Harlem program to spread word of availability of emergency contraception among teenagers

Alwyn Cohall wants to spill the beans on "the nation’s best-kept secret." That’s the term health care providers give emergency contraception, usually a protocol of high-dose oral contraceptives taken within 72 hours of unprotected intercourse.

Mr. Cohall, a physician on the front line as chief of adolescent medicine at St. Luke’s-Roosevelt Hospital Center in New York City, is campaigning to expand the profile and use of emergency contraception particularly among teenagers and their doctors.

"In general, the American public is fairly well uninformed about emergency contraception," he says. In Europe, 95% of adolescents and adults know about the practice, Mr. Cohall adds.

The legal status of emergency contraception has changed dramatically in the United States during the past two years. In February 1997, the Food and Drug Administration issued a statement identifying certain oral contraceptive protocols as "safe and effective" in preventing pregnancy after sex. The first pills packaged for use as emergency contraceptives were approved in late 1998, and a progestin-only emergency contraception promising fewer side effects was approved this summer.

With funds from the American Academy of Pediatrics and George Soros’ Open Society Institute, Mr. Cohall is starting in the Harlem neighborhood where he works to survey and educate physicians and teenagers about emergency contraception.

"Providers don’t have reservations about it, but they don’t think about it, and very few providers prescribe it at all," he says.

Mr. Cohall is describing his program to participants of the American Public Health Association meeting in November. One point he plans to raise there: Emergency contraception is rarely used as a routine method of birth control. A survey of 115 of his clinic’s emergency patients found two who had used it more than once. But such methods often become a precursor to more conventional forms of contraception and other health care services, he says.

Contact Mr. Cohall at (212) 939-3453.