Choice of Emergency Contraceptive and Decision Making Regarding Subsequent Unintended Pregnancy

Abstract

Objectives: To prospectively evaluate (1) pregnancy desirability, (2) stated intentions should pregnancy occur among emergency contraception (EC) users, and (3) explore differences between women selecting the copper T380 intrauterine device (Cu IUD) or oral levonorgestrel (LNG) regarding hypothetical pregnancy plans and actual pregnancy actions during subsequent unintended pregnancies.

Study design: In this prospective observational trial, women received the Cu IUD or oral LNG for EC without cost barriers. At baseline, participants completed a visual analogue scale measuring pregnancy desirability (anchors: 0, "trying hard not to get pregnant"; 10, "trying hard to get pregnant") and self-reported plans (abortion, adoption, parenting, and unsure) if the pregnancy test were to come back positive. Pregnancies were tracked for 12 months, and actions regarding unintended pregnancies were compared between EC method groups.

Results: Of 548 enrolled women, 218 chose the Cu IUD and 330 the oral LNG for EC. Pregnancy desirability at baseline was low, with no difference between EC groups (IUD group: 0.51, SD ± 1.60; LNG group: 0.68, SD ± 1.74). Fifty-four (10%) women experienced unintended pregnancies. Pregnancy plans from baseline changed for 27 (50%) women when they became pregnant. EC groups did not differ in hypothetical pregnancy intention (p = 0.15) or in agreement of hypothetical pregnancy intention with actual pregnancy action (p = 0.80).

Conclusions: Women presenting for EC state high desire to prevent pregnancy regardless of method selected. When considering a hypothetical pregnancy, half of women had a plan for how they would respond to that situation, but when confronting an actual unintended pregnancy, half altered their plan.

Clinical trial registration number: Clinicaltrials.gov identifier NCT00966771.

Keywords: emergency contraception; pregnancy intentions; unintended pregnancy.

FIG. 1.

Study flowchart. There were 14 pregnancies overall in the Cu IUD intention-to-treat group and 40 pregnancies in the oral LNG intention-to-treat group. There were 9 pregnancies overall among women who actually received IUDs (i.e., had successful insertions) and 45 pregnancies among women who received oral LNG (i.e., LNG intention-to-treat plus failed IUD insertions). Cu IUD, copper T380 intrauterine device; LNG, levonorgestrel.

FIG. 2.

Pregnancy intention versus action by EC selection group Baseline pregnancy intention and action during subsequent unintended pregnancy for patients initially selecting the Cu IUD (n = 14) or oral LNG (n = 40). Percentages are within intention and arrows are weighted to reflect proportions of patients with given action. For example, of the individuals who selected an IUD and were unsure of what they would do if pregnant at baseline, 50% parented and 50% aborted at time of subsequent pregnancy. EC, emergency contraception.