A comparative analysis of regulated vs. deregulated emergency contraception
Alicia Nguyen, PA-S and Patricia Bunton, MS, PA-C
Department of Physician Assistant
College of Health Professions, Wichita State University
INTRODUCTION
The United States holds the highest rate for
unplanned teen pregnancies among all
developed countries in the world. It is apparent
that abstinence and the utilization of
contraceptives are vital in the reduction of
these numbers.
Among all methods of
contraception, accessibility to emergency
contraception (EC) has been problematic, as
has education regarding its proper utilization.
Central arguments that have prevented
deregulation of EC include concern that
improved access would compromise routine
contraceptive use and increase the incidence
of risky behavior and/or sexually transmitted
diseases. Methods that would constitute as
deregulation or increased access of EC would
include direct supply by pharmacies or
emergency departments, advanced provision
of emergency contraception (AEC) by health
professionals and dispensing of EC over-thecounter (OTC).
METHODS
This was an evidenced-based medicine
literature review using
Medline and
included articles from 1998 to the present.
Peer-reviewed articles were chosen based
on the requirement that each article was to
be retrospective, a randomized controlled
trial, cohort, actual use study or a literature
review. The following key terms were used:
emergency contraception, EC, Plan B,
levonorgestrel, advanced provision, OTC,
over-the-counter, deregulation, regulation,
prescription. Twenty-six articles met the
criteria.
RESULTS
DISCUSSION
Eight of 12 studies showed that most
patients used EC correctly and had a good
understanding of the mechanism of
action, the therapeutic uses and/or its
adverse effects.
This evidence-based review supports
findings of other studies. It is interesting to
note that although AEC allowed for earlier
and more timely access to EC, those who
had AEC were not using it when it was
indicated because they did not believe they
were at an increased risk of pregnancy.
Future comparison studies of the risks and
benefits of EC need to include OTC and
pharmacy access, as well as AEC, to
evaluate patient behavior when there are
various deregulated routes of EC access.
•
• Four studies indicated pregnancy rates
in treatment groups were higher than
expected. Despite improved access and
an increase in EC usage, EC is still
underused.
• One study showed that increased
access to EC negatively affected the use
of routine contraception.
•Two studies showed that, although AEC
led to a higher likelihood of timely use
compared to obtaining EC through clinic
access, those who received AEC had
higher rates of unprotected sex. Other
studies have indicated that risky behavior
is not associated with increased EC
availability.
CONCLUSIONS
This review found
no evidence to
indicate that regulated access to EC is
more advantageous than deregulated.
Deregulation and increased accessibility
to EC leads to increased usage, promotes
timely access, does not compromise
routine use of contraceptives and is safe
enough to be dispensed OTC or in
advanced provisions. Of all deregulated
methods of EC, AEC proves to be the
best route to EC access. Women need to
be educated on reproduction and fertility
risks so they understand the need and
importance of EC availability and usage.