Emergency Contraception: A Primer for Pediatric Providers

Alana L. Clements; Alison Moriarty Daley

Disclosures

Pediatr Nurs. 2006;32(2):147-153. 

In This Article

Adolescents and the Use of EC

EC has the potential to prevent 50% of unplanned pregnancies and thus 60%-70% of abortions annually (Henshaw, 1998; Trussell, Stewart, Guest & Hatcher, 1992). Plan B has an efficacy rate of up to 89%, slightly higher than that of combined estrogen-progestin EC (Task Force on Postovulatory Methods of Fertility Regulation, 1998). The safety and efficacy of EC make it a particularly important tool for sexually active adolescents, because 78% of pregnancies in this age group are unplanned (Allan Guttmacher Institute, 1999; Henshaw, 1998). Recently released statistics indicate that the rate of teen pregnancy in the United States continues to drop from its peak in the early 1990s (Allan Guttmacher Institute, 1999). Though this decline is promising, the rate of unplanned pregnancies in adolescents in the United States continues to be higher than that of any other industrialized nation in the world. Approximately 40% of young women in the United States become pregnant at least once before they turn 20 (Annie E. Casey Foundation, 1998). EC is a crucial tool in the continued effort to decrease rates of teen pregnancy, unplanned pregnancy in women of all ages, and abortion. The FDA's decision not to allow over-the-counter sales of Plan B keeps Plan B out of reach for some of those who could potentially benefit most from its use. The utility of this drug hinges upon rapid access. The current requirement to contact a health care provider for a prescription at the time of need may prevent many women, particularly young women, from obtaining EC when they need it. Young teens may continue to face barriers to obtaining Plan B, even if it is granted over the counter status because they may be too young to work, and therefore not have money to purchase it, or may have difficulty obtaining timely transportation to a pharmacy.

In the letter from the FDA to Barr pharmaceuticals, the FDA attributed their rejection of the OTC proposal to lack of research evidence regarding use and safety of Plan B by adolescent women. Contrary to this assertion, there is a substantial body of literature that supports the use of EC in adolescents. A study by Harper, Rocca, Darney, von Hertzen, and Raine (2004) examined both the ability of adolescents to self-administer Plan B properly and the side effects they experienced following the regimen. Participants in the study ranged in age from 13-16 years old and of the 52 adolescents, 51 were able to administer the product correctly and took the second dose as directed 12 hours after the first. The study results also indicate that adolescents do not experience increased rates of side effects compared to adults. The mean duration of menses remained constant before and after use of EC and onset of menses after the treatment was within 2-3 weeks. The other side effects evaluated - including nausea, vomiting, headache, fatigue, and breast tenderness - were at approximately the same rate as in adult users (Harper et al., 2004).

Another initial concern addressed is whether adolescents will abandon more traditional birth control methods, such as condoms and OCPs, with increased availability of EC. Multiple studies completed in the last few years have not validated this concern (Gold, Sucato, Conard, Hillard & Society for Adolescent Medicine 2004; Gold, Wolford, Smith & Parker, 2004; Raymond, Chen & Dalebout, 2003; Roye & Johnsen, 2001; Stewart, Gold, & Parker, 2003). One preliminary study indicates that advanced provision of EC - the practice of providing either a prescription for EC or the drug itself at either a primary care or reproductive visit in advance of need - is not associated with decreased use of condoms (Roye & Johnsen, 2001). This study also found some evidence that advance provision of EC results in more responsible use of contraception (Roye & Johnsen, 2001). Use of EC - either through advanced provision or by request at time of need - has not been shown to increase the risk of sexually transmitted infections (STI) or pregnancy in adolescents (Gold et al., 2004; Stewart et al., 2003). Another significant finding is that advanced provision of EC to adolescents may serve as an entrée into regular gynecologic care, including annual pap smears to screen for cervical cell abnormalities and testing for STIs (Stewart et al., 2003).

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