Emergency contraception: Advance provision in a young, high-risk clinic population

Objective: To assess whether advance provision of emergency contraception i ncreases its use and whether it has secondary effects on regular contracept ive use. Methods: We conducted a controlled trial of female clients, aged 16-24 year s, who attended a publicly funded family planning clinic. Women were system atically assigned to receive an advance provision of emergency contraceptio n and education (treatment) or education only (control). Among 263 particip ants enrolled (133 treatment, 130 control), follow-up was completed in 213 (111 treatment, 102 control). The main outcome measures were emergency cont raception knowledge and use, frequency of unprotected sex, and pattern of c ontraceptive use in the past 4 months. Results: Participants were aware of emergency contraception at follow-up, b ut the treatment group was three times as likely to use it (P =.006). Altho ugh the treatment group did not report higher frequencies of unprotected se x than the control group, women in the treatment group (28%) were more like ly than those in the control group (17%) to report using less effective con traception at follow-up compared with enrollment (P =.05). The proportion o f women in both groups who reported consistent pill use increased from enro llment to follow-up (34% versus 45%); however, the control group (58%) was more likely than the treatment group (32%) to report consistent pill use at follow-up (P =.03). Conclusion: Use of emergency contraception was increased by providing it in advance, but not by education alone. Changes to less effective contracepti ve methods and patterns of pill use were potentially negative effects that need to be explored in relation to observed benefits. (Obstet Gynecol 2000; 96:1-7. (C) 2000 by The American College of Obstetricians and Gynecologists .).