, NJ. About 66% of respondents to the 2002 survey say they use Plan B, up from 62.5% in 2001. About 15% report use of Preven; about 11% noted such use in 2001. About 20% said they issued oral contraceptives for EC, down from the 25.6% number in 2001.
Plan B is the preferred ECP at Pacific Coast Women’s Health in Encinitas, CA, says Suzanne Schmidt, CRNP, a nurse practitioner at the facility. EC information is available in every exam room and Schmidt says she offers a prescription to all annual exam patients.
When discussing EC use, remember to note that some women experience temporary side effects with EC, which may include nausea, vomiting, lower abdominal pain, fatigue, headache, dizziness, and breast tenderness.1 For advance prescriptions of EC, advise women who use a combined OC product for EC to purchase a long-lasting antiemetic and keep it next to their ECPs.2
Use of the Copper T380A intrauterine device (IUD) [marketed in the United States as the Paragard Intrauterine Copper Contraceptive by Ortho-McNeil Pharmaceutical, Raritan, NJ] for emergency contraception remains low, report respondents to the 2002 survey. About 83% reported no insertions for EC purposes, compared to 88.5% in 2001. About 9% said they inserted one to five IUDs, similar to 2001 numbers. A total of 4% reported more than 15 insertions, up from 1% in 2001.
According to A Pocket Guide to Managing Contra-ception, a copper IUD can be inserted following the usual procedures within five days of unprotected or inadequately protected intercourse.2 It may be used up to eight days after intercourse, if ovulation is known to have occurred three days or more after the unprotected sex. This form of EC is more frequently used outside the United States, where method costs are lower and IUD candidate restrictions are less stringent.
In the United States, use of the IUD for EC is generally restricted to use by women who intend to continue to use the IUD as an ongoing method of contraception. When discussing this option with patients, allow them to make the choice when it comes to IUD insertion, the book advises.2
More women need information about EC, according to a recent poll on the subject. In a July 2002 survey "likely voters" conducted for the Reproductive Health Technologies Project (RHTP) of Washington, DC, more than 60% of respondents said they do not know of a product or drug that has been proven effective in preventing pregnancy if used within the first few days after unprotected sex or contraceptive failure. When asked to specify an EC product, almost one-third of respondents who said they knew of such a product identified it as "RU-486," indicating EC is often mistakenly confused with other drugs.
Sen. Patty Murray (D-WA) and Rep. Louise Slaughter (D-NY) have introduced the Emergency Contraception Education Act (S1990 and HR3887), which will authorize funding for the Atlanta-based Centers for Disease Control and Prevention and the Washington, DC-based Health Resources and Services Administration to develop and distribute information on EC to the public and to health care providers. The legislation has been referred to health-related committees.
RHTP survey respondents say they support the government’s role in educating the public about emergency contraception. Once informed about EC, 72% said they favored legislation aimed at expanding public health information about EC and its availability. Such information should be broadly available to the general public and to all women of childbearing age, including teen-agers, they affirmed.
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; 352:416, 428-433.
2. Hatcher RA, Nelson AL, Zieman M, et al. A Pocket Guide to Managing Contraception. Tiger, GA: Bridging the Gap Foundation; 2001