Advance provision of emergency contraception among adolescent and young adult women: a systematic review of literature

Objective: The purpose of this review is to summarize the findings of randomized controlled trials assessing the advance provision of emergency contraception (EC) to women 24 years of age or younger.

Design: We conducted a comprehensive search of the PubMed database from 1950 to November 11, 2009. This review includes seven studies that randomly assigned women aged 24 and younger to advance provision of EC or a control group.

Results: All studies reviewed found that women assigned to advance provision were more likely to use EC, though not all reached statistical significance. Furthermore, studies assessing time to EC use (N = 4) found that those with advance provision used EC sooner following intercourse. Most studies found that women assigned to advance provision of EC did not engage in more sexual risk taking behaviors (assessed by reported number of sexual partners, number of episodes of unprotected intercourse, and acquisition of sexually transmitted infections) or switch to less reliable contraceptive methods. Despite increased use and decreased time to use, women who were provided EC in advance did not report significantly lower pregnancy rates.

Conclusions: The existing literature suggests that among women 24 years of age or younger, advance provision has a positive impact on use and time to use of EC. Most findings indicate that increased use of EC does not have significant negative effects for ongoing contraceptive use or sexual risk taking behaviors. Despite increased use, advanced provision of EC has not been associated with a significant corresponding decrease in pregnancy.