Having Plan B pills on hand fails to alter young women's use.

NEWPORT BEACH, CALIF. -- Having emergency contraception pills on hand instead of a prescription didn't increase the risk for unprotected sex, infectious disease, or pregnancy in a randomized study of 409 high-risk young women, but neither did it increase the use of emergency contraception.

A majority of the mostly adolescent cohort-aged 14-21 years--in both groups gave reasons for not using the emergency contraception after unprotected sex that suggested they did not understand the need for it or lacked the motivation to avoid getting pregnant, Dr. Stephanie Teal reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

"We tried to remove the infrastructural barrier" of having