Pediatricians Urge Better Access to Emergency Contraception

By Reuters Staff

November 22, 2019

NEW YORK (Reuters Health) - Pediatricians should be aware of emergency contraception (EC) methods, according to a new policy statement from the American Academy of Pediatrics (AAP) that supports broader access to EC for reducing teen pregnancy.

"EC is an important back-up method to which all teenagers should have access," Dr. Krishna K. Upadhya of Children's National Health System in Washington, D.C., and the AAP's Committee on Adolescence, writes in the report, online November 18 in Pediatrics.

About two in three teens have started having sex by age 19, Dr. Upadhya notes. Adolescents, especially those with developmental and other disabilities, are also at risk of sexual assault leading to unintended pregnancy.

EC indications include unprotected intercourse, condom breakage or slippage, missed or delayed contraceptive doses, vomiting after taking an oral contraceptive and sexual assault.

EC pills available in the U.S. include the oral progesterone receptor agonist-antagonist ulipristal acetate (UPA), available by prescription; levonorgestrel (LNG), approved as Plan B by the U.S. Food and Drug Administration in 1999 and available over-the-counter since 2013; and a regimen of off-label oral contraceptives called the Yuzpe method that has been available since 1974. Insertion of a copper IUD (Cu-IUD) within five days of intercourse is the most effective EC method.

All ECs must be used within 120 hours of intercourse, and earlier use increases the chance that hormonal contraceptives will be effective, Dr. Upadhya noted. Patients who use a hormonal EC should be counseled to abstain from sex or use a backup contraceptive method until their next period, he added.

Educating adolescent male patients about EC is also important, according to the author.

Barriers to EC use among adolescents include their cost, at around $50 for EC pills, and accessibility. A recent study found 64% of pharmacies stocked emergency contraceptives, with almost half keeping them on a locked shelf, Dr. Upadhya notes.

"Surveys suggest that most practicing pediatricians and pediatric residents do not routinely counsel patients about EC and do not prescribe it," he adds.

"It is important that information about EC be included in all contraceptive and STI counseling for adolescents wherever these visits occur: the primary care office, the emergency department, specialty clinics, or inpatient units. Discussions should include indications for use and how patients can access EC in a timely fashion," the author says.

"It is important that pediatricians also provide this counseling to adolescents with physical and cognitive disabilities and their parents," he added. "At the policy level, pediatricians should advocate for low-cost or free, nonprescription access to ECPs for teenagers regardless of age and insurance coverage of EC without cost sharing to further reduce cost barriers."


Pediatrics 2019.