Sex!Life! - Keeping track (What's New)

Keeping track (What's New)

Important Information about Emergency Contraception

SH&FPA POSITION STATEMENT ON EMERGENCY CONTRACEPTION

Emergency contraception is under-utilised in Australia and has the potential to significantly reduce the incidence of abortion. SH&FPA supports universal access to emergency contraception, in recognition of the human right to free and informed choice regarding sexual health. SH&FPA recognises the urgency of the need for access to emergency contraception particularly in communities where there are high rates of teenage pregnancy and unplanned pregnancy due to sexual violence; SH&FPA also recognises that trauma can be reduced by the prevention of pregnancy in victims of rape. SH&FPA supports the principle of equity of access whereby people in developing countries are entitled to the same reproductive health care as people in Australia

SH&FPA supports the following recommendations of the World Health Organisation, International Planned Parenthood Federation and Family Health International

prompt and easy access to emergency contraception is crucial to its effective use
government and non government organisations should include emergency contraceptives in all Family Planning Programs and on all national essential drug lists
all women seeking contraception from health providers should be informed of emergency contraception
drug regulatory authorities should require explicit descriptions of emergency use in the labelling of oral contraceptives and copper IUDs that can be used for emergency contraception

SH&FPA notes the approval by the Therapeutic Goods Administration, of the levonorgestrel method of emergency contraception for prescription by medical practitioners in Australia.

SH&FPA recognises the need for ongoing educational and promotional strategies to ensure greater public awareness and use of emergency contraception
SH&FPA supports the levonorgestrel emergency contraceptive being made available through the Pharmaceutical Benefits Scheme.
SH&FPA, considering the efficacy and safety of the method, supports it being available from specifically trained pharmacists and nurses without a prescription. The medication should be supplied with dosage, expected and side effect information and advice regarding links to services for ongoing contraception and sexually transmitted infection screening.

Further Information about Emergency Contraception

Definition

The emergency contraceptive pill is a dose of female hormones. There are three methods but in Australia the 'progesterone only' method is mainly used:
1) The 'progesterone only' method:
Two pills containing Levonorgestrel are taken, which is similar to taking a large quantity of the levonorgestrel containing mini-pill
2) The combined pill or Yuzpe method containing oestrogen and progesterone:
This has been available for decades and is a high dose of "the (combined) pill". It is not used very often now that the progesterone only method is available.
3) IUD insertion:
It is only used as emergency contraception in special circumstances because usually it is used as a long-term method of contraception. Also, it may not be suitable for some women.

Emergency contraception should be taken within 72 hours of unprotected intercourse (sex). However, it can be taken up to 120 hours after unprotected intercourse, but it is probably less effective after 72 hours. It will not cover any pregnancy risk that may have pccurred earlier in the cycle.

The TGA has given approval for Postinor 2 to be sold by a pharmacist without a prescription.

Who

In 1999 levonorgestrel 750mg was added to the list of WHO essential drugs defined as “those that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in the appropriate dosage forms, and at a price that individuals and the community can afford (WHO Expert Committee on the Use of Essential Drugs, 1999)”.

Australian Fertility Data

In 1999 the Australian fertility rate for women aged 15-19 years was 18.1 births per 1,000. This compares well with some other developed countries such as Canada, UK and USA that respectively have birth-rates of 20.2 29.7 and 51.1 per 1,000 women aged 15-19 years [1], but compares poorly with the 1995 figures for France, Netherlands and Switzerland of , 9, 6 and 7 births per 1,000 women aged 15-19 years, respectively [2]. Teenage pregnancy in Australia is under represented by the birth rate as the 3 states and territories that collect abortion data, South Australia, Western Australia and Northern Territory have a teenage pregnancy rates of 44.4, 44.6 and 100.0 pregnancies per 1,000 women aged 15-19 respectively. [1]

Overseas experience

France, UK, New Zealand, some American states and Canadian provinces have non-prescription emergency contraception, as do Portugal, Sweden, Belgium, Denmark, South Africa and African French speaking countries. In Norway EC is available without seeing a pharmacist or a doctor. In none of the countries have there been any significant medical problems reported subsequent to increased availability.

Role of the Pharmacist

The role of pharmacist training has been positively evaluated in the UK [3] and has been used as template for training in Australia.

Concerns around potential for abuse

Concerns on the potential for abuse of emergency contraception are addressed in many studies. In a landmark Scottish study women were randomised into groups to be either given information about EC (emergency contraception), or be given the same information and provided with EC to use in the event of unprotected sex. Those assigned to the later used EC correctly, were not more likely to use it repeatedly and used other methods of contraception similarly to the comparative group [4].

Side effects and contraindications

There are no evidence-based contra-indications to LEC and the World Health Organisation gives no absolute contraindications to LEC use except pregnancy [5]. There have been no definite serious side effects associated with levonorgestrel emergency contraception use.

There is no definitive information on the outcomes of pregnancies after failed LEC. There is reassurance from the absence of an increased risk of congenital abnormalities in women who have continued to inadvertently take the combined oral contraceptive pill whilst pregnant [6].

Concerns on the potential for abuse of emergency contraception are addressed in many studies. In a landmark Scottish study women were randomised into groups to be either given information about EC, or be given the same information and provided with EC to use in the event of unprotected sex. Those assigned to the later used EC correctly, were not more likely to use it repeatedly and used other methods of contraception similarly to the comparative group [4].

References

1. Ford J, N.N., Sullivan EA, Chambers G &Lancaster P, Reproductove health indicators Australia 2002. 2003, AIHW NPSU: Canberra.
2. US Burea of the Census: International Data Base. 1995.
3. Bacon, L., et al., Training and supporting pharmacists to supply progestogen-only emergency contraception. J Fam Plann Reprod Health Care, 2003. 29(2): p. 17-22.
4. Glasier, A. and D. Baird, The effects of self-administering emergency contraception. N Engl J Med, 1998. 339(1): p. 1-4.
5. Improving Access to qualtiy care in Family Planning. 2000, World Health Organisation: Geneva.
6. Bracken, M.B., Oral contraception and congenital malformations in offspring: a review and meta-analysis of the prospective studies. Obstet Gynecol, 1990. 76(3 Pt 2): p. 552-7.