How Frequently is Emergency Contraception Prescribed? (RESEARCH NOTE).

A 1993 survey of 294 reproductive health care providers, family practitioners and emergency room physicians investigated the frequency of prescribing emergency contraception. Hormonal emergency contraception had been prescribed by respondents an average of 3.4 times in the preceding 12 months. Almost one-third of the prescriptions were for rape victims, the majority written by emergency physicians. Fifteen IUD insertions for emergency contraception were performed in the preceding year. Few respondents had ever discussed emergency contraception with patients or had literature available on the topic.

Emergency contraception, also known as "post-coital contraception," is used to prevent a pregnancy after unprotected intercourse. One example of hormonal emergency contraception is the "morning after pill." Not only can emergency contraception be useful in preventing a pregnancy, but it can also be a means for a woman to enter the health care system and obtain a reliable contraceptive method. Emergency contraception is used extensively in some countries. In the United States, however, emergency contraception is believed to be prescribed primarily for rape victims in emergency rooms, and in other limited situations, such as college health centers and family planning clinics.

Two forms of emergency contraception are currently in use. (1) Oral contraceptives can be used in a different dosage than is prescribed for regular use. An alternative form of emergency contraception is the insertion of a copper-containing IUD. Although both methods are of known effectiveness, they may be underutilized by the health care community.

The rate of unintended pregnancy among young women is much higher in the United States than in other developed countries. (2) One possible explanation for this difference is that emergency contraception is seldom prescribed in the United States. This study assesses how frequently emergency contraception is prescribed by a sample of practitioners in the United States.

Methodology

Health care providers who are likely to prescribe emergency contraception were selected from the directories of four professional groups: the Association of Reproductive Health Professionals, the American College of Obstetricians and Gynecologists, the American Board of Family Practice, and the American College of Emergency Physicians. A total of 416 providers were selected--104 members of each organization. Two were chosen from each state, from Washington, D.C., and from Puerto Rico; usually the names chosen were the fifth and 10th listing for that state or geographical area.

In 1993, a letter explaining the survey and a short questionnaire were sent to each provider in the sample. The questionnaire asked for their degree and specialty, whether the provider ever prescribed contraceptives and the extent to which the provider prescribed emergency contraception. If a survey could not be delivered to the original addressee, it was sent to another member of the same organization, usually the next name on the list. If the respondent gave a range when asked for the frequency of prescribing emergency contraception, the largest number was used in tabulating the results.