Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1448 (doi:10.1542/peds.2005-2491)
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Emergency Contraception

Joseph B. Stanford, MD, MSPH
Department of Family and Preventive Medicine
University of Utah
Salt Lake City, UT 84108

Rafael T. Mikolajczyk, MD
Department of Public Health Medicine
School of Public Health
University of Bielefeld
D-33501 Bielefeld, Germany

To the Editor.—

The American Academy of Pediatrics Committee on Adolescence policy statement on emergency contraception1 reports the effectiveness of the Yuzpe regimen (ethinyl estradiol and levonorgestrel) in terms of a pregnancy reduction of 70% to 80% and of levonorgestrel-only emergency contraception of 85%. These estimates are outdated. Using current methods for estimating effectiveness, the effectiveness rates seem to be in the range of 50% to 66% and 72% to 80%, respectively.2–5 Because there are no randomized trials with a placebo arm, considerable uncertainty remains about the effectiveness of emergency contraception.3,5

The policy statement also proposes that "[e]mergency contraception has tremendous potential to reduce unintended pregnancy rates in teens and adults." This statement remains, as yet, a hypothesis that is unsupported by empirical evidence. Several studies have failed to document a decrease in rates of unintended pregnancy or abortion in populations that are provided with advance access to emergency contraception.6–8 This suggests that the studies that have demonstrated no changes in sexual behavior with advance access (other than increased use of emergency contraception) have used inadequate surrogate end points or have failed to detect small changes in sexual behavior that were nevertheless sufficient to negate any decrease in unintended pregnancy.

REFERENCES

  1. American Academy of Pediatrics, Committee on Adolescence. Emergency contraception. Pediatrics. 2005;116 :1026 –1035[Abstract/Free Full Text]
  2. Trussell J, Ellertson C, von Hertzen H, et al. Estimating the effectiveness of emergency contraceptive pills. Contraception. 2003;67 :259 –265[Medline]
  3. Raymond E, Taylor D, Trussell J, Steiner MJ. Minimum effectiveness of the levonorgestrel regimen of emergency contraception. Contraception. 2004;69 :79 –81[Medline]
  4. Mikolajczyk RT, Stanford JB. A new method for estimating the effectiveness of emergency contraception that accounts for variation in timing of ovulation and previous cycle length. Fertil Steril. 2005;83 :1764 –1770[CrossRef][ISI][Medline]
  5. Stanford JB, Mikolajczyk RT. Methodologic review of the effectiveness of emergency contraception. Curr Womens Health Rev. 2005;1 :119 –129[CrossRef]
  6. Hu X, Cheng L, Hua X, Glasier A. Advanced provision of emergency contraception to postnatal women in China makes no difference in abortion rates: a randomized controlled trial. Contraception. 2005;72 :111 –116[CrossRef][ISI][Medline]
  7. Glasier A, Fairhurst K, Wyke S, et al. Advanced provision of emergency contraception does not reduce abortion rates. Contraception. 2004;69 :361 –366[CrossRef][ISI][Medline]
  8. Raine TR, Harper CC, Rocca CH, et al. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial. JAMA. 2005;293 :54 –62[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

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Emergency Contraception: In Reply
Jonathan Klein
Pediatrics 2006 117: 1450. [Extract] [Full Text]  




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