Emergency Contraception: A Primer for Pediatric Providers

Alana L. Clements; Alison Moriarty Daley


Pediatr Nurs. 2006;32(2):147-153. 

In This Article

The History of Emergency Contraception

The initial study supporting the use of estrogen and progesterone in combination to prevent pregnancy after an act of unprotected sex was completed at Yale University in 1963 (Croxatto et al., 2001; Morris & van Wagenen, 1966). In 1974, a Canadian researcher named Albert Yuzpe published a paper on the use of existing oral contraceptive pills as a post-coital contraceptive method (Yuzpe et al., 1974). Referred to as the Yuzpe regimen, this regimen of combining specific doses of oral contraceptive pills has been used safely for the last 30 years, mostly by health care providers in their offices or in emergency rooms for women presenting after a sexual assault. For the purpose of this paper, the Yuzpe regimen will be referred to as combined estrogen-progestin EC. In 1993, Princeton University established a Web site that listed the contact information of providers who were willing to prescribe OCPs off-label for this purpose (Reproductive Health Technologies Project, 2005). Three years later, on Valentine's Day of 1996, Princeton and the Reproductive Health Technologies Project expanded this project and launched an EC hotline and now Web site (1-888-NOT-2-LATE; www.not-2-late.com) (Office of Population Research at Princeton, 2005).

Since that time, the U.S. Food and Drug Administration (FDA) has approved multiple dedicated forms of EC. In 1997, six brands of oral contraceptive pills were approved specifically for off-label prescription use as EC (FDA, 1997). One year later, the first dedicated product, Preven, received FDA approval (FDA, 1998). Preven is no longer on the market in the United States because of the superior efficacy and tolerability of Plan B and the ease of using combined estrogen-progestin OCPs as EC when Plan B is not available (Office of Population Research at Princeton, 2005). Plan B, the first progestin-only form of EC, was approved in 1999. Two years after the approval of Plan B, Barr Pharmaceuticals submitted an over-the-counter application to the FDA (FDA, 2004). In 2004, the FDA submitted a non-approval letter to Barr Pharmaceuticals, citing lack of evidence regarding use in women under the age of 16. Barr resubmitted the application with the stipulation that it would remain prescription-only for women under 16 years of age. The decision on that application is still pending and has been delayed multiple times, most recently in November, 2005.


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