Emergency contraception: a contraceptive intervention approaching target despite controversy and opposition

Original Article
First Online:
Received:
Accepted:

Abstract

The objective of this study is to make the public aware of progress, safety, effectiveness of use, acceptance, and over-the-counter availability of emergency contraception (EC). Data were extracted from the literature for the period 2000–2006 via MEDLINE using a keyword, and also from some pre-2000 journals. Randomised trials, reviews, surveys, clinical investigations, and articles relevant to the subject matter are considered in this review. Approximately 85%, 57% and 84% of unintended pregnancy could be prevented by using levonorgestrel, the Yuzpe regimen (levonorgestrel plus ethinylestradiol), and mifepristone, respectively, as EC. Levonorgestrel was more effective than the Yuzpe regimen in preventing pregnancy. A dose of 1.5 mg levonorgestrel seemed to have similar effectiveness as that of split doses (0.75 mg twice) at 12 h apart, and that of a low-dose (10 mg) of mifepristone. Nausea and vomiting, dizzy spells and fatigue were less frequent in women using levonorgestrel only than in those receiving the Yuzpe regimen. The mode of action of EC is associated primarily with inhibition of ovulation. EC acts before implantation and hence does not amount to abortion. Teenagers are more likely to be repeat users of EC. Easy access to EC over the counter is likely to increase its use but will widen the chance of misuse or abuse. Both adolescents and health care providers need to be adequately educated and informed about EC to make this method successful. Over the counter supply of EC without prescription but with pharmacists’ counselling may increase reduction of unintended pregnancy and abortion. The controversy surrounding, and opposition to, EC may subside with more awareness and knowledge among the public about its mode of action, safety and effectiveness. Educational programmes on EC and further studies on the psychosocial aspects of its use may resolve hurdles for implementation of ‘advance provision’ or ‘over the counter supply’ of EC in the community.

Keywords

Post-coital contraceptive Adolescents Risky sexual behaviour Health care providers 
This is a preview of subscription content, log in to check access.

