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Does use of emergency contraception prevent abortion

Can it work? Does it work? Is it worth it?. Can emergency contraception work?. There has never been a placebo controlled trial of emergency contraception . So to assess whether EC works we have to look to trials comparing two methods and calculate the number of pregnancies expected and t

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Does use of emergency contraception prevent abortion

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    1. Does use of emergency contraception prevent abortion? Anna Glasier

    2. Can it work? Does it work? Is it worth it?

    3. Can emergency contraception work?

    4. There has never been a placebo controlled trial of emergency contraception

    5. So to assess whether EC works we have to look to trials comparing two methods and calculate the number of pregnancies expected and the number that actually occur

    6. So to assess whether EC works we have to look to trials comparing two methods and calculate the number of pregnancies expected and the number that actually occur

    13. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis. Glasier et al Lancet 2010;375:555-62.

    14. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis. (Glasier et al Lancet 2010) 2221 women presenting for EC in USA and UK Randomised to LNG (levonelle) or UPA (ellaOne) 1696 took EC within 72 hours When they took EC the date of their LMP was documented, also their normal menstrual cycle length

    15. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis.

    16. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis.

    17. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis.

    18. So in clinical trials comparing two EC methods (LNG and UPA), emergency contraception prevents half to two thirds of expected pregnancies

    19. So in clinical trials comparing two EC methods, emergency contraception prevents half to two thirds of expected pregnancies So yes, in the context of a carefully controlled clinical trial, emergency contraception can work

    20. Can it work? Does it work? Is it worth it?

    21. There cannot be a trial comparing EC with placebo among women who do not want to get pregnant - so is there any indirect evidence that EC prevents unintended pregnancy ?

    22. Emergency contraception: why the absent effect on abortion rates? (Pederson W. Acta Obstet Gynecol Scand ) EC licensed in Norway in 1995 1997 < 5000 courses sold 2000 EC deregulated 2001 almost 70,000 courses sold 2007 >150,000 courses sold A 30 fold increase in EC sales but no change in abortion rates

    23. No reduced number of abortions despite easily available emergency contraceptive pills. Studies of women's knowledge, attitudes and experience of the method. (Tyden et al Lakartidningen 2002)

    24. EC use with time among UK women choosing abortion

    26. But these sorts of studies are very indirect, many factors are involved in changes abortion rates. Is there any more direct evidence?

    27. Studies of advanced provision EC must be used within 72 hours of unprotected sex Much unprotected sex occurs at weekends Until deregulation EC was only available from a doctor GP and FPC often closed at weekends If women had a supply of EC to hand they would be more likely to use it If they used it more often it would reduce abortion

    28. Advanced provision of mifepristone to women after childbirth in Shanghai (Hu et al 2005) 2000 women recruited from hospital Randomised - mifepristone 3 courses at home Four monthly phone follow -up Followed up for one year EC use and use of other methods Pregnancies

    29. EC use at one year

    31. Advance provision of emergency contraception for pregnancy prevention (Polis CB et al Cochrane Database of Systematic Reviews 2007) 11 RCTs 7695 patients in the US, China, India, Sweden. Use of EC increased (single use: doubled; multiple use: quadrupled) EC was used sooner after sex (mean difference -12.98 hours)

    32. Advance provision of emergency contraception for pregnancy prevention (Polis CB et al Cochrane Database of Systematic Reviews 2007) But advance provision did not decrease pregnancy rates (odds ratio (OR) 0.98, 95% confidence interval (CI) 0.76 to 1.25

    34. Can it work? Does it work? Is it worth it?

    36. Has making EC available free of charge from pharmacies throughout Scotland further increased its use?

    37. Sales of LNG emergency contraception in Scotland 07-09

    38. Impact of free emergency contraception from Scottish pharmacies upon use amongst women requesting abortion (Cameron ST et al 2011) 6 weeks in November/December 2010 283 women attending RIE for abortion 250 anonymous questionnaires distributed 204 completed (RR 82%)

    39. Impact of free emergency contraception from Scottish pharmacies upon use amongst women requesting abortion (Cameron ST et al 2011) 122 (60%) had ever used EC 143 (70%) knew about free EC 22 women (11%) used EC to prevent this pregnancy

    40. EC use with time among UK women choosing abortion

    41. Conclusions Can we prevent abortion with emergency contraception? Can it work? – yes (but…)

    42. Can we prevent abortion with emergency contraception? Can it work? – yes (but…) Does it work? – there is no evidence that it can reduce abortion rates

    43. Can we prevent abortion with emergency contraception? Can it work ? – yes (but…) Does it work ? – there is no evidence that it can reduce abortion rates Is it worth it ? – for individual women, of course, but…

    44. Community pharmacists providing emergency contraception give little advice about future contraceptive use: a mystery shopper study (Glasier et al Contraception 2010) EC was offered in 28 (70%) of pharmacies and the service was good Ongoing contraception after EC use was discussed in only 32.5% of all pharmacies and only 43% of those issuing EC And, of course, in none of them was ongoing contraception provided

    45. Can we prevent abortion with emergency contraception? Can it work ? – yes (but…) Does it work ? – there is no evidence that it can reduce abortion rates Is it worth it ? – for individual women, of course, but as a public health intervention perhaps not because emergency contraception has been de-linked from ongoing effective methods

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