Advance provision of emergency contraception for pregnancy prevention: a meta-analysis.
OBJECTIVE
Advance provision of emergency contraception can circumvent some obstacles to timely use. We performed a meta-analysis to summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors.


METHODS
In August 2006, we searched CENTRAL, EMBASE, POPLINE, MEDLINE, a specialized emergency contraception article database, and contacted experts to identify published or unpublished trials.


METHODS
We included randomized controlled trials comparing advance provision to standard access, defined as any of the following: counseling (with or without information about emergency contraception) or provision of emergency contraception on request at a clinic or pharmacy.


RESULTS
Two reviewers independently assessed study quality. We performed a meta-analysis using Review Manager software. Eight randomized controlled trials met inclusion criteria, representing 6,389 patients in the United States, China, and India. Advance provision did not decrease pregnancy rates, despite increased use (single use, odds ratio [OR] 2.52, 95% confidence interval [CI] 1.72-3.70; multiple use: OR 4.13, 95% CI 1.77-9.63) and faster use (weighted mean difference -14.6 hours, 95% CI -16.77 to -12.4 hours). Advance provision did not increase rates of sexually transmitted infections (OR 0.99, 95% CI 0.73-1.34), unprotected intercourse, or changes in contraceptive methods. Women who received emergency contraception in advance were as likely to use condoms as other women.


CONCLUSIONS
Advance provision of emergency contraception did not reduce pregnancy rates and did not negatively affect sexual and reproductive health behaviors and outcomes compared with conventional provision.


METHODS
III.
Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21202, USA. cpolis@jhsph.edu
Chelsea B
CB
Polis
Kate
K
Schaffer
Kelly
K
Blanchard
Anna
A
Glasier
Cynthia C
CC
Harper
David A
DA
Grimes
D044363:Contraception, Postcoital / Q000379:methods*; D003281:Contraceptives, Postcoital / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016017:Odds Ratio; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic; D012646:Self Administration; D016896:Treatment Outcome
D003281:Contraceptives, Postcoital