Emergency Contraception Use Not Associated With Risky Sexual Behavior

Jennifer Reid Holman, MA

December 15, 2005

Dec. 15, 2005 (Philadelphia) — Critics of emergency contraception (EC) have raised concerns that making it easily accessible could result in women having more unprotected sex, unintended pregnancies, and sexually transmitted infections.

A new study, presented this week at the American Public Health Association annual meeting, suggests those concerns are unfounded.

"We found the opposite to be true," said Toni Felice, PhD, study coauthor and associate director of applied research for the Family Health Council, Inc, in Pittsburgh, Pennsylvania. "The women we followed used EC for exactly what it's intended to be used for — only in an atypical emergency situation in which they had unprotected sex and did not want to become pregnant."

The study sample included 1082 women receiving care at 1 of 9 family planning offices in the Philadelphia and Pittsburgh areas. Each woman completed an enrollment interview and was asked to complete a monthly questionnaire about her sexual practices over 18 months. Among this group, 113 participants indicated they had used EC during the study period, and 78 of these women completed telephone surveys the month prior to EC use, the month of EC use, and the month after. A random sample of 78 other participants, who had not used EC during the study, was also surveyed during the 3 consecutive months. Some data were also collected at enrollment and during clinical visits during the 18-month study period.

The study participants were primarily 19- to 24-year-old women who had never been married. Nearly half of the EC users were African American and 40% were white. More EC users (60% vs 41%) had had at least one child. Fewer of the EC users reported having had an abortion in the past compared with non-EC users (24% vs 30%).

At enrollment, more than half of the women who eventually used EC during the study said condoms were their main birth control method. Birth control pills were the main method reported by women who did not use EC during the study. More women who eventually used EC reported having had unprotected sex in the 30 days prior to enrollment.

According to the telephone surveys, more than half of the EC users indicated they used EC after a sexual encounter when they had used no birth control. Just over 10% indicated they took it after a problem with a condom.

More than twice as many of the EC users (15%) reported having had a new sex partner during the month she had taken EC compared with the nonusers (6%).

The frequency of unprotected sex fluctuated in both groups over the three months. The only statistically significant difference that surfaced, however, was that EC users were more likely than nonusers to have had 1 unprotected sexual encounter during month 2 (when EC was used) than during either the preceding or subsequent month.

At the end of each survey month, EC users were also more likely to have used condoms during their last sexual encounter, whereas women who hadn't used EC were more likely to have used birth control pills. During the 18-month period, there were no significant differences between the 2 groups in terms of chlamydia, gonnorhea, or pregnancy test results.

"Some people are still playing the what-if game about EC, but there's really no data that suggest women would ever make EC their regular form of birth control," said Dr. Felice. "In fact, considering the side effects like nausea and how easily women can attain regular birth control, it seems highly unlikely."

In fact, other data refute concerns regarding the possible misuse of EC, noted James Trussell, MD, director of the Office of Population Research at Princeton University in New Jersey.

"The results of Dr. Felice's study are consistent with the findings of 7 published studies specifically designed to test the hypothesis that easier access to EC promotes risk-taking," Dr. Trussell told Medscape. "All of these studies showed that easier access did not result in more unprotected sex and did not reduce the use of regular contraceptive methods."

According to Dr. Felice, the public could be better served by moving beyond the "what-ifs" and focusing on the available research data.

"I imagine some of the same sort of concerns were tossed around when general contraception was introduced," said Dr. Felice. "The fact is that EC is really underused at this point." Half of all unintended pregnancies in the United States could be averted if EC was readily available and used, she noted.

APHA 133rd Annual Meeting: Abstract 102917. Presented Dec. 12, 2005.

Reviewed by Peggy Keen, PhD, FNP

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