Emergency contraception, efficacy and public health impact.
OBJECTIVE
Emergency contraception in the past two decades had been proven to be effective and well tolerated. Counseling and advance provision and prescription of emergency contraception have been embraced by professional organizations in practice guidelines for its potential to reduce the number of unintended pregnancies and abortions. Has emergency contraception lived up to that promise?


RESULTS
Mifepristone (not available in the USA) is the agent of choice. Emergency contraception has not reduced the number of unintended pregnancies. Acceptance by healthcare providers and the public has not been optimal, and multiple financial and healthcare system barriers to use emergency contraception continue to exist. The public health impact of emergency contraception has been disappointing.


CONCLUSIONS
Although emergency contraception may continue to be an important component of contraceptive practice, only increased access to more effective methods of contraception will change unintended pregnancy rates. The use of mifepristone for emergency contraception in the USA must be considered.
Broekhuizen
Fredrik F
FF
Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA. fbroekhu@mcw.edu
D044363:Contraception, Postcoital / Q000706:statistics & numerical data*; D003283:Contraceptives, Postcoital, Synthetic / Q000627:therapeutic use*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015735:Mifepristone / Q000627:therapeutic use*; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D011634:Public Health; D016896:Treatment Outcome; D014481:United States
D003283:Contraceptives, Postcoital, Synthetic; D015735:Mifepristone