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A Glasier - One of the best experts on this subject based on the ideXlab platform.
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ulipristal acetate versus levonorgestrel for Emergency Contraception a randomised non inferiority trial and meta analysis
The Lancet, 2010Co-Authors: A Glasier, Sharon Cameron, Paul Fine, Susan J S Logan, William Casale, Jennifer Van Horn, Laszlo Sogor, Diana L BlitheAbstract:Summary Background Emergency Contraception can prevent unintended pregnancies, but current methods are only effective if used as soon as possible after sexual intercourse and before ovulation. We compared the efficacy and safety of ulipristal acetate with levonorgestrel for Emergency Contraception. Methods Women with regular menstrual cycles who presented to a participating family planning clinic requesting Emergency Contraception within 5 days of unprotected sexual intercourse were eligible for enrolment in this randomised, multicentre, non-inferiority trial. 2221 women were randomly assigned to receive a single, supervised dose of 30 mg ulipristal acetate (n=1104) or 1·5 mg levonorgestrel (n=1117) orally. Allocation was by block randomisation stratified by centre and time from unprotected sexual intercourse to treatment, with allocation concealment by identical opaque boxes labelled with a unique treatment number. Participants were masked to treatment assignment whereas investigators were not. Follow-up was done 5–7 days after expected onset of next menses. The primary endpoint was pregnancy rate in women who received Emergency Contraception within 72 h of unprotected sexual intercourse, with a non-inferiority margin of 1% point difference between groups (limit of 1·6 for odds ratio). Analysis was done on the efficacy-evaluable population, which excluded women lost to follow-up, those aged over 35 years, women with unknown follow-up pregnancy status, and those who had re-enrolled in the study. Additionally, we undertook a meta-analysis of our trial and an earlier study to assess the efficacy of ulipristal acetate compared with levonorgestrel. This trial is registered with ClinicalTrials.gov, number NCT00551616. Findings In the efficacy-evaluable population, 1696 women received Emergency Contraception within 72 h of sexual intercourse (ulipristal acetate, n=844; levonorgestrel, n=852). There were 15 pregnancies in the ulipristal acetate group (1·8%, 95% CI 1·0–3·0) and 22 in the levonorgestrel group (2·6%, 1·7–3·9; odds ratio [OR] 0·68, 95% CI 0·35–1·31). In 203 women who received Emergency Contraception between 72 h and 120 h after sexual intercourse, there were three pregnancies, all of which were in the levonorgestrel group. The most frequent adverse event was headache (ulipristal acetate, 213 events [19·3%] in 1104 women; levonorgestrel, 211 events [18·9%] in 1117 women). Two serious adverse events were judged possibly related to use of Emergency Contraception; a case of dizziness in the ulipristal acetate group and a molar pregnancy in the levonorgestrel group. In the meta-analysis (0–72 h), there were 22 (1·4%) pregnancies in 1617 women in the ulipristal acetate group and 35 (2·2%) in 1625 women in the levonorgestrel group (OR 0·58, 0·33–0·99; p=0·046). Interpretation Ulipristal acetate provides women and health-care providers with an effective alternative for Emergency Contraception that can be used up to 5 days after unprotected sexual intercourse. Funding HRA Pharma.