References

  1. AAPCA (American Academy of Paediatrics Committee on Adolescence) (2005) Emergency contraception. Paediatrics 116:1026–1035CrossRefGoogle Scholar
  2. Adekunle AO, Arowojolu AO, Adedimeji AA, Okunlola MA (2000) Emergency contraception: survey of knowledge, attitudes and practice of health care professionals in Ibadan, Nigeria. J Obstet Gynaecol 20:284–289CrossRefPubMedGoogle Scholar
  3. Arora N, Mittal S (2005) Emergency contraception and prevention of induced abortion in India. J Fam Plann Reprod Health Care 31:294–296CrossRefPubMedGoogle Scholar
  4. Bacon L, Savage I, Cook S, Taylor B (2003) Training and supporting pharmacists to supply progestogen-only emergency contraception. J Fam Plann Reprod Health Care 29:17–22CrossRefPubMedGoogle Scholar
  5. Bajos N, Goulard H, Job-Spira N (2003) Emergency contraception: from accessibility to counselling. Contraception 67:39–40CrossRefPubMedGoogle Scholar
  6. Beckman LJ, Harvey SM, Sherman CA (2001) Changes in providers’ views and practices about emergency contraception with education. Obstet Gynaecol 97:942–946CrossRefGoogle Scholar
  7. Blanchard K, Haskell S, Ferden S, Hohnstone K, Spears A, Evans M et al (2002) Difference between emergency contraceptive users in the United States and the United Kingdom. J Am Med Women’s Assoc 57:200–203, 214PubMedGoogle Scholar
  8. Blanchard K, Bungay H, Furedi A, Sanders L (2003) Evaluation of an emergency contraception advance provision service. Contraception 67:343–348CrossRefPubMedGoogle Scholar
  9. Brooker C, Guillebaud J (2004) Unanswered questions in contraceptive management: what do the experts do? J Fam Plann Reprod Health Care 30:29–235CrossRefPubMedGoogle Scholar
  10. Camp SL, Wilkerson DS, Raine TR (2003) The benefits and risks of over-the-counter availability of levonorgestrel emergency contraception. Contraception 68:309–317CrossRefPubMedGoogle Scholar
  11. Changhai H, Youlun G, Tie Y, Bingshun W, Exiang Z, Ersheng G et al (2002) A randomised comparative study on mifepristone alone and in combination with tamoxifen for emergency contraception. Contraception 66:221–224CrossRefPubMedGoogle Scholar
  12. Cheng L, Gulmezoglu AM, Oel CJ, Piaggio G, Ezcurra E, van look PF (2004) Interventions for emergency contraception. Cochrane Database System Review 3, CD001324Google Scholar
  13. Chuang CH, Freund RM (2005) Emergency contraception: an intervention on primary care providers. Contraception 72:182–186CrossRefPubMedGoogle Scholar
  14. Cohen SA (1999) Objection, confusion among pharmacists threatens access to emergency contraception. Guttmacher Rep Public Policy 2:1–3Google Scholar
  15. Conard LA, Gold MA (2004) Emergency contraceptive pills: a review of the recent literature. Curr Opin Obstet Gynaecol 16:389–395CrossRefGoogle Scholar
  16. Cook RJ, Dicken BM (2003) Access to emergency contraception. J Obstet Gynaecol Can 25:914–916PubMedGoogle Scholar
  17. Cook RJ, Dickens BM, Ngwena C, Plata MI (2001) The legal status of emergency contraception. Int Gynaecol Obstet 75:185–191CrossRefGoogle Scholar
  18. Danielsson KG, Marions L (2004) Mechanisms of action of mifepristone and levonorgestrel when used for emergency contraception. Hum Reprod Update 10:341–348CrossRefPubMedGoogle Scholar
  19. Dickens BM (2001) Reproductive health services and the law and ethics of conscientious objection. Med Law 20:283–293PubMedGoogle Scholar
  20. Dupont S, Webber J, Dass K, Tornton S (2002) Emergency contraceptive pill (ECP) and sexual risk behaviour. Int J STD AIDS 13:482–485CrossRefPubMedGoogle Scholar
  21. Durand M, del Carmen Cravioto M, Raymond EG, Duran-Sanchez O, De la Luz Cruz-Hinojosa M, Castell-Rodriguez A et al (2001) On the mechanism of action of short-term levonorgestrel administration in emergency contraception. Contraception 64:227–234CrossRefPubMedGoogle Scholar
  22. Edgardh K (2002) Adolescent sexual health in Sweden. Sex Transm Infect 78:352–356CrossRefPubMedGoogle Scholar
  23. Ellertson C, Evans M, Ferden S, Leadbetter C, Spears S, Johnstrone K et al (2003) Extending the time limit for starting the Yuzpe regimen of emergency contraception to 120 hours. Obstet Gynaecol 101:1168–1171CrossRefGoogle Scholar
  24. Espey E, Ogburn T, Howard D, Qualls C, Ogburn J (2003) Emergency contraception: pharmacy access in Albuquerque, New Mexico. Obstet Gynaecol 102:918–921CrossRefGoogle Scholar
  25. Falk G, Falk L, Hanson U, Milson L (2001) Young women requesting emergency contraception are, despite contraceptive counselling, a high risk group for new unintended pregnancies. Contraception 64:23–27CrossRefPubMedGoogle Scholar
