Reproductive health outcomes of insured adolescent and adult women who access oral levonorgestrel emergency contraception.
OBJECTIVE
To assess the level of risk for adolescents and women who seek emergency contraception through various clinical routes and the opportunities for improved care provision.


METHODS
This study looked at a retrospective cohort to assess contraception and other reproductive health outcomes among adolescents and women aged 15-44 years who accessed oral levonorgestrel emergency contraception through an office visit or the call center at Kaiser Permanente Northern California from 2010 to 2011.


RESULTS
Of 21,421 prescriptions, 14,531 (67.8%) were accessed through the call center. In the subsequent 12 months, 12,127 (56.6%) adolescents and women had short-acting contraception (pills, patches, rings, depot medroxyprogesterone) dispensed and 2,264 (10.6%) initiated very effective contraception (intrauterine contraception, implants, sterilization). Initiation of very effective contraception was similar for adolescents and women who accessed it through the call center-1,569 (10.8%) and office visits-695 (10.1%) (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 0.93-1.13). In the subsequent 6 months, 2,056 (9.6%) adolescents and women became pregnant. Adolescents and women who accessed emergency contraception through the call center were less likely to become pregnant within 3 months of accessing emergency contraception than woman who accessed it through office visits (adjusted OR 0.82, 95% CI 0.72-0.94); however, they were more likely to become pregnant within 4-6 months (adjusted OR 1.37, 95% CI 1.16-1.60). Among adolescents and women who were tested for chlamydia and gonorrhea, 689 (7.8%) and 928 (7.9%) were positive in the 12 months before and after accessing emergency contraception, respectively.


CONCLUSIONS
Protocols to routinely address unmet needs for contraception at every call for emergency contraception and all office visits, including visits with primary care providers, should be investigated.
Division of Research and Regional Women's Health, Kaiser Permanente Northern California, Oakland, and the Department of Obstetrics and Gynecology, the Permanente Medical Group, Oakland and Vallejo, California.
Tina
T
Raine-Bennett
Maqdooda
M
Merchant
Fiona
F
Sinclair
Justine W
JW
Lee
Nancy
N
Goler
D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D002690:Chlamydia Infections / Q000453:epidemiology; D003268:Contraception Behavior / Q000706:statistics & numerical data; D044363:Contraception, Postcoital / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000627:therapeutic use*; D003280:Contraceptives, Oral, Synthetic / Q000008:administration & dosage; D004343:Drug Implants / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D016912:Levonorgestrel / Q000008:administration & dosage; D009819:Office Visits / Q000706:statistics & numerical data*; D011247:Pregnancy; D018873:Pregnancy Rate; D060728:Reproductive Health; D012189:Retrospective Studies; D013689:Telephone / Q000706:statistics & numerical data*; D055815:Young Adult
D003271:Contraceptive Agents, Female; D003280:Contraceptives, Oral, Synthetic; D004343:Drug Implants; D016912:Levonorgestrel