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advance provision of Emergency Contraception for pregnancy prevention a meta analysis
Obstetrics & Gynecology, 2007Co-Authors: Chelsea B Polis, A Glasier, Cynthia C Harper, Kelly Blanchard, Kate Schaffer, David A GrimesAbstract:OBJECTIVE:Advance provision of Emergency Contraception can circumvent some obstacles to timely use. We performed a meta-analysis to summarize randomized controlled trials evaluating advance provision of Emergency Contraception to explore effects on pregnancy rates, sexually transmitted infections, a
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Emergency Contraception why can t you give it away qualitative findings from an evaluation of advance provision of Emergency Contraception
Contraception, 2004Co-Authors: Karen Fairhurst, Sue Ziebland, Sally Wyke, Peter Seaman, A GlasierAbstract:Abstract The Lothian Emergency Contraception Project (LECP)—a primary care-based intervention to offer advance supplies of Emergency Contraception (EC) to women aged 16–29 was not associated with a reduction in abortion rates. We undertook case studies, utilizing qualitative and quantitative methods, to evaluate the intervention. In this article we present findings from qualitative interviews with 44 primary care professionals working at case study sites and 22 women who had received advance supplies to explain this failure. Professionals reported that women rarely asked for advance supplies of EC and they were reluctant to offer supplies to women because of concerns about contradictory sexual health messages implied by the offer, a perceived association of EC use with chaotic behavior by women, views about the sort of women suitable for advance supplies and practical difficulties making the offer. Women were reluctant to ask for advance supplies because of misgivings about the appropriateness of offering advance supplies to everybody and concerns about being judged by health professionals as morally inadequate. If advance provision of EC is to be successful in reducing abortion rates, professionals must address their concerns about EC and develop imaginative ways of encouraging women most at risk of unwanted pregnancy to take supplies home.
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Emergency Contraception.
Best practice & research. Clinical obstetrics & gynaecology, 2002Co-Authors: A GlasierAbstract:The last decade has seen a huge interest in Emergency Contraception (EC) because of the potential it has to reduce abortion rates. A variety of hormonal methods is available although mifepristone-arguably the best method-is only licensed in China. The intrauterine device is highly effective but its use is limited because of the technical skill required for successful insertion. The mechanism of action of both the Yuzpe regimen of EC and of levonorgestrel is poorly understood and for all methods there are serious methodological difficulties involved with calculating efficacy. Nevertheless the risks and side-effects of EC are negligible and the practicalities of prescribing it are extremely simple. Research and programmatic efforts should concentrate on improving availability if EC is to fulfil its promise as a public health intervention to reduce unwanted pregnancy.
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Emergency Contraception.
British medical bulletin, 2000Co-Authors: A GlasierAbstract:Knowledge and use of Emergency Contraception world-wide is extremely limited. Recent research has demonstrated that levonorgestrel alone is at least as effective as the Yuzpe regimen and is much better tolerated. Levonorgestrel is likely to become the method of choice in the early 21st century. Mifepristone is highly effective even at doses which are not abortifacient. Efficacy cannot be calculated precisely, but all presently available methods seem to prevent at least 74% of unwanted pregnancies. The Yuzpe regimen inhibits or delays ovulation, but there is no good evidence that it prevents implantation. There are no data on the mechanism of action of levonorgestrel alone and the mode of action of mifepristone depends on when in the reproductive cycle it is used. Accessibility to Emergency Contraception is limited by the requirement for it to be prescribed by a doctor. Advanced provision of Emergency Contraception may prevent a significant number of unwanted pregnancies.
Elizabeth G Raymond - One of the best experts on this subject based on the ideXlab platform.
