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Self-administered emergency contraception

Study
Results
Comment

Emergency postcoital contraception is thought to be underused because it must be prescribed by a doctor and used within 72 hours of intercourse. Getting an appointment in time may be difficult, and there may be a degree of embarrassment. One of the concerns about making emergency contraception more easily available, for instance through pharmacists without a prescription or by having it available at home, is that it may be mis-used. A randomised study from Scotland suggests that is not the case [1].

Study


Women aged 16 to 44 years were recruited at a follow-up consultation following use of emergency contraception or after a termination. Women agreeing to participate in the study were randomised on the basis of even/odd birth dates to receive one packet of emergency hormonal contraceptive tablets to keep at home, or were simply informed of emergency contraception availability and use. The emergency contraception used was tablets containing 50 μg ethinyl oestradiol and 0.25 mg levonorgestryl.

Women were given a notification to mail to the study centre if they used emergency contraception. Those with emergency contraception at home could obtain a replacement package. After one year, all the women were sent a questionnaire asking about use of contraception, pregnancies and terminations. This was followed up on two occasions, and if it was not returned, information was sought from family doctor or Scottish Health Department with registers of births and terminations.

Results


There were 549 women in the treatment and 522 in the control group. The final questionnaire was returned by about 65% of women, and information on births or terminations was available on about 93%.

Women who were given emergency contraception to be kept at home were significantly more likely to use it once than those who had to obtain it from a doctor (Figure). There was no difference in the proportion of women using emergency contraception twice or more over the year. Emergency contraception was almost always used correctly.

Figure: Use of emergency postcoital contraception


Emergency contraception was used on 387 occasions (248 times in treatment group and 139 times by controls). Twelve pregnancies began in a cycle in which emergency contraception had been used, representing a failure rate of about 3%.

The total number of unintended pregnancies was 18 (3%) in those with emergency contraception at home, compared with 25 (5%) in those who had to get it from a doctor. This was not statistically different. During the year, in both groups, the predominant form of contraception changed from condoms to oral contraception.

Comment


The fear that emergency contraception kept by women at home would be misused has been dispelled by this trial. Bandolier could not find any other similar trials published.

Reference:

  1. A Glasier, D Baird. The effects of self-administered emergency contraception. New England Journal of Medicine 1998 339: 1-4.
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