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Emergency Contraception for Non-Clinical Providers in Washington State
1 Emergency Contraception for Non-Clinical Providers in Washington State
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2 Learning Objectives Understand the critical role of emergency contraception (EC) in pregnancy prevention Understand EC safety and effectiveness Clarify role of non-clinical providers in educating clients about EC Identify mechanisms for raising awareness of EC within client population Increase awareness of EC resources
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Why Is Emergency Contraception Needed?
3 Why Is Emergency Contraception Needed? Around 10 million couples have sexual intercourse every night in America Approximately 27,000 condoms break or slip Even perfect contraceptors can and do experience contraceptive failure Source: Trussell & Kowal, 1998.
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Current Proportion of Unintended Pregnancy
4 Current Proportion of Unintended Pregnancy United States: 49% Washington State: 55% Source: Henshaw, 1998; Schrager, 1997.
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Definition of Unintended Pregnancy
5 Definition of Unintended Pregnancy Pregnancy that is unwanted or mistimed at conception Does not mean unwanted births/unloved children Does mean less opportunity to prepare: Pre-pregnancy risk identification Management of preexisting conditions Changes in diet and vitamins Avoidance of alcohol, toxic exposure, and smoking
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Consequences of Unintended Pregnancy
6 Consequences of Unintended Pregnancy Approximately half of all unintended pregnancies end in abortion Greater risks for mother depression; physical abuse; not achieving educational, financial, career goals; relationship challenges Greater risks for child low birthweight, dying in first year of life, abuse, and neglect Source: Institute of Medicine, 1995.
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7 The Institute of Medicine Recommends That the Nation Adopt a New Social Norm All pregnancies should be intended–that is, they should be consciously and clearly desired at the time of conception. Source: Institute of Medicine, 1995.
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Emergency contraception prevents pregnancy AFTER sex
8 Emergency contraception prevents pregnancy AFTER sex
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Emergency Contraception Obstacles to Use
9 Most women don’t know about the method 11% of women know the basic facts about EC 1% have used it Most health care providers do not routinely discuss EC with their clients approximately 1 in 10 routinely discuss EC These data are supported by PATH’s local assessment Source: Kaiser Family Foundation, 1997.
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What Is Emergency Contraception?
1010 What Is Emergency Contraception? Emergency Contraceptive Pills (ECPs) Have been in use since the 1960s Often referred to as “the morning-after pill” Birth control pill hormones taken in high doses within 3 days (72 hours) of unprotected sex IUD Insertion Within 5 days (120 hours) of unprotected sex Can also be a long-term contraceptive method
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ECPs Can Be Used Any Time Unprotected Intercourse Has Occurred
1111 A woman was raped No contraception used Condom slipped, leaked, or broke Diaphragm or cervical cap inserted incorrectly, removed too soon, or torn Two consecutive birth control pills were missed An IUD was partially or totally expelled A three-month contraceptive injection was missed by more than two weeks A one-month contraceptive injection was missed by more than three days
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1212 Limitations of ECPs ECPs are not as effective as regular contraceptive methods Should be used as a bridge to long-term birth control options ECPs do not protect against STDs
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Are ECPs Safe? ECPs are safe and easy to use 1313
The amount of active ingredient (hormone) is small Short-term use Hormones leave the body quickly Source: WHO, 1996.
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What if a Woman Is Already Pregnant?
1414 What if a Woman Is Already Pregnant? ECPs cannot dislodge an established pregnancy They do not cause abortion ECPs do not affect fetal development Source: FDA, 1997.
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Two Types of ECPs 1515 Progestin-only
Reduces the risk of pregnancy by 89% Side effects Nausea (23%) Vomiting (6%) Estrogen and Progestin Reduces the risk of pregnancy by 75% Side effects Nausea (50%) Vomiting (20%) Both Methods: First dose within 72 hours after intercourse Second dose 12 hours later Source: Task Force on Postovulatory Methods of Fertility Regulation, 1998.
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Effectiveness: Single-Use Progestin Only
1616 Effectiveness: Single-Use Progestin Only 100 women have unprotected sex in the 2nd or 3rd week of their cycle 8 will become pregnant without emergency contraception 1 will become pregnant using progestin-only ECPs (89% reduction) Adapted from ARHP, Source: Task Force on Postovulatory Methods of Fertility Regulation, 1998.
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Effectiveness: Single-Use Combination Pill
1717 Effectiveness: Single-Use Combination Pill 100 women have unprotected sex in the 2nd or 3rd week of their cycle 8 will become pregnant without emergency contraception 2 will become pregnant using combined ECPs (75% reduction) Adapted from ARHP, Source: Trussell, Rodriguez, and Ellertson, 1998.
