Emergency contraception provision catches on

Just six years ago, a national report asked, "Is the secret getting out?" when it comes to emergency contraception (EC).1 If results of the 2003 Contraceptive Technology Update Contraception Survey are any indication, EC’s message now is being heard loud and clear.

More than 84% of survey respondents said their facility prescribes EC on site and provides emergency contraceptive pills (ECPs) at any time, continuing an upward trend from 2001’s 81% mark. In 1997, just 54% of survey participants indicated such full access to the method.

Use of EC has grown at the University of Wisconsin-La Crosse, observes Carol Burgmeier, MSN, FNP, a family nurse practitioner at the university’s Student Health Center. Fliers advertising the availability of EC are placed in the dorm rooms for incoming freshmen, she notes.

"Our number of requests for ECPs a little more than doubled last year," says Ruth Napolitan, RNC, BSN, WHNP, a nurse practitioner at the St. Clair County Health Department in Port Huron, MI. "Because we live in a small, extremely conservative community, we do not advertise; word of mouth historically has been our way of advertising."

Benzie Leelanau District Health Department in Benzonia, MI, provides EC in advance, says Patricia Bauer, MSN, RNC, a nurse practitioner. Posters are placed in the clinic to advertise the availability of the method, and clinicians counsel on it during patient education sessions, she reports.

Just-published results of a randomized trial indicate that advance provision of EC significantly increased use without adversely affecting use of routine contraception.2 The trial compared advance provision of EC with usual care in 370 postpartum women from an inner-city public hospital. All participants received routine contraceptive education, with the intervention group receiving a supply of EC and a five-minute educational session on its use. Women provided with ECP were four times as likely to have used emergency contraception as women in the control group over the course of the year, but they were no more likely to have changed to a less effective method of birth control or to use contraception less consistently.2

Reinforce the standard of advance prescription, says Anita Nelson, MD, professor in the obstetrics and gynecology department at the University of California in Los Angeles (UCLA) and medical director of the women’s health care clinic and nurse practitioner training program at Harbor-UCLA Medical Center in Torrance. The Washington, DC-based American College of Obstetricians and Gynecologists urged its members in March 2002 to issue advance prescriptions for EC. (CTU reported on the group’s advocate stance in the May 2002 issue; see "Emergency contraception is gaining momentum from local to national levels" p. 49.)

What does your clinic dispense when it comes to EC? The majority of respondents to the 2003 CTU survey say they use Plan B, the levonorgestrel regimen marketed by the Washington, DC-based Women’s Capital Corp. About 58% of responses indicated use of the drug, with 12% listing the other dedicated ECP, Preven (Gynétics of Belle Mead, NJ), and 18% listing one of the 18 other contraceptive pills recognized as safe and effective for EC use by the Food and Drug Administration. These pills are:

• Ovral, Lo/Ovral, Ovrette, Triphasil and Alesse (Wyeth-Ayerst, Philadelphia);

• Ogestrel, Low-Ogestrel, Levora, and Trivora (Watson Pharmaceuticals, Corona, CA);

• Levlen, Levlite and Tri-Levlen (Berlex Laboratories, Montville, NJ);

• Aviane, Lessina, Portia, Enpresse, and Cryselle (Barr Laboratories, Pomona, NY);

• Nordette (King Pharmaceuticals, Bristol, TN).

Clinicians at the Charlottesville-based University of Virginia Student Health Center use Plan B, reports Christine Peterson, MD, the center’s director of gynecology. Research indicates that the levonorgestrel-only EC approach offers better effectiveness, a lower rate of nausea, and less vomiting than that experienced with the Yuzpe regimen,3 she notes.

Clinicians at the health center saw a 50% increase in the use of EC in 2003, reports Peterson. The center has offered the method since 1988 and has advertised its availability through a variety of avenues, including trained peer health educators, brochures, fliers, and its web site (www.virginia.edu/studenthealth/contraception.html). (Take a look at the school’s EC information, as well as its EC triage protocol, at CTU’s web site, www.contraceptiveupdate.com. Your user name is your subscriber number from your mailing label. Your password is ctu (lowercase) plus your subscriber number, with no spaces. Click on "toolkit.")

It received heightened awareness in 2003 when another Virginia school, Harrisonburg-based James Madison University, ended sale of ECPs at its student health center following opposition raised by Virginia state legislator Robert Marshall of Prince William County. While clinicians at James Madison’s student health center still can write prescriptions for EC, they no longer can dispense ECP through the student health center.4

"Fortunately, we have always had a well-defined evaluation protocol and an informed consent procedure that includes information on possible mechanisms of action, as well as side effects, etc.," states Peterson. "Those have stood up to scrutiny by medical and administrative reviewers; nonetheless, we expect continued political efforts to deprive our patients of this vital service."

References

1. Henry J. Kaiser Family Foundation. Emergency Contraception. Is the Secret Getting Out? Menlo Park, CA; March 1997.

2. Jackson RA, Bimla Schwarz E, Freedman L, et al. Advance supply of emergency contraception. Effect on use and usual contraception — a randomized trial. Obstet Gynecol 2003; 102:8-16.

3. 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; 352:428-433.

4. Duncan T. ECP issue causes stir. The Breeze; April 24, 2003: Accessed at: www.thebreeze.org/archives/4.24.03/front/front1.shtml.