title: Routine counseling about intrauterine contraception for women seeking emergency contraception.
abstract: OBJECTIVE
  To compare contraceptive knowledge and use among women seeking emergency contraception (EC) before and after an inner-city clinic began providing structured counseling and offering same-day intrauterine device (IUD) or implant placement to all women seeking EC.
  
  
  METHODS
  For 8 months before and 21 months after this change in clinic policy, women aged 15-45 who wanted to avoid pregnancy for at least 6 months were asked to complete surveys immediately, 3 and 12 months after their clinic visit. In addition, we abstracted electronic medical record (EMR) data on all women who sought EC (n=328) during this period. We used chi-squared tests to assess pre/post differences in survey and EMR data.
  
  
  RESULTS
  Surveys were completed by 186 women. After the clinic began offering structured counseling, more women had accurate knowledge of the effectiveness of IUDs, immediately and 3 months after their clinic visit. In addition, more women initiated IUD or implant use (survey: 40% vs. 17% preintervention, p=0.04; EMR: 22% vs. 10% preintervention, p=0.01), and fewer had no contraceptive use (survey: 3% vs. 17% preintervention, p<0.01; EMR: 32% vs. 68%, p<0.01) in the 3 months after seeking EC. EMR data indicate that when same-day placement was offered, 11.0% of women received a same-day IUD. Of those who received a same-day IUD, 88% (23/26) reported IUD use at 3-months and 80% (12/15) at 12 months.
  
  
  CONCLUSIONS
  Routine provision of structured counseling with the offer of same-day IUD placement increases knowledge and use of IUDs 3 months after women seek EC.
  
  
  CONCLUSIONS
  Women seeking EC from family planning clinics should be offered counseling about highly effective reversible contraceptives with the option of same-day contraceptive placement.
authors.affiliation: University of Pittsburgh, Department of Medicine; University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology; University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences. Electronic address: schwarzeb@upmc.edu.
authors.forename: E Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.affiliation: University of Pittsburgh, Department of Medicine.
authors.forename: Melissa
authors.initials: M
authors.lastname: Papic
authors.affiliation: University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Parisi
authors.affiliation: University of Pittsburgh, Department of Medicine.
authors.forename: Erin
authors.initials: E
authors.lastname: Baldauf
authors.affiliation: University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rapkin
authors.affiliation: University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences.
authors.forename: Glenn
authors.initials: G
authors.lastname: Updike
mesh_terms: D000293:Adolescent; D044363:Contraception, Postcoital; D003376:Counseling; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D008875:Middle Aged; D055815:Young Adult
keywords: Contraceptive counseling; Copper IUD; Emergency contraception; Intrauterine contraception; Same day; Title X