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Emergency Contraception a last chance to prevent unintended pregnancy
Contemporary Readings in Law and Social Justice, 2014Co-Authors: James Trussell, Elizabeth G Raymond, Kelly ClelandAbstract:ABSTRACT. Emergency Contraception provides women with a last chance to prevent unintended pregnancy after sex. In the United States, available options for Emergency Contraception are three kinds of pills (levonorgestrel, ulipristal acetate, and regular oral contraceptive pills in different doses) and the copper IUD. Of these, the copper IUD is by far the most effective, followed by ulipristal acetate and levonorgestrel pills. After years of political struggle, levonorgestrel Emergency contraceptive pills are now available without age or point-of-sale restrictions on store shelves. Although Emergency contraceptive pills have not been shown to reduce unintended pregnancy or abortion rates at the population level, they are an important option for women who have experienced a failure of their regular method, have not used a method, or are sexually assaulted.Keywords: Emergency Contraception; levonorgestrel; copper IUD; Contraception; postcoital Contraception; morning-after pill1. IntroductionHalf of all pregnancies in the United States are unintended: 3.2 million occurred in 2006 alone, the last year for which data are available.1 Emergency Contraception offers women a last chance to prevent pregnancy after unprotected intercourse. Emergency Contraception is especially important for outreach to the 4.5 million women at risk of pregnancy but not using a regular method2 by providing a bridge to use of an ongoing contraceptive method. Although Emergency contraceptives do not protect against sexually transmitted infection, they do offer reassurance to the 8.6 million women who rely on condoms for protection against pregnancy2 in case of condom slippage or breakage. Emergency contraceptives available in the United States include Emergency contraceptive pills and the Copper T intrauterine device (IUD).3,4'52. Emergency Contraceptive PillsThere are three types of ECPs: combined ECPs containing both estrogen and progestin, progestin-only ECPs, and ECPs containing an antiprogestin (either mifepristone or ulipristal acetate). All three are available in the United States. Progestin-only ECPs have now largely replaced the older combined ECPs because they are more effective and cause fewer side effects. Although this therapy is commonly known as the morning-after pill, the term is misleading; ECPs may be initiated sooner than the morning after - immediately after unprotected intercourse - or later - for at least 120 hours after unprotected intercourse.Combined ECPs contain the hormones estrogen and progestin. The hormones that have been studied extensively in clinical trials of ECPs are the estrogen ethinyl estradiol and the progestin levonorgestrel or norgestrel (which contains two isomers, only one of which - levonorgestrel - is bioactive). One combined, dedicated (meaning it was specially packaged for use as EC) EC product (Preven) was approved by the FDA in 1998 but withdrawn from the market in 2004. This combination of active ingredients used in this way is also sometimes called the Yuzpe method, after the Canadian physician who first described the regimen. When dedicated ECPs are not available, certain ordinary birth control pills can be used in specified combinations as Emergency Contraception. In either case, the regimen is one dose followed by a second dose 12 hours later, where each dose consists of 1, 2, 4, 5, or 6 pills, depending on brand. Currently, 26 brands of combined oral contraceptives are approved in the United States for use as Emergency Contraception (see http://ec.princeton.edU/worldwide/default.asp#country).6 Research has demonstrated the safety and efficacy of an alternative regimen containing ethinyl estradiol and the progestin norethindrone;7 this result suggests that oral contraceptive pills containing progestins other than levonorgestrel may also be used for Emergency Contraception.Progestin-only ECPs contain no estrogen. Only the progestin levonorgestrel has been studied for freestanding use as an Emergency contraceptive. …
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Emergency Contraception.
Annals of Internal Medicine, 2002Co-Authors: David A Grimes, Elizabeth G RaymondAbstract:Emergency Contraception is used to prevent pregnancy after a coital act not adequately protected by a regular method of Contraception. In contrast to early medical abortion, Emergency Contraception prevents a pregnancy from starting and does not disrupt an established pregnancy. The most commonly used approaches consist of two oral doses of contraceptive steroids. The levonorgestrel-only regimen (levonorgestrel, 0.75 mg, repeated in 12 hours) appears to be more effective and better tolerated than the Yuzpe regimen (ethinyl estradiol, 100 microg, and levonorgestrel, 0.5 mg, repeated in 12 hours). In the largest randomized, controlled trial to date, levonorgestrel prevented about 85% of pregnancies that would have occurred without its use. Hormonal Emergency Contraception has no known medical contraindications, although it is not indicated for suspected or confirmed pregnancy. However, if hormonal Emergency Contraception is inadvertently taken in early pregnancy, neither the woman nor the fetus will be harmed. Nausea and vomiting associated with the Yuzpe regimen can be reduced by prophylactic use of meclizine. A strong medical and legal case exists for making hormonal Emergency Contraception available over the counter, as has happened in countries other than the United States. Easier access to and wider use of Emergency Contraception could dramatically lower the high rates of unintended pregnancy and induced abortion in the United States.
