Having emergency contraception at home does not boost rate of unprotected sex among teens


University of Pittsburgh study also finds corresponding increase in condom use

PITTSBURGH, March 30 When emergency contraceptive pills are readily available, teen-agers are more likely to use them and use them sooner, when they are more effective. But they are not more likely to have unprotected sex, according to a University of Pittsburgh study being published in the April issue of the Journal of Pediatric and Adolescent Gynecology.

Between 1997 and 2001, more than 300 young women ages 15 to 20 were enrolled in the study. They were given education about emergency contraceptive pills and received monthly follow-up telephone calls to assess sexual activity and their usage of various methods of contraception.

Study participants, who were followed for a period of six months, were randomized to receive emergency contraceptive education along with a package of emergency contraceptive pills or education only, with instruction on how to get the pills if they were needed. All participants were sexually active, with a mean age at first intercourse between 14 and 15 years.

Previously known as the "morning after pill," emergency contraceptives can reduce the risk of pregnancy by about 89 percent if taken within 72 hours of unprotected sex, according to Women's Capitol Corp., makers of Plan B™. Since the beginning of this study, the U.S. Food and Drug Administration has approved two forms of emergency contraceptive pills for sale by prescription Preven™ in 1998 and Plan B in 1999.

"At one- and six-month follow-up interviews, there were no differences between the groups in reported unprotected sex within that month," says Melanie A. Gold, D.O., lead study author and associate professor of pediatrics at the University of Pittsburgh School of Medicine, noting that there also were no differences by group in reported use of other hormonal contraceptives such as birth control pills or long-acting contraceptive injections at the one- or six-month follow-up interviews.

"Interestingly, at the six-month interviews, more of the study participants who had received emergency contraceptive pills reported using condoms during that month," Dr. Gold adds.

Of particular importance is that more teen-agers who were given the pills in advance used them within the first 12 hours of unprotected sex, when they are most effective, she notes. Emergency contraception is effective when taken within 120 hours after intercourse, but it is more effective the sooner it is taken.

"If used following all contraceptive failures or episodes of unprotected sex, emergency contraceptives could prevent up to 50 percent of unintended pregnancies and 60 percent to 70 percent of abortions annually," says Dr. Gold.

At one-month interviews, teen-agers who already had packages of emergency contraceptive pills were nearly twice as likely to use them, with 15 percent of the advance group reporting use and 8 percent of the education-only control group reporting such use, says Dr. Gold. But by final follow-up at six months, the differences between the groups had mostly disappeared, with 8 percent of the advance group reporting using emergency contraceptive pills and 6 percent of the control group using the pills.

"There is no evidence from this study to suggest that providing advance emergency contraception causes adolescents to have more unprotected intercourse or less consistent contraceptive use," the authors write. "However, the study does add to the growing body of literature that demonstrates there are no negative behavioral or health ramifications to making emergency contraceptives available outside the confines of a pediatric health care visit."

The study was funded in part by the Laurel Foundation. Additional study authors are Jennifer E. Wolford, MPH, Philadelphia College of Osteopathic Medicine; Kym A. Smith, B.S., CCRC, Children's Hospital of Pittsburgh; and Andrew Parker, Ph.D., Virginia Polytechnic Institute and State University.

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