  26. Faundes A, Brache V, Alvarez F (2003) Emergency contraception-clinical and ethical aspects. Int J Gynaecol Obstet 82:297–305CrossRefPubMedGoogle Scholar
  27. Folkes L, Graham A, Weiss M (2001) A qualitative study of the views of women aged 18–29 on over-the-counter availability of hormonal emergency contraception. J Fam Plann Reprod Health Care 27:189–192CrossRefPubMedGoogle Scholar
  28. Free C, Lee RM, Ogden J (2002) Young women’s accounts of factors influencing their use and non-use of emergency contraception: in-depth interview study. BMJ 325:1393CrossRefPubMedGoogle Scholar
  29. Gainer E, Bkum J,Toverud EL, Portugal N,Tyden T, Nasheim BI et al (2003) Bringing emergency contraception over the counter: experiences of non-prescription users in France, Norway, Sweden and Portugal. Contraception 68:117–124CrossRefPubMedGoogle Scholar
  30. Gold MA, Wolford JE, Smith KA, Parker AM (2004) The effects of advance provision of emergency contraception on adolescent women’s sexual and contraceptive behaviours. Pediatr Adolesc Gynaecol 17:187–196CrossRefGoogle Scholar
  31. Grimes DA, Creinin MD (2004) Induced abortion: an overview for internists. Ann Intern Med 140:620–626PubMedGoogle Scholar
  32. Hariparsad N (2001a) Knowledge of emergency contraception among pharmacists and doctors in Durban, South Africa. Eur J Contracept Reprod Health Care 6:21–26PubMedCrossRefGoogle Scholar
  33. Hariparsad N (2001b) Attitudes and practices of pharmacists towards emergency contraception in Durban, South Africa. Eur J Contracept Reprod Health Care 6:87–92PubMedCrossRefGoogle Scholar
  34. Henshaw SK (1998) Unintended pregnancy in the United States. Fam Plann Perspect 30:24–29, 46PubMedCrossRefGoogle Scholar
  35. Harper CC, Minnis AM, Padian NS (2003) Sexual partners and use of emergency contraception. Am J Obstet Gynaecol 189:1093–1099CrossRefGoogle Scholar
  36. He CH, Shi YE, Xu JQ, Van Look PF (1991) A multi-centre clinical study on two types of levonorgestrel tablets administered for post coital contraception. Int J Gynaecol Obstet 36:43–48CrossRefPubMedGoogle Scholar
  37. Jackson RA, Bimla Schwarz E, Feedman L, Darney P (2003) Advance supply of emergency contraception, effect on use and usual contraception—a randomised trial. Obstet Gynaecol 102:8–16CrossRefGoogle Scholar
  38. Jian Z, Linan C (2003) Ectopic gestation following emergency contraception with levonorgestrel. Eur J Contracept Reprod Health Care 8:225–228PubMedCrossRefGoogle Scholar
  39. Kettle H, Gay S, Brown A, Glasier A (2002) Screening for Chlamydia trachomatis infection is indicated for women under 30 using emergency contraception. Contraception 66:251–253CrossRefPubMedGoogle Scholar
  40. Kozinszky Z, Bartai G (2004) Contraceptive behaviour of teenagers requesting abortion. Eur J Obstet Gynaecol Reprod Biol 112:80–83CrossRefGoogle Scholar
  41. Kubba A (1998) Emergency contraception with levonorgestrel or the Yuzpe regimen. Lancet 12;352:428–433Google Scholar
  42. Kulier A, Gulmezoglu AM, Nofmeyr GJ, Cheng LN, Campana A (2004) Medical methods for first trimester abortion. Cochrane Database Syst Rev 2:CD002855PubMedGoogle Scholar
  43. Lindberg CE (2003) Emergency contraception for prevention of adolescent pregnancy. MCN Am J Matern Child Nurs 28:199–204CrossRefPubMedGoogle Scholar
  44. Mandiracioglu A, Movsim V, Tugul Q (2003) Health personnel perceptions about emergency contraception in primary health-care centres. Eur J Contracept Reprod Health Care 8:145–149PubMedCrossRefGoogle Scholar
  45. Marciante KD, Gardner JS, Veenstra DL, Sullivan SD (2001) Modelling the cost and outcomes of pharmacist-prescribed emergency contraception. Am J Public Health 91:1443–1445PubMedCrossRefGoogle Scholar
  46. Marions L, Hultenby K, Lindell I, Sun X, Stabi B, Danielsson KG (2002) Emergency contraception with mifepristone and levonorgestrel: mechanism of action. Obstet Gynaecol 100:65–71CrossRefGoogle Scholar
  47. Mayor S (2002) Court rules that emergency contraception is lawful. BMJ 324:995CrossRefPubMedGoogle Scholar
  48. Nielson C, Miller L (2000) Ectopic gestation following emergency contraceptive pill administration. Contraception 62:275–276CrossRefPubMedGoogle Scholar
  49. Norris Turner A, Ellertson C (2002) How safe is emergency contraception? Drug Safety 25:695–706CrossRefPubMedGoogle Scholar
  50. Olsen CL, Santaraiero EC, Spatz D (2002) Qualitative analysis of African-American adolescent females’ beliefs about emergency contraceptive pills. J Paediatr Adolesc Gynaecol 15:285–292CrossRefGoogle Scholar