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Bundling a pregnancy test with the yuzpe regimen of Emergency Contraception
Obstetrics and gynecology, 1999Co-Authors: David A Grimes, Elizabeth G RaymondAbstract:The recent United States Food and Drug Administration approval of a commercial kit containing the Yuzpe regimen for Emergency Contraception is a welcome event. Unlike Emergency contraceptive pills sold in other countries, however, the United States product has a pregnancy test bundled with the pills. The test could identify existing pregnancies and avoid unnecessary use of the pills, although any protection against lawsuits alleging injury to an embryo is speculative. Conversely, no major medical organization recommends routine pregnancy testing before using Emergency contraceptive pills. The test might stigmatize the Yuzpe regimen as being dangerous to an embryo. Difficulty in understanding the pregnancy test instructions could, paradoxically, deter some women from using the pills after having bought them. The bulky size of the pregnancy test reagent stick makes the package indiscreet, and the test adds unnecessary cost to Emergency Contraception. The greatest usefulness of the test could be to confirm or exclude a pregnancy several weeks after taking the pills, rather than before. If bundling an unnecessary test with Emergency Contraception is the only way to bring this useful product to the United States market, then the public health benefits could outweigh the disadvantages. However, this approach sets a worrisome precedent and further isolates the United States from the international medical community.
David A Grimes - One of the best experts on this subject based on the ideXlab platform.
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advance provision of Emergency Contraception for pregnancy prevention a meta analysis
Obstetrics & Gynecology, 2007Co-Authors: Chelsea B Polis, A Glasier, Cynthia C Harper, Kelly Blanchard, Kate Schaffer, David A GrimesAbstract:OBJECTIVE:Advance provision of Emergency Contraception can circumvent some obstacles to timely use. We performed a meta-analysis to summarize randomized controlled trials evaluating advance provision of Emergency Contraception to explore effects on pregnancy rates, sexually transmitted infections, a
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Emergency Contraception.
Annals of Internal Medicine, 2002Co-Authors: David A Grimes, Elizabeth G RaymondAbstract:Emergency Contraception is used to prevent pregnancy after a coital act not adequately protected by a regular method of Contraception. In contrast to early medical abortion, Emergency Contraception prevents a pregnancy from starting and does not disrupt an established pregnancy. The most commonly used approaches consist of two oral doses of contraceptive steroids. The levonorgestrel-only regimen (levonorgestrel, 0.75 mg, repeated in 12 hours) appears to be more effective and better tolerated than the Yuzpe regimen (ethinyl estradiol, 100 microg, and levonorgestrel, 0.5 mg, repeated in 12 hours). In the largest randomized, controlled trial to date, levonorgestrel prevented about 85% of pregnancies that would have occurred without its use. Hormonal Emergency Contraception has no known medical contraindications, although it is not indicated for suspected or confirmed pregnancy. However, if hormonal Emergency Contraception is inadvertently taken in early pregnancy, neither the woman nor the fetus will be harmed. Nausea and vomiting associated with the Yuzpe regimen can be reduced by prophylactic use of meclizine. A strong medical and legal case exists for making hormonal Emergency Contraception available over the counter, as has happened in countries other than the United States. Easier access to and wider use of Emergency Contraception could dramatically lower the high rates of unintended pregnancy and induced abortion in the United States.