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How Do ECPs Work? The same way as ordinary birth control pills by
1818 The same way as ordinary birth control pills by Preventing or delaying the release of a woman’s egg (ovulation) ECPs may affect the uterine lining so that a fertilized egg cannot implant ECPs may prevent fertilization by affecting the movement of the sperm and their ability to fertilize an egg Timing impacts how ECPs work Source: Swahn et al., 1996; Ling et al., 1979; Rowlands et al., 1986; Ling et al., 1983; Kubba et al., 1986; Taskin et al., 1994; Von Hertzen & Van Look, 1996.
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Medical Definition of Pregnancy
1919 Medical Definition of Pregnancy NIH, FDA, and ACOG all define pregnancy as beginning with implantation It takes about 6 days for a fertilized egg to begin to implant Intervention within 72 hours cannot result in abortion ECPs are not effective if a women is already pregnant Source: Code of Federal Regulations, 1998; Hughes, 1972.
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Providing EC Information
2020 Providing EC Information Some women will want to base their decision on whether to use ECPs on how they work. It is important that women clearly understand how pills are believed to work so they can make an informed choice.
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Key Points on Mechanism of Action
2121 Key Points on Mechanism of Action ECPs will not interrupt or harm an established pregnancy ECPs will not affect future fertility ECPs are not the same as the “abortion pill” (RU486), which is used after pregnancy is already established ECPs work through various mechanisms
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What are the key messages to get across to your clients?
2222 What are the key messages to get across to your clients?
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Key Messages for Clients
2323 Key Messages for Clients 72-hour time frame (but sooner is better) Safe and effective Mechanism of action (informed choice) Do not cause abortion Side effects: nausea and vomiting Not as effective as other contraceptives for regular use Potential bridge to regular contraception ECPs do not protect against STDs Sources for accessing ECPs
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What other issues might be of importance to clients?
2424 What other issues might be of importance to clients?
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Key Topics of Importance to Clients
2525 Key Topics of Importance to Clients No future impact on childbearing No threat to potential pregnancy Not abortion Religion (individual’s religious background not always predictive of EC interest) Expense of ECPs (covered by Medicaid) Confidentiality Adolescents Diverse communities Interpreters
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Where Can Women Get ECPs?
2626 Where Can Women Get ECPs? Advance-of-need prescribing/distribution Doctor or clinic Walk-in visit/appointment Telephone screening Some pharmacies in Washington State can provide ECPs directly to women
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Advance Distribution or Advance-of-Need Prescribing of ECPs
2727 Advance Distribution or Advance-of-Need Prescribing of ECPs ECPs are more effective when taken sooner Advance prescription reduces access barrier Women are not more likely to use ECPs repeatedly Advance prescription does not decrease the use of other birth control methods Source: Glasier and Baird, 1998.
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Expanded Access Through Pharmacies in Washington State
2828 Expanded Access Through Pharmacies in Washington State Collaborative drug therapy agreement between pharmacist and independent prescriber Trained pharmacists participating in a collaborative agreement can provide ECPs directly to women who request them Currently over 145 pharmacies participating In first 16 months of project pharmacists wrote and filled almost 12,000 prescriptions for ECPs
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Medicaid Coverage of ECPs
2929 Medicaid Coverage of ECPs Medicaid covers ECP prescriptions Medicaid covers pharmacist counseling time for women who receive ECPs directly from pharmacist Medicaid will also cover advance-of-need prescriptions
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3030 Cost of ECP For prescriptions written by medical providers (MDs, ARNPs, PAs): If covered by insurance: $5-10 co-pay If no insurance coverage: Plan B™: $18-35 Preven™: $20-35 Note: client also must pay for office visit to get prescription For prescription and consultation at pharmacy: Pills and counseling: $35-45 As dedicated products become more widely used, cost may rise slightly: $40-45
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Resources Included in Provider Packet
3131 Resources Included in Provider Packet Q & A for non-clinical providers Key messages to convey to clients EC referral card Emergency Contraception: Client Materials for Diverse Audiences booklet List of pharmacies that provide ECPs in Washington State EC reference list
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EC Materials for Diverse Audiences
3232 EC Materials for Diverse Audiences Provides EC information in 13 languages: Amharic Arabic Cambodian Chinese English Haitian-Creole Korean Laotian Portuguese Russian Somali Spanish Vietnamese
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Clinics and Pharmacies That Provide ECPs in Your Area
3333 Clinics and Pharmacies That Provide ECPs in Your Area EC Hotline 1-888-NOT-2-LATE ( ) EC website Planned Parenthood website Washington State Family Planning Hotline
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How will you emphasize ECPs in your setting?
3434 How will you emphasize ECPs in your setting?
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Tell Your Clients About ECPs by:
3535 Tell Your Clients About ECPs by: Routinely discussing ECPs Making ECP materials available in agency setting Encouraging advance-of need-prescribing
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JWVP15058 (8/24/00)
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