Does EC impact contraceptive use?

When it comes to emergency contraception (EC), does its availability and use impact ongoing contraceptive methods? Initial research from one study indicates that adolescent mothers who are given a supply of EC are no less likely to use condoms and other forms of birth control than teen mothers who are not given EC.1

Six-month data from the study, which included 160 teen mothers between ages 14 and 20 in the Los Angeles area, show the importance of advance supply, says Marvin Belzer, MD, assistant professor of pediatrics at the University of Southern California’s Keck School of Medicine and medical director of the adolescent clinic and HIV services at the division of adolescent medicine at Children’s Hospital, both in Los Angeles.

Belzer and his colleagues recruited teen mothers from local teen parenting case management programs and presented them with a short educational program on how to use and obtain EC. After the presentation, one-half of the group received an advance supply of EC.

Availability of EC did not impact the teens’ methods of protection, notes Belzer. Six months after they received a supply of EC, teen mothers did not decrease their condom use, he reports. At baseline, 42% in the treatment group who were sexually active used condoms; at six months, 58% used condoms. In the control group, 52% used condoms at baseline; 57% reported condom use at six months. While 7% of teens with an advance supply of EC became pregnant six months later, 18% of adolescents who did not receive an advance supply reported pregnancies. The researchers are analyzing 12-month data and will publish findings upon completion, says Belzer.

Do women use EC wisely?

One impediment to the availability of EC has been concern about repeat use or "abuse" of the method.2 However, a study of women in the United Kingdom showed that such repeat use is rare.3 In the study, which assigned 553 women to be given an advance supply of EC and 530 women to use EC through a provider visit, very few women in the first group used it more than once, and they were no more likely to do so than those in the control group. In addition, the greater accessibility of the medication did not affect the pattern of conventional contraceptive use.

A more recent California-based study led by Tina Raine, MD, MPH, assistant clinical professor of obstetrics, gynecology, and reproductive sciences at the University of California San Francisco shows that young women who have an advance provision of EC are more likely to use it when they need it, but such availability does not appear to increase risky sexual behavior.4

The study followed 213 young women ages 16-24 who were at high risk for unintended pregnancy. Study participants were assigned to one of two groups: those receiving educational information about EC along with advance provision of a single treatment dose and those receiving only information. Researchers compared behavior patterns in the two groups over a four-month period.

Researchers report that women who had EC on hand were three times more likely to use it than women who only had received information about it, and they did not have more unprotected sex or use condoms less. Women in the advance provision group were more likely to report using a less-effective method of birth control, such as condoms; 28% of women in the advance provision group reported using less-effective methods at the end of the study compared to the time of enrollment, vs. 17% in the information-only group.4

Provide EC in advance

To maximize EC’s effectiveness, it is important to provide women with an advance supply, says Belzer. Before his study began, just 7% of study participants said they had used EC. However, 85% of the teens given an advance supply reported they had used it during the following six months if they had uncontracepted sex.

Be sure to present information on EC when discussing contraceptive methods, says Raine. This discussion is particularly important when talking with adolescent patients, she notes.

Teen-agers use less-effective contraceptive methods, observes Raine. They are less likely to use hormonal contraception and are more likely to use barrier methods such as condoms, she points out. Clinicians can counsel on the importance of EC as a backup if teens do choose less-effective birth control methods, she says.

"The other thing is that teen-agers tend to be sporadic users of hormonal methods, so they may use them for a few months and stop; sometimes that coincides with relationship changes," Raine points out. "EC can be something they can use in the interval when they are switching from one method to another [and they have unprotected sex]."

References

1. Belzer M, Yoshida E, Tejirian T, et al. Advanced supply of emergency contraception for adolescent mothers increased utilization without reducing condom or primary contraception use. Presented at the 2003 Annual Meeting of the Society for Adolescent Medicine. Seattle; March 19, 2003.

2. Shelton JD. Repeat emergency contraception: Facing our fears. Contraception 2002; 66:15-17.

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

4. Raine T, Harper C, Leon K, et al. Emergency contraception: Advance provision in a young, high-risk clinic population. Obstet Gynecol 2000; 96:1-7.