Update on Emergency Contraception – Introduction

(Published March 2011)

Unintended pregnancy continues to be a major public health issue in the United States. About one-half of the 6-million pregnancies in the United States each year are unintended (Figure 1).¹ The majority of women in their childbearing years (aged 15–44 years) use some form of contraception, but more than one-half of all unintended pregnancies occur when these women experience contraceptive failure. The remaining pregnancies occur in women not using any contraceptive method;² therefore, efforts to increase use of the most effective contraceptives would decrease the rate of unintended pregnancy.

Emergency contraception (EC) has the potential to reduce women’s risk of unintended pregnancy, and EC medications are the only contraceptive method that can easily be used postcoitally to prevent pregnancy.³ EC is a therapy for women who have had unprotected sexual intercourse, including sexual assault and known or suspected contraceptive failure, and want to avoid pregnancy. The two most common reasons for seeking EC are failure of a barrier method (usually condoms) and failure to use any contraceptive method.⁴

Even women who do not desire pregnancy may practice contraception poorly or not use a birth control method. This contradiction can be explained by a number of factors, including women’s ambivalence about potential pregnancy; experiences with contraceptive methods; partner influences; lifestyle factors such as travel, work, and relationships; and interactions with contraceptive care providers. These factors influence gaps in contraceptive use, which heighten the risk of unintended pregnancy.⁵

The need for EC, and ready access to it, may be more critical when women and families are faced with financial hardship. In the best of economic times, the poorest women are more likely to face unintended pregnancy. The Guttmacher Institute recently collected data on the effect of recession on women’s family-planning decisions. In the current recession environment of increasing unemployment, lower incomes, and concerns about health insurance and access to care, one in four women have delayed a gynecologic or birth control visit to save money and one in four women are having a harder time paying for birth control. Many are stretching their monthly medication supply, changing to a less expensive (and perhaps less effective) method, or not using a contraceptive.⁶

Progestin-only emergency contraception pills (ECPs) are available without a prescription behind pharmacy counters for purchase by women and men 17 years of age or older in the United States. In the previous decade, the regulatory status for progestin-only ECPs has evolved from prescription-only to over-the-counter (OTC) for those 18 years or older and now to OTC for those 17 years or older. Although the changes and dual status (prescription-only or OTC based on age) have certainly improved access to progestin-only EC, they have also created confusion among patients, clinicians, and pharmacists. Recently, a new ECP was approved by the Food and Drug Administration (FDA), ella^®. This prescription-only product gives women another option to prevent pregnancy after unprotected intercourse.

References:

1. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006;38(2):90–6.
2. American Pregnancy Association. Statistics.
3. Coeytaux F, Wells ES, Westley E. Emergency contraception: have we come full circle? Contraception. 2009;80(1):1–3.
4. Stewart F, Trussell J, Van Look PFA. Emergency contraception. In: Hatcher RA, Trussell J, Nelson AL, et al., Eds. Contraceptive technology. 19th revised ed. New York: Ardent Media; 2007:87–116.
5. Frost JJ, Darroch JE, Remez L. In brief: improving contraceptive use in the United States. Accessed at www.guttmacher.org/pubs/2008/05/09/ImprovingContraceptiveUse.pdf, January 26, 2010.
6. Guttmacher Institute. A real-time look at the impact of the recession on women’s family planning and pregnancy decisions. Accessed at www.guttmacher.org/pubs/RecessionFP.pdf, October 21, 2009.