Mini-ReviewAdvance Provision of Emergency Contraception among Adolescent and Young Adult Women: A Systematic Review of Literature
Introduction
The birth rate for women 15 to 17 and 18 to 19 years of age decreased 45% and 26%, respectively between 1991 and 2005.1 Unfortunately, this trend has reversed with a 3% increase between 2005 and 2006 for adolescents 15 to 19 years of age. This trend was also observed among 20 to 24-year-olds with a 1% increase between 2004 and 2005, and a 4% increase between 2005 and 2006. Not surprisingly, a large portion of these births were unintended, corresponding to a higher number of abortions.2, 3 Since 1973, the number of abortions per live births has been highest for those <15 years of age.3 Women 15 to 19 years of age have had the second highest ratio since the early 1980s, although the ratio for women ≥40 years of age did exceed that of this age group briefly in the early 1990s. The ratio for women 20 to 34 years of age is generally lower than the ratio for those ≥40 years of age, but has been higher than that of women 35 to 39 years of age since the late 1990s. Furthermore, women 20 to 24 years of age account for 33% of all legal abortions. The risk of unintended pregnancy among young women is demonstrated by the fact that 26% of women 15 to 19 years of age did not use any contraceptive method the first time they had sex.4 Further, among women 24 years and younger who were obtaining abortions, less than half reported contraceptive use in the month prior to conception.5
While combination oral contraceptive pills and condoms are the most common methods used among women ≤24 years of age,6 intrauterine devices, implantable contraceptive methods, hormonal injectables, the patch, and the contraceptive ring are other contraceptive options young women may consider to prevent unplanned pregnancy. Emergency contraception (EC) may still be warranted for individuals who choose hormonal methods in the event that an injection is not received in a timely manner or if the patch or ring is not applied/inserted on time. EC pills undoubtedly have the most potential for women who choose to use time-sensitive hormonal birth control methods and those who choose to use less reliable, coitally timed methods including barrier methods, spermicides, withdrawal, fertility awareness, or no method at all.
Plan B™, the most commonly used EC pill available in the United States, consists of two tablets, each containing 0.75mg of levonorgestrel; it is estimated to prevent 85% of pregnancies when started within 72 hours of unprotected sexual intercourse. As time passes following unprotected intercourse, the effectiveness of this method diminishes.7 While the FDA has approved over-the-counter access to Plan B™ for women ages 17 years of age and older, state regulations vary. Some states have passed regulations to further restrict EC availability, while others provide less restricted access compared to the federal regulations.8 Access restrictions impacting adolescent and young adult women may hinder EC effectiveness considering the importance of timely use after unprotected intercourse. One alternative for adolescent women is to provide EC prior to unprotected intercourse, which may overcome some potential access barriers.
We systematically review studies designed to determine the effect of advance provision of EC prior to unprotected intercourse on its rate of and time to use following unprotected intercourse. Changes in sexual risk taking behaviors will be reviewed to determine whether or not advance provision is associated with more frequent reporting of these behaviors. Pregnancy rates will also be assessed given that the ultimate goal of EC use is pregnancy prevention.
Section snippets
Methods
This review includes original, peer-reviewed journal articles that evaluated the impact of advance provision on the use of EC among women ≤24 years of age. Advance provision refers to providing EC before, rather than after, unprotected intercourse. Randomized trials assessing the use of EC among women assigned to advance provision versus a control group were included in this review. Publications were excluded if they did not address the specific intervention mentioned, did not provide
Results
Studies assessing the advance provision of EC among adolescent and young adult women are characterized in Table 1 with findings and limitations addressed in Table 2. Several studies have been conducted comparing educational information about EC plus advance provision of EC to information alone.9, 10, 11 The primary aim of a randomized clinical trial conducted by Gold and colleagues was to assess whether providing EC in advance corresponded with an increase in risk-taking behavior among 301
Discussion
The findings of these studies suggest that advance provision increases use of EC and improves promptness of EC use following unprotected intercourse. Most studies found no negative effects in ongoing contraceptive use or risky sexual behaviors. However, Belzer and colleagues found that women in the advance provision group were more likely to report having unprotected sex at the 12-month follow-up.10 Although EC use appeared to increase with advance provision, a corresponding decrease in
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Cited by (30)
Trends in U.S. adolescent sexual behavior and contraceptive use, 2006-2019
2021, Contraception: XCitation Excerpt :Given the estimated stability in the proportion of adolescent females engaging in penile-vaginal intercourse, combined with shifts to more effective contraceptive methods, these data further extend the conclusion of earlier studies that improvements in contraceptive use continue to be the critical driver of declines in U.S. adolescent fertility and suggest further declines in adolescent pregnancy rates should be expected [8,17,18]. Additionally, our findings show that increased use of contraceptive methods overall was achieved without any parallel increase in sexual activity, bolstering the body of evidence that improvements in adolescent contraceptive use do not promote sexual activity [17–19]. The findings around condom use in this study are complicated, reflecting that condoms are coital-dependent methods, use can be episodic, and they are increasingly used in combination with another method.
Over-the-Counter Access to Oral Contraceptives for Adolescents
2017, Journal of Adolescent HealthCitation Excerpt :Specific to adolescents, research on condom availability in schools or contraceptive access through school-based health centers likewise has demonstrated no increase in sexual risk behavior [37]. Similarly, reducing barriers to EC access has not been demonstrated to lead to increases in sexual risk behaviors as measured by number of sexual partners, number of episodes of unprotected intercourse, and acquisition of sexually transmitted infections [38]. Increased access to EC has not been shown to reduce the likelihood of using more effective contraceptive methods [39].
Sometimes You Do Get a Second Chance: Emergency Contraception for Adolescents
2017, Pediatric Clinics of North AmericaCitation Excerpt :Thus, sexually active adolescents are at high risk for unwanted or unplanned pregnancy compared with adults and are an important target for EC education and usage. Usage of EC in adolescents greatly improves if they receive counseling and prescriptions for usage before any need arises2 (Table 1). Despite decreases in the rate of teen births over the past 50 years in the United States, the teen birth rate remains high compared with other industrialized nations.3,4
Canadian Contraception Consensus Chapter 3 Emergency Contraception
2015, Journal of Obstetrics and Gynaecology CanadaAdvance provision of emergency contraception in an urban pediatric emergency department
2011, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :Emergency contraception (EC) is estimated to be 58–95% effective in preventing pregnancy when used appropriately after unprotected sexual intercourse.4 Providing EC in advance, either by dispensing the product for future use or by providing a prescription, has been identified in multiple studies as the primary predictor for increasing the use of EC by young women.5–9 Both the Society for Adolescent Health and Medicine (SAHM) and the American Academy of Pediatrics (AAP) have issued statements in support of this practice.10,11
Current Resources for Evidence-Based Practice, September/October, 2011
2011, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing