Oral and IUD emergency contraception provision

Although the survey in the journal Contraception revealed that 84% of respondents made available at least one form of emergency contraception, only 18% offer oral ulipristal acetate 30 mg and 29% a copper IUD.

“This study gives us a good picture of ob/gyn practices regarding emergency contraception, in particular about the use of the copper IUD, and highlights areas for improvement,” said principal investigator Daniel Grossman, MD, a professor of ob/gyn and reproductive sciences at the University of California, San Francisco.

Daniel Grossman, MD

The survey targeted fellows and junior fellows of the American College of Obstetricians and Gynecologists (ACOG) between August 2016 and March 2017. The final sample was 1,280 respondents, for a 52.2% response rate.¹

In total, 80.4% of respondents reported offering patients levonorgestrel 1.5 mg, while 30.5% reported offering combined hormonal contraceptive pills specifically for emergency contraception.

Only 5.4% reported not offering any form of emergency contraception and 11.3% reported not seeing patients for emergency contraception or referring them elsewhere.

The three major reasons for not recommending a copper IUD for emergency contraception were that it was rare for a patient to come to the office seeking emergency contraception (52.4%), lack of patient interest and/or request (33.7%), and that the practice did not stock copper IUDs on site (27.8%).

Expense, inadequate insurance reimbursement, and concern that the IUD acts as an abortifacient were also cited as reasons not to recommend a copper IUD.

Among respondents who reported offering copper IUDs for emergency contraception, only 56.8% reported recommending it for emergency contraception in the past 12 months; 52.3% reported recommending it 10 times or less in the past year and 4.6% reported recommending it 11 times or more in the past year.

Moreover, only 30.3% of practitioners who offered copper IUDs for emergency contraception reported placing one in the prior 12 months, 22.7% reported placing a copper IUD once or twice in the past year, and 7.6% reported placing one three or more times in the past year.

“I was surprised that practices are still lagging behind the evidence that ulipristal acetate and the copper IUD are the two most effective forms of emergency contraception,” Grossman told Contemporary Ob/GYN. “I was also surprised that almost a third of ob/gyns still offer combined oral contraceptives for emergency contraception, which are no longer recommended by ACOG.”

The barriers to offering the copper IUD for emergency contraception include the patient lacking information about the option and the physician not stocking the IUD on site. “The former could be addressed by patient education, while the latter could be addressed by training,” Grossman said.

ACOG operates the Long-Acting Reversible Contraception (LARC) Program Help Desk to assist with both clinical and billing/reimbursement questions.

Grossman said ob/gyns should educate their patients about all of the options for emergency contraception and address the barriers in their practices and communities to offering ulipristal acetate and the copper IUD. “For example, if few pharmacies stock ulipristal acetate, clinicians should consider prescribing the medication in advance because patients may face delays in filling the prescription,” he said. “That way, they will have the medication on hand, if and when they need it.”

Even though levonorgestrel emergency contraception is available over the counter, “ob/gyns and other women’s health clinicians play an important role in ensuring access to the most effective emergency contraception methods, as well as providing ongoing contraception to those who want it,” Grossman said.

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Disclosure
Dr. Grossman reports no relevant financial disclosures.

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Reference

1. Castleberry NM, Stark L, Schulkin J, et al. Oral and IUD emergency contraception provision among a national sample of obstetrician-gynecologists. Contraception. Published online September 6, 2020. doi:10.1016/j.contraception.2020.08.013