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Bundling a pregnancy test with the yuzpe regimen of Emergency Contraception
Obstetrics and gynecology, 1999Co-Authors: David A Grimes, Elizabeth G RaymondAbstract:The recent United States Food and Drug Administration approval of a commercial kit containing the Yuzpe regimen for Emergency Contraception is a welcome event. Unlike Emergency contraceptive pills sold in other countries, however, the United States product has a pregnancy test bundled with the pills. The test could identify existing pregnancies and avoid unnecessary use of the pills, although any protection against lawsuits alleging injury to an embryo is speculative. Conversely, no major medical organization recommends routine pregnancy testing before using Emergency contraceptive pills. The test might stigmatize the Yuzpe regimen as being dangerous to an embryo. Difficulty in understanding the pregnancy test instructions could, paradoxically, deter some women from using the pills after having bought them. The bulky size of the pregnancy test reagent stick makes the package indiscreet, and the test adds unnecessary cost to Emergency Contraception. The greatest usefulness of the test could be to confirm or exclude a pregnancy several weeks after taking the pills, rather than before. If bundling an unnecessary test with Emergency Contraception is the only way to bring this useful product to the United States market, then the public health benefits could outweigh the disadvantages. However, this approach sets a worrisome precedent and further isolates the United States from the international medical community.
Charlotte Ellertson - One of the best experts on this subject based on the ideXlab platform.
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How Safe is Emergency Contraception?
Drug Safety, 2002Co-Authors: Abigail Norris Turner, Charlotte EllertsonAbstract:Emergency Contraception is used to prevent pregnancy after unprotected sex but before pregnancy begins. Currently, women can use Emergency Contraception by taking higher doses of the active ingredients found in ordinary oral contraceptive pills [either combined estrogen-progestogen (progestin) or progestogen-only formulations], or by having providers insert copper-bearing intrauterine devices (IUDs). The antiprogestogen mifepristone also has an excellent efficacy and safety profile as Emergency Contraception, but it is currently available for this indication only in China. Many studies have documented providers’ and women’s fears about the individual and public health safety risks of Emergency Contraception. Some of these concerns include potentially increased risks of cardiovascular events (including arterial and venous disease), worries about possible effects on future fertility, feared teratogenic consequences following method failure or inadvertent use during pregnancy, exaggerated or extreme fears of adverse tolerability, and concerns about drug interactions with other medications. Wider public health questions include feared reductions in the use of ongoing, more effective Contraception, possible ‘abuse’ of Emergency Contraception through overly frequent use, and potential increases in risky sexual encounters (owing to the existence of a backup, postcoital method) and therefore in rates of sexually transmitted infections, including HIV/AIDS. These fears can each be generally allayed. Direct and indirect investigations of Emergency Contraception in the biomedical and social science literature, the extensively documented safety profile of ordinary oral contraceptives, and more than 30 years of clinical experience since hormonal Emergency Contraception was first described, give strong evidence for its safety. This review confirms declarations by the World Health Organization and the US Food and Drug Administration, and shows that Emergency Contraception has an excellent safety profile in nearly all women. Finally, Emergency Contraception allows women a second chance to avoid unwanted pregnancies. Whether pregnancy is carried to term or terminated, the condition has inherent risks that are greater than any posed by Emergency Contraception.
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Emergency Contraception randomized comparison of advance provision and information only
Obstetrics & Gynecology, 2001Co-Authors: Charlotte Ellertson, James Trussell, Shubba Ambardekar, Allison Hedley, Kurus Coyaji, Kelly BlanchardAbstract:OBJECTIVE: To determine whether multiple courses of Emergency contraceptive therapy supplied in advance of need would tempt women using barrier methods to take risks with their more effective ongoing contraceptive methods. METHODS: We randomly assigned 411 condom users attending an urban family planning clinic in Pune, India, to receive either information about Emergency Contraception along with three courses of therapy to keep in case of need, or to receive only information, including that about the locations where they could obtain Emergency Contraception if needed. For up to 1 year, women returned quarterly for follow-up, answering questions about unprotected intercourse, Emergency contraceptive use, pregnancies, sexually transmitted infections, and acceptability. RESULTS: Women given advance supplies reported unprotected intercourse at rates nearly identical to those among women given only information (0.012 versus 0.016 acts per month). Among those who did have unprotected intercourse, however, supply recipients were nearly twice as likely (79% versus 44%) to have taken Emergency Contraception, although numbers were too small to permit statistically significant inferences. No women used Emergency Contraception more than once during the study, even though everyone in the advance-supplies group had extra doses available. All women found knowing about Emergency Contraception useful, and all those receiving only information wished they had received supplies as well. CONCLUSION: Multiple Emergency Contraception doses supplied in advance did not tempt condom users to risk unprotected intercourse. After unprotected intercourse, however, those with pills on hand used them more often. Women found advance provision useful.