  51. Pham A (2002) Emergency contraction (post-coital contraception). J Okla State Med Assoc 95:371–374PubMedGoogle Scholar
  52. Psychoyos A, Nikas G, Sarantis I, Gravantis A (1995) Hormonal anti-implantation agents: anti-progestins. Hum Reprod 10:140–150PubMedGoogle Scholar
  53. Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD et al (2005) Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomised controlled trial. JAMA 293:54–62CrossRefPubMedGoogle Scholar
  54. Ralph SG, Preston A, Clarke J (2001) Over-the-counter advice for genital problems: the role of the community pharmacist. Int J STD AIDS 12:513–515CrossRefPubMedGoogle Scholar
  55. Ratanajamit C, Chongsuvivatwong V, Geater AF (2002) A randomised controlled educational intervention on emergency contraception among drugstore personnel in Southern Thailand. J Am Med Womens Assoc 57:196–199, 207PubMedGoogle Scholar
  56. Raymond EG, Chen PL, Dalebout SM (2003) ‘Actual use’ study of emergency contraceptive pills provided in a stimulated over-the-counter manner. Obstet Gynaecol 102:17–23CrossRefGoogle Scholar
  57. Roizen J, Garside R, Barnett L (2001) Repeat use of emergency contraception: how frequent is it? J Fam Plann Reprod Health care 27:197–201CrossRefPubMedGoogle Scholar
  58. Rowland S, Devalia H, Lawrenson R, Logie J, Ineichen B (2000) Repeat use of hormonal emergency contraception by younger women in UK. Brit J Fam Plann 26:138–143CrossRefGoogle Scholar
  59. Sarkar NN (1999) Emergency contraception. Int J Clin Pract 53:199–204PubMedGoogle Scholar
  60. Sarkar NN (2003) Levonorgestrel as an emergency contraceptive drug. Int J Clin Pract 57:824–828PubMedGoogle Scholar
  61. Schenk KD (2003) Emergency contraception: lessons learned from the UK. J Fam Plann Reprod Health Care 29:35–40CrossRefPubMedGoogle Scholar
  62. Seston EM, Holden K, Cantrill J (2001) Emergency hormonal contraception: the community pharmacy perspective. J Fam Plann Reprod Health Care 27:203–208CrossRefPubMedGoogle Scholar
  63. Shawe J, Ineichen B, Lawrenson R (2001) Emergency contraception: who are the users? J Fam Plann Reprod Health Care 27:209–212CrossRefPubMedGoogle Scholar
  64. Sheffer-Mimouni G, Pauzner D, Maslovitch S, Lessing JB, Ganzu R (2003) Ectopic pregnancies following emergency levonorgestrel contraception. Contraception 67:267–269CrossRefPubMedGoogle Scholar
  65. Sommers SD, Chaiykunapruk N, Gardner JS, Winkler J (2001) The emergency contraception collaborative prescribing experience in Washington State. J Am Pharmacol Assoc (Wash) 41:60–66Google Scholar
  66. Spence MR, Elgen KK, Harwell TS (2003) Awareness, prior use, and intent to use emergency contraception among Montana women at the time of pregnancy testing. Matern Child Health J 7:197–203CrossRefPubMedGoogle Scholar
  67. Sucato GS, Gardner JS, Koepsell TD (2001) Adolescents’ use of emergency contraception provided by Washington State pharmacists. J Pediatr Adolesc Gynaecol 14:163–169CrossRefGoogle Scholar
  68. Task force (1998) Task force on postovulatory method of fertility regulation. Randomised controlled trial of levonorgestrel versus Yuzpe regimen of combined oral contraceptive for emergency contraception. Lancet 352:428–433CrossRefGoogle Scholar
  69. Task force (2000) Task force on postovulatory methods of fertility regulation. Efficacy and side effects of immediate post-coital levonorgestrel use repeatedly for contraception. Contraception 61:303–308CrossRefGoogle Scholar
  70. Trussell J, Koenig J, Ellertson C, Stewart F (1997) Preventing unintended preganccy: the cost-effectiveness of three methods of emergency contraception. Am J Public Health 87:932–937PubMedGoogle Scholar
  71. Trussell J, Ellertson C, Stewart F, Raymond EG, Shochet T (2004) Role of emergency contraception. Am J Obstet Gynaecol 190(4 Suppl):S30–S538CrossRefGoogle Scholar
  72. Uzuner A, Unalan P, Aknan M, Cifcili S, Tuncer I, Cohen E et al (2005) Providers’ knowledge of, attitude to and practice of emergency contraception. Eur J Contracept Reprod Health Care 10:43–50CrossRefPubMedGoogle Scholar
  73. Von Hertzen H, Piaggio G, Ding S, Chen J, Song S, Bartfai G et al (2002) Low-dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multi centre randomised trial. Lancet 360:1803–1810CrossRefPubMedGoogle Scholar
  74. Wan RS, Lo SS (2005) Are women ready for more liberal delivery of emergency contraceptive pills? Contraception 71:432–437CrossRefPubMedGoogle Scholar
  75. Watson R (2003) Belgium to subsidise costs of contraception to teenagers. BMJ 327:945CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of Reproductive BiologyAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations