emco

REVIEW

Advance Provision of Emergency Contraception for Pregnancy Prevention

A Meta-Analysis

Chelsea B. Polis¹, Kate Schaffer, MSc², Kelly Blanchard, MS³, Anna Glasier, MD, FRCOG⁴, Cynthia C. Harper, PhD⁵ and David A. Grimes, MD⁶

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.

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MEDLINE, a specialized emergency contraception article database, and contacted experts to identify published or unpublished trials.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