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Emergency Contraception a review of the programmatic and social science literature
Contraception, 2000Co-Authors: Charlotte Ellertson, Kelly Blanchard, Tara Shochet, James TrussellAbstract:Many biomedical aspects of Emergency Contraception have been investigated and documented for >30 years now. A large number of social science questions, however, remain to be answered. In this article, we review the rapidly growing but geographically lopsided literature on this topic. Using computer database searches supplemented by reference reviews and professional correspondence with those active in the field, we gathered literature on the social science and service delivery aspects of Emergency Contraception published in English up through December 1998, as well as a few unpublished papers from the same time and slightly later, representing regions where published material is practically nonexistent. Methodologically acceptable papers are summarized in our tables and text, and form the basis for suggested improvements in existing Emergency contraceptive services. The review also offers ideas for designing new Emergency Contraception services where they do not yet exist. We conclude by proposing an agenda for further social science research in this area.
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preventing unintended pregnancy the cost effectiveness of three methods of Emergency Contraception
American Journal of Public Health, 1997Co-Authors: James Trussell, Charlotte Ellertson, Jacqueline Koenig, Felicia H StewartAbstract:OBJECTIVES: This study examined the cost-effectiveness of Emergency contraceptive pills, minipills, and the copper-T intrauterine device (IUD) as Emergency Contraception. METHODS: Cost savings were modeled for both (1) a single contraceptive treatment following unprotected intercourse and (2) Emergency contraceptive pills provided in advance. RESULTS: In a managed care (public payer) setting, a single treatment of Emergency Contraception after unprotected intercourse saves $142 ($54) with Emergency contraceptive pills and $119 ($29) with minipills. The copper-T IUD is not cost-effective as an Emergency contraceptive alone, but savings quickly accrue as use continues. Advance provision of Emergency contraceptive pills to women using barrier contraceptives, spermicides, withdrawal, or periodic abstinence saves from $263 to $498 ($99 to $205) annually. CONCLUSIONS: Emergency Contraception is cost-effective whether provided when the Emergency arises or in advance to be used as needed. Greater use of Emergency...
James Trussell - One of the best experts on this subject based on the ideXlab platform.
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Emergency Contraception a last chance to prevent unintended pregnancy
Contemporary Readings in Law and Social Justice, 2014Co-Authors: James Trussell, Elizabeth G Raymond, Kelly ClelandAbstract:ABSTRACT. Emergency Contraception provides women with a last chance to prevent unintended pregnancy after sex. In the United States, available options for Emergency Contraception are three kinds of pills (levonorgestrel, ulipristal acetate, and regular oral contraceptive pills in different doses) and the copper IUD. Of these, the copper IUD is by far the most effective, followed by ulipristal acetate and levonorgestrel pills. After years of political struggle, levonorgestrel Emergency contraceptive pills are now available without age or point-of-sale restrictions on store shelves. Although Emergency contraceptive pills have not been shown to reduce unintended pregnancy or abortion rates at the population level, they are an important option for women who have experienced a failure of their regular method, have not used a method, or are sexually assaulted.Keywords: Emergency Contraception; levonorgestrel; copper IUD; Contraception; postcoital Contraception; morning-after pill1. IntroductionHalf of all pregnancies in the United States are unintended: 3.2 million occurred in 2006 alone, the last year for which data are available.1 Emergency Contraception offers women a last chance to prevent pregnancy after unprotected intercourse. Emergency Contraception is especially important for outreach to the 4.5 million women at risk of pregnancy but not using a regular method2 by providing a bridge to use of an ongoing contraceptive method. Although Emergency contraceptives do not protect against sexually transmitted infection, they do offer reassurance to the 8.6 million women who rely