AAP supports emergency contraception for teens

October 2005

In a new policy statement, “Emergency Contraception,” the AAP supports the availability of emergency contraception for adolescents and encourages abstinence combined with comprehensive sexual education as the best way to help prevent unintended pregnancies and sexually transmitted diseases (STDs).

“Emergency contraception has the potential to significantly reduce teen pregnancy rates,” the Committee on Adolescence wrote in the policy. “The AAP continues to support improved availability of emergency contraception to teens and young adults, including over-the-counter access and limiting the barriers to access placed by some health care providers and venues.”

Improving the knowledge, accessibility and availability of contraceptive services may help to reduce unplanned pregnancies among teenagers and young adults. Ensuring access to contraception with appropriate education on proper use and indications of the various methods are essential components to comprehensive sex education for sexually active teenagers and young adults.

The focus of the policy statement is to provide pediatricians with information about emergency contraceptives, so that they can better inform patients about their use, the AAP statement suggested.

The statement provided a review of emergency contraception, available formulations, potential adverse events, efficacy, use and contraindications. It also included adolescents and young adults’ reported knowledge and attitudes about access and availability to hormonal emergency contraception.

Statement summarized

Although the adolescent birth rate has declined in the past 10 years, seventy-four percent to 95% of U.S. pregnancies among 15- to 19-year olds are unintended, according to the statement. Since 1990, the birth rate among this group has declined by 28% to a low of 43 per 1,000 in 2002; however, the nation’s rate is still two to 10 times higher than other developed countries.

“Reduction of unintended pregnancy is best achieved by strategies that include developing and implementing effective programs to delay and reduce sexual activity, increasing the use of effective contraceptives and improving knowledge about the correct use of different contraceptive methods,” the committee wrote.

Proper use of emergency contraception has the potential to significantly reduce pregnancy rates, which will similarly reduce the abortion rate. Products dedicated as emergency contraceptives have been available by prescription since 1998. Use of multiple doses of oral contraceptives was first described in literature in the 1970s.

The AAP noted that an increase in awareness and availability of emergency contraception to teenagers does not change the reported rate of sexual activity or increase the frequency of unprotected intercourse among teenagers.

Emergency contraception is the use of hormonal medications within 72 to 120 hours after unprotected or inadequately protected sexual intercourse for the prevention of unintended pregnancy.

The policy recommends that physicians address emergency contraception when they discuss sexuality issues with all young adult patients during annual preventive health care visits. Currently, only 20% to 25% of health care providers discuss emergency contraception with their patients.

Preven and Plan B

The policy statement noted that the two FDA-approved medications, Preven (Gynetics) and Plan B (Barr Pharmaceuticals), are safe and effective for adolescent use.

The FDA approved Preven, the combination of estrogen (ethinyl estradiol) and progestin (levonorgestrel) emergency contraception, in 1998.

A year later, the FDA approved Plan B, made of levonorgestrel. Plan B, the progestin-only method, Preven, is more effective and better tolerated than the combined hormone method, and it is the first choice of dedicated products for emergency contraception. Emergency contraception adverse events are few. Preven, effectively off the market since this past year, is gradually but completely being replaced in stock by Plan B in pharmacies.

The committee advised that patients who use emergency contraception should see their physician for identification of a more dependable contraceptive method and testing for STDs. That visit should also include the discussion of abstinence as a strategy for decreasing the risk of unwanted pregnancy and avoiding STDs.

For more information:

• For more information visit the AAP’s Web site at www.aap.org.
• Committee on Adolescence. Emergency contraception. Pediatrics. 2005;116:1038-1047.