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Advance Provision of Emergency Contraception for Pregnancy Prevention: A Meta-Analysis

Polis, Chelsea B.; Schaffer, Kate MSc; Blanchard, Kelly MS; Glasier, Anna MD, FRCOG; Harper, Cynthia C. PhD; Grimes, David A. MD

doi: 10.1097/01.AOG.0000295603.84568.f6
Review

OBJECTIVE: Advance provision of emergency contraception can circumvent some obstacles to timely use. We performed a meta-analysis to summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors.

DATA SOURCES: In August 2006, we searched CENTRAL, EMBASE, POPLINE, MEDLINE, a specialized emergency contraception article database, and contacted experts to identify published or unpublished trials.

METHODS OF STUDY SELECTION: We included randomized controlled trials comparing advance provision to standard access, defined as any of the following: counseling (with or without information about emergency contraception) or provision of emergency contraception on request at a clinic or pharmacy.

TABULATION, INTEGRATION AND RESULTS: Two reviewers independently assessed study quality. We performed a meta-analysis using Review Manager software. Eight randomized controlled trials met inclusion criteria, representing 6,389 patients in the United States, China, and India. Advance provision did not decrease pregnancy rates, despite increased use (single use, odds ratio [OR] 2.52, 95% confidence interval [CI] 1.72–3.70; multiple use: OR 4.13, 95% CI 1.77–9.63) and faster use (weighted mean difference –14.6 hours, 95% CI –16.77 to –12.4 hours). Advance provision did not increase rates of sexually transmitted infections (OR 0.99, 95% CI 0.73–1.34), unprotected intercourse, or changes in contraceptive methods. Women who received emergency contraception in advance were as likely to use condoms as other women.

CONCLUSION: Advance provision of emergency contraception did not reduce pregnancy rates and did not negatively affect sexual and reproductive health behaviors and outcomes compared with conventional provision.

LEVEL OF EVIDENCE: III

Advance provision of emergency contraception does not seem to reduce pregnancy rates on a population level, nor does it negatively affect sexual behavior.

From the 1Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; 2Pathfinder International, Watertown, Massachusetts; 3Ibis Reproductive Health, Cambridge, Massachusetts; 4Family Planning and Well Women Services, Lothian Primary Care NHS Trust, Edinburgh Scotland; 5Bixby Center for Reproductive Health Research and Policy, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California; and 6Family Health International, Research Triangle Park, North Carolina.

Partially supported by Ibis Reproductive Health.

The authors thank the late Charlotte Ellertson, who conceived the idea for this review and provided generous encouragement and advice. The authors also thank Carol Manion for assistance with their search strategy.

This article is based on a Cochrane review published in the Cochrane Library 2007, Issue 2 (see www.thecochranelibrary.com for information). Cochrane reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the most recent version of the review.

The results of a Cochrane review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of review authors, and are not necessarily shared by the Cochrane Collaboration.

Corresponding author: Ms. Chelsea Polis, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Room W4510, 615 North Wolfe Street, Baltimore, MD 21202; e-mail: cpolis@jhsph.edu.

Financial Disclosure Ms. Blanchard is the President of Ibis Reproductive Health (Cambridge, MA). The other authors have no potential conflicts of interest to disclose.

© 2007 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.