on condoms for protection against pregnancy2 in case of condom slippage or breakage. Emergency contraceptives available in the United States include Emergency contraceptive pills and the Copper T intrauterine device (IUD).3,4'52. Emergency Contraceptive PillsThere are three types of ECPs: combined ECPs containing both estrogen and progestin, progestin-only ECPs, and ECPs containing an antiprogestin (either mifepristone or ulipristal acetate). All three are available in the United States. Progestin-only ECPs have now largely replaced the older combined ECPs because they are more effective and cause fewer side effects. Although this therapy is commonly known as the morning-after pill, the term is misleading; ECPs may be initiated sooner than the morning after - immediately after unprotected intercourse - or later - for at least 120 hours after unprotected intercourse.Combined ECPs contain the hormones estrogen and progestin. The hormones that have been studied extensively in clinical trials of ECPs are the estrogen ethinyl estradiol and the progestin levonorgestrel or norgestrel (which contains two isomers, only one of which - levonorgestrel - is bioactive). One combined, dedicated (meaning it was specially packaged for use as EC) EC product (Preven) was approved by the FDA in 1998 but withdrawn from the market in 2004. This combination of active ingredients used in this way is also sometimes called the Yuzpe method, after the Canadian physician who first described the regimen. When dedicated ECPs are not available, certain ordinary birth control pills can be used in specified combinations as Emergency Contraception. In either case, the regimen is one dose followed by a second dose 12 hours later, where each dose consists of 1, 2, 4, 5, or 6 pills, depending on brand. Currently, 26 brands of combined oral contraceptives are approved in the United States for use as Emergency Contraception (see http://ec.princeton.edU/worldwide/default.asp#country).6 Research has demonstrated the safety and efficacy of an alternative regimen containing ethinyl estradiol and the progestin norethindrone;7 this result suggests that oral contraceptive pills containing progestins other than levonorgestrel may also be used for Emergency Contraception.Progestin-only ECPs contain no estrogen. Only the progestin levonorgestrel has been studied for freestanding use as an Emergency contraceptive. …
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copper intrauterine device for Emergency Contraception clinical practice among contraceptive providers
Obstetrics & Gynecology, 2012Co-Authors: Cynthia C Harper, Joseph J Speidel, Eleanor A Drey, James Trussell, Maya Blum, Philip D. DarneyAbstract:Objective—The copper intrauterine device (IUD) is the most effective Emergency contraceptive available but is largely ignored in clinical practice. We examined clinicians’ recommendation of the copper IUD for Emergency Contraception in a setting with few cost obstacles. Methods—We conducted a survey among clinicians (n=1,246; response rate 65%) in a California State family planning program, where U.S. Food and Drug Administration-approved contraceptives are available at no cost to low-income women. We used multivariable logistic regression to measure the association of intrauterine contraceptive training and evidence-based knowledge with having recommended the copper IUD for Emergency Contraception. Results—The large majority of clinicians (85%) never recommended the copper IUD for Emergency Contraception, and most (93%) required two or more visits for an IUD insertion. Multivariable analyses showed insertion skills were associated with having recommended the copper IUD for Emergency Contraception, but the most significant factor was evidence-based knowledge of patient selection for IUD use. Clinicians who viewed a wide range of patients as IUD candidates were twice as likely to have recommended the copper IUD for Emergency Contraception. While over 93% of obstetrician–gynecologists were skilled in inserting the copper IUD, they were no more likely to have recommended it for Emergency Contraception than other physicians or advance practice clinicians. Conclusion—Recommendation of the copper IUD for Emergency Contraception is rare, despite its high efficacy and long-lasting contraceptive benefits. Recommendation would require clinic flow and scheduling adjustments to allow same-day IUD insertions. Patient-centered and highquality care for Emergency Contraception should include a discussion of the most effective method.
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Emergency Contraception randomized comparison of advance provision and information only
Obstetrics & Gynecology, 2001Co-Authors: Charlotte Ellertson, James Trussell, Shubba Ambardekar, Allison Hedley, Kurus Coyaji, Kelly BlanchardAbstract:OBJECTIVE: To determine whether multiple courses of Emergency contraceptive therapy supplied in advance of need would tempt women using barrier methods to take risks with their more effective ongoing contraceptive methods. METHODS: We randomly assigned 411 condom users attending an urban family planning clinic in Pune, India, to receive either information about Emergency Contraception along with three courses of therapy to keep in case of need, or to receive only information, including that about the locations where they could obtain Emergency Contraception if needed. For up to 1 year, women returned quarterly for follow-up, answering questions about unprotected intercourse, Emergency contraceptive use, pregnancies, sexually transmitted infections, and acceptability. RESULTS: Women given advance supplies reported unprotected intercourse at rates nearly identical to those among women given only information (0.012 versus 0.016 acts per month). Among those who did have unprotected intercourse, however, supply recipients were nearly twice as likely (79% versus 44%) to have taken Emergency Contraception, although numbers were too small to permit statistically significant inferences. No women used Emergency Contraception more than once during the study, even though everyone in the advance-supplies group had extra doses available. All women found knowing about Emergency Contraception useful, and all those receiving only information wished they had received supplies as well. CONCLUSION: Multiple Emergency Contraception doses supplied in advance did not tempt condom users to risk unprotected intercourse. After unprotected intercourse, however, those with pills on hand used them more often. Women found advance provision useful.
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Emergency Contraception a review of the programmatic and social science literature
Contraception, 2000Co-Authors: Charlotte Ellertson, Kelly Blanchard, Tara Shochet, James TrussellAbstract:Many biomedical aspects of Emergency Contraception have been investigated and documented for >30 years now. A large number of social science questions, however, remain to be answered. In this article, we review the rapidly growing but geographically lopsided literature on this topic. Using computer database searches supplemented by reference reviews and professional correspondence with those active in the field, we gathered literature on the social science and service delivery aspects of Emergency Contraception published in English up through December 1998, as well as a few unpublished papers from the same time and slightly later, representing regions where published material is practically nonexistent. Methodologically acceptable papers are summarized in our tables and text, and form the basis for suggested improvements in existing Emergency contraceptive services. The review also offers ideas for designing new Emergency Contraception services where they do not yet exist. We conclude by proposing an agenda for further social science research in this area.
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preventing unintended pregnancy the cost effectiveness of three methods of Emergency Contraception
American Journal of Public Health, 1997Co-Authors: James Trussell, Charlotte Ellertson, Jacqueline Koenig, Felicia H StewartAbstract:OBJECTIVES: This study examined the cost-effectiveness of Emergency contraceptive pills, minipills, and the copper-T intrauterine device (IUD) as Emergency Contraception. METHODS: Cost savings were modeled for both (1) a single contraceptive treatment following unprotected intercourse and (2) Emergency contraceptive pills provided in advance. RESULTS: In a managed care (public payer) setting, a single treatment of Emergency Contraception after unprotected intercourse saves $142 ($54) with Emergency contraceptive pills and $119 ($29) with minipills. The copper-T IUD is not cost-effective as an Emergency contraceptive alone, but savings quickly accrue as use continues. Advance provision of Emergency contraceptive pills to women using barrier contraceptives, spermicides, withdrawal, or periodic abstinence saves from $263 to $498 ($99 to $205) annually. CONCLUSIONS: Emergency Contraception is cost-effective whether provided when the Emergency arises or in advance to be used as needed. Greater use of Emergency...