The Society for Adolescent Health and Medicine has issued emergency contraception guidelines for health care providers in the latest issue of the Journal of Adolescent Health.
The guidelines address recommendations for the use of emergency contraception in clinical settings, as well as access and advocacy.
According to the authors of the Society for Adolescent Health and Medicine (SAHM) guidelines, increased accessibility and options have led to dramatic decreases in teen pregnancy, birth and abortion rates throughout the world, but some areas still have high rates of unintended pregnancy.
"Despite well-proven safety and effectiveness, global access to [emergency contraception] continues to vary with local political and religious conventions," they wrote. "Although [emergency contraception] is only effective before implantation (the medical definition of pregnancy), many people continue to conceptualize and discuss [emergency contraception] as an abortifacient. And in many locations, access to oral [emergency contraception] medication continues to be limited by financial, knowledge and other barriers. Other methods of [emergency contraception] are provider dependent due to need for prescription or insertion, thus further restricting access. Nonetheless, [emergency contraception], and oral levonorgestrel in particular, is now more widely available to women of all ages throughout the world."
SAHM recommends that all health care providers be knowledgeable regarding all methods of emergency contraception, including hormonal emergency contraception options such as Mifeprex (mifepristone, Danco Laboratories), levonorgestrel and the Yuzpe method, as well as nonhormonal options such as the copper IUD, and offer them during routine and preventive visits. They said it is important that there is "confidential counseling for all adolescents and young adults of all genders."
Providers should counsel overweight and obese women regarding the risk for the reduced efficacy of oral emergency contraception medication and provide information about the copper IUD, which is an option that is effective regardless of weight. If health care providers cannot insert the IUDs themselves, they should work with other clinicians who can do so and also provide oral emergency contraception with the referral.
Additionally, SAHM stated that receipt of emergency contraception should not be contingent on STI testing, cervical cancer screening, pregnancy testing or pelvic examination. Options should be offered whenever a patient reports unprotected or underprotected intercourse within the past 5 days. Female patients who are being treated for sexual assault should be offered emergency contraception during assessment.
SAHM also outlined recommendations to increase access and advocacy, which included the support of efforts to change the status of all oral emergency contraception medication to over the counter, regardless of age or sex. The organization urged health care providers to "explore circumstances affecting [emergency contraception] access with patients, including financial and transportation issues, confidentiality, and prescription or OTC access and other barriers associated with access."
Providers and other relevant parties also are encouraged to establish protocols and follow laws, regardless of their individual beliefs, develop and disseminate educational materials, and advocate for emergency contraception affordability and insurance coverage parity.
"[Emergency contraception] is a vital component of comprehensive reproductive health care, enabling women of all ages to decrease the risk of an unwanted pregnancy after assault or contraceptive failure or nonuse," the authors concluded. "Virtually all healthy female adolescents and young adult women can safely use [emergency contraception]. The combined efforts of clinicians, pharmacists, educators and legislators are necessary to increase awareness, access and use of [emergency contraception] for female adolescents and young women. Such work has the potential to decrease the consequences of unintended pregnancies throughout the world." – by Chelsea Frajerman Pardes
Disclosure: The authors report no relevant financial disclosures.