EC: Healthcare providers are not counseling

A just-published study indicates that many providers are failing to counsel women on the availability of emergency contraception (EC). Among the 63% of women who reported having received a Pap test or pelvic examination in the past 12 months, just 4% reported receiving counseling about EC.1

Researchers analyzed data from the 2006-2008 National Survey of Family Growth, a periodic government survey, to perform the study. Their analysis indicates that while use of emergency contraception in the United States has increased after its prescription status changed in 2006, providers aren't offering adequate counseling about the availability of EC.

Despite the over-the-counter (OTC) availability of emergency contraception for most women, a significant proportion of women still might be unaware that EC exists or of when and how to access it, based on the low rates of having received counseling about this method reported among women in this study, says the study's lead author, Megan Kavanaugh, DrPH, MPH, senior research associate at the Guttmacher Institute in New York City. Additionally, study data indicates use was highest among higher-income women, she notes. This suggests that the cost of the method still might be a barrier for poorer women, despite this group's increased need for emergency contraception due to higher rates of contraceptive failure and unintended pregnancy, Kavanaugh states.

The "very sad news"

It is "very sad" that clinicians are not providing prescriptions of emergency contraception in advance of need, states Anita Nelson, MD, professor in the Obstetrics and Gynecology Department at the David Geffen School of Medicine at the University of California in Los Angeles. Advance prescriptions remind women about its existence and enables insurance to cover the costs, she notes.

"The OTC status is helpful for episodic problems, but the foundation of emergency contraception should be laid by the clinician who either provides methods that don't need EC — such as intrauterine devices and implants — or provides prescriptions for EC to be filled as soon as possible and stored in the medicine cabinet next to the bandages," Nelson says. "Accidents happen."

Providers need to be aware that emergency insertion of a Copper T 380A intrauterine device (ParaGard IUD, Duramed Pharmaceuticals, Pomona, NY) is more effective than emergency contraceptive pills and can provide 12 years of excellent contraception for a woman if she finds the IUD an acceptable method, says Robert Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta. Results of 2007 systematic review indicate that while increased access to emergency contraceptive pills enhances use, it has not been shown to reduce unintended pregnancy rates, Hatcher notes.2

Will restrictions lift?

The Food and Drug Administration (FDA) in 2006 approved the levonorgestrel-only EC pill Plan B (Teva Pharmaceuticals, Woodcliff Lake, NJ) for "behind-the-counter" sales to adults 18 and older, which allowed purchase without a prescription. The age restriction was later lowered to 17 in 2009.

Teva filed a request with the FDA in February 2011 to make the drug available to women of all ages. The request is under review at the FDA, says Denise Bradley, Teva spokesperson. In filing its request, Teva provided the regulatory agency additional data based on a study of actual use of the contraceptive in girls and teenagers ages 11-16.

"Although FDA's request for new data from the company before removing the age restriction was unwarranted and unnecessary, we hope the FDA finally has all the information it needs to make a decision and will use this opportunity to confirm their ongoing commitment to public health and scientific integrity," said Kirsten Moore, president & chief executive office of the Washington, DC-based Reproductive Health Technologies Project, in a statement issued after the application filing.3

The New York City-based Center for Reproductive Rights filed a motion for contempt against the FDA in November 2010 for failing to follow a court order regarding access to emergency contraception for women of all ages. Judge Edward Korman of the U.S. District Court for the Eastern District of New York issued a ruling in March 2009 that the FDA's decision to limit OTC access to Plan B to women over 18 was based on politics rather than science, and he ordered the agency to reconsider its decision. Nancy Northup, president of the Center for Reproductive Rights, said in a February 2011 statement, "We certainly support any actions that will increase women's access to emergency contraception, but Teva's application does not absolve the FDA of its responsibility to comply with the court order. There's enough scientific evidence before the agency to decide whether to make Plan B available over-the-counter, and there has been for 10 years."4

References

  1. Kavanaugh ML, Williams SL, Schwarz EB. Emergency contraception use and counseling after changes in United States prescription status. Fertil Steril2011. Doi:10.1016/j.fertnstert.2011.03.011.
  2. Raymond EG, Trussell J, Polis CB. Population Effect of Increased Access to Emergency Contraceptive Pills: A Systematic Review. Obstet Gynecol 2007; 109:181-188.
  3. Reproductive Health Technologies Project. Women's health advocates applaud movement to remove over-the-counter age restriction Plan B One-Step. Press release. Feb. 10, 2011. Accessed at http://www.arhp.org/modules.
  4. Center for Reproductive Rights. Plan B over-the-counter application is filed, but CRR says FDA has enough evidence. Feb. 10, 2011. Press release. Accessed at http://reproductiverights.org.