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Meta-Analysis
. 2007 Apr 18;2007(2):CD005497.
doi: 10.1002/14651858.CD005497.pub2.

Advance provision of emergency contraception for pregnancy prevention (full review)

C B Polis  1 , K Schaffer, K Blanchard, A Glasier, C C Harper, D A Grimes
Affiliations
Meta-Analysis

Advance provision of emergency contraception for pregnancy prevention (full review)

C B Polis et al. Cochrane Database Syst Rev. .

Abstract

Background: Emergency contraception can prevent pregnancy when taken after unprotected intercourse. Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision, in which women receive a supply of emergency contraception before unprotected sex, could circumvent some obstacles to timely use.

Objectives: 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.

Search strategy: In August 2006, we searched CENTRAL, EMBASE, POPLINE, MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials.

Selection criteria: We included randomized controlled trials comparing advance provision and standard access, which was defined as any of the following: counseling which may or may not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy.

Data collection and analysis: We evaluated all identified titles and abstracts found for potential inclusion. Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 4.2.8. We calculated odds ratios with 95% confidence intervals for dichotomous data and weighted mean differences with 95% confidence intervals for continuous data.

Main results: Eight randomized controlled trials met our criteria for inclusion, representing 6389 patients in the United States, China and India. Advance provision did not decrease pregnancy rates (OR 1.0; 95% CI: 0.78 to 1.29 in studies for which we included twelve month follow-up data; OR 0.91; 95% CI: 0.69 to 1.19 in studies for which we included six month follow-up data; OR 0.49; 95% CI: 0.09 to 2.74 in a study with three month follow up data), despite increased use (single use: OR 2.52; 95% CI 1.72 to 3.70; multiple use: OR 4.13; 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -14.6 hours; 95% CI -16.77 to -12.4 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 0.99; 95% CI 0.73 to 1.34), increased frequency of unprotected intercourse, nor changes in contraceptive methods. Women who received emergency contraception in advance were equally as likely to use condoms as other women.

Authors' conclusions: Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy. However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.

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Conflict of interest statement

Two review co‐authors were also co‐authors of included studies (Cynthia Harper: Raine 2005, and Anna Glasier: Lo 2004 and Hu 2005).

Figures

1.1
1.1. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 1 Pregnancy (at twelve‐month follow‐up).
1.2
1.2. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 2 Pregnancy (at seven‐month follow‐up).
1.3
1.3. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 3 Pregnancy (at six‐month follow‐up).
1.4
1.4. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 4 Pregnancy (at three‐month follow‐up).
1.5
1.5. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 5 Pregnancy for levonorgestrel regimens only.
1.6
1.6. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 6 Pregnancy for Yuzpe regimens only.
1.7
1.7. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 7 Pregnancy for mifepristone regimens only.
1.8
1.8. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 8 Pregnancy for levonorgestrel or Yuzpe regimens.
1.9
1.9. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 9 Sexually transmitted infections.
1.10
1.10. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 10 Ever use of emergency contraceptives during trial.
1.11
1.11. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 11 Multiple uses of emergency contraceptives during trial.
1.12
1.12. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 12 Mean time interval between unprotected intercourse and use of emergency contraception.
1.13
1.13. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 13 Ever unprotected intercourse in past two weeks.
1.14
1.14. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 14 Ever unprotected intercourse in past month.
1.15
1.15. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 15 Ever unprotected intercourse in past three months.
1.16
1.16. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 16 Ever unprotected intercourse in past six months.
1.17
1.17. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 17 Condom use at 12 months.
1.18
1.18. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 18 Condom use at 6 months.
1.19
1.19. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 19 Condom use at 3 months.
1.20
1.20. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 20 Condom use in last month.
1.21
1.21. Analysis
Comparison 1 Advance provision vs. standard provision of emergency contraception, Outcome 21 Condom use at last sex.
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References

References to studies included in this review

Belzer 2005 {published data only}
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Blanchard 2003 {published data only}
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Polis 2007
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