Emergency contraception: lack of awareness among patients presenting for pregnancy termination

Emergency contraception, otherwise known as postcoital contraception, refers to a group of birth control modalities that, when used after unprotected intercourse within defined time constraints, can markedly reduce the risk of a resultant unintended pregnancy. The English literature, using British and American awareness data, consistently claims that these contraceptive options are underutilized in the United States because of a lack of patient and physician awareness of their existence. The objective of this study was to determine the level of awareness of postcoital contraceptive techniques in a population of American women who were presenting for pregnancy termination. The secondary goal was to calculate (theoretically) how many of these surgical terminations could have been prevented through the use of postcoital contraception.

A questionnaire was administered to patients presenting to an abortion clinic. It was intended to anonymously identify patient demographics and knowledge of the various emergency contraceptive options and, in hindsight, to determine what percentage of these women would have been willing candidates for one of these medical modalities. On completing the questionnaire, all patients received an emergency contraceptive information sheet for future consideration.

Eighty-three patients completed the study. They ranged in age from 15 to 44 years (mean, 24 years). Forty-six percent of the patients were 21 years of age or younger. A total of 71% of all patients had no real knowledge of the existence of emergency contraceptive options; 26% had some limited knowledge, and only 3% had somewhat complete and valuable information. Fifty-one percent of the patients would have been appropriate, realistic, and willing candidates for at least the emergency contraceptive pill. Assuming at least a 75% effectiveness rate for the emergency contraceptive pill, 38% of the surgical pregnancy terminations performed on this population of women could have been avoided.

Our data confirm that emergency contraceptive options are underutilized because of a lack of patient awareness. Contraception education, especially directed toward adolescents, should include disseminating enhanced information about postcoital contraception options.