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Increased access to emergency contraception: why it may fail.

Laura Baecher1, Mark A Weaver, Elizabeth G Raymond

  • 1Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7570, Chapel Hill, NC 27514, USA. lbaecher@hotmail.com

Human Reproduction (Oxford, England)
|December 20, 2008
PubMed
Summary
This summary is machine-generated.

Increased emergency contraception (EC) access did not reduce pregnancies because it was more impactful for women at lower risk. Higher-risk women showed less benefit from enhanced EC availability.

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Area of Science:

  • Reproductive Health
  • Clinical Trials
  • Public Health Interventions

Background:

  • A randomized controlled trial investigated why increased access to emergency contraception (EC) did not reduce pregnancy rates.
  • Previous studies suggested broader EC access would decrease unintended pregnancies.

Purpose of the Study:

  • To identify risk factors for unintended pregnancy among women aged 14-24.
  • To examine the impact of increased EC access on pregnancy risk based on baseline risk levels.

Main Methods:

  • Multivariable logistic regression analyzed risk factors for unintended pregnancy in 1490 sexually active women.
  • Predictive modeling generated pregnancy risk scores; EC use was assessed by risk category (low vs. high).

Main Results:

  • Gravidity, recent unprotected sex, and lower pregnancy aversion predicted unintended pregnancy.
  • Women with increased EC access used EC more repeatedly than those with standard access.
  • This increased EC use was more pronounced in lower-risk women (RR 10.0) compared to higher-risk women (RR 5.5).

Conclusions:

  • Increased emergency contraception access demonstrated a greater effect on women with lower baseline pregnancy risk.
  • This differential impact may partially explain the lack of measurable benefit in previous clinical trials of enhanced EC access.