title: Advance supply of emergency contraception. effect on use and usual contraception--a randomized trial.
abstract: OBJECTIVE
  To evaluate whether advance provision of emergency contraception increases its use and/or adversely affects usual contraceptive practices.
  
  
  METHODS
  We performed a randomized controlled trial comparing advance provision of emergency contraception with usual care in 370 postpartum women from an inner-city public hospital. Participants were followed for 1 year; 85% were available for at least one follow-up session. All participants received routine contraceptive education. The intervention group received a supply of emergency contraception (eight oral contraceptive pills containing 0.15 mg of levonorgestrel and 30 microg of ethinyl estradiol) and a 5-minute educational session. We compared use of emergency contraception and changes in contraceptive behaviors between groups.
  
  
  RESULTS
  Women provided with pills were four times as likely to have used emergency contraception as women in the control group over the course of the year (17% versus 4%; relative risk [RR] 4.0; 95% confidence interval [CI] 1.8, 9.0). Women were no more likely to have changed to a less effective method of birth control (30% versus 33%; RR 0.92; 95% CI 0.63, 1.3), or to be using contraception less consistently (18% versus 25%; RR 0.74; 95% CI 0.45, 1.2). About half of each group reported at least one episode of unprotected intercourse during follow-up, but women who received emergency contraception were six times as likely to have used it (25% versus 4%; RR 5.8; 95% CI 2.1, 16.4).
  
  
  CONCLUSIONS
  Advance provision of emergency contraception significantly increased use without adversely affecting use of routine contraception. It is safe and appropriate to provide emergency contraception to all postpartum women before discharge from the hospital.
authors.affiliation: Center for Reproductive Health Research and Policy and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA. jacksonr@obgyn.ucsf.edu
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Jackson
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.forename: Lori
authors.initials: L
authors.lastname: Freedman
authors.forename: Philip
authors.initials: P
authors.lastname: Darney
mesh_terms: D000328:Adult; D002140:California; D016001:Confidence Intervals; D003267:Contraception / Q000379:methods*; D003276:Contraceptives, Oral / Q000008:administration & dosage; D003281:Contraceptives, Postcoital / Q000008:administration & dosage* / Q000600:supply & distribution*; D004630:Emergencies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011247:Pregnancy / Q000706:statistics & numerical data*; D011275:Pregnancy, Unwanted; D012016:Reference Values
chemical_list: D003276:Contraceptives, Oral; D003281:Contraceptives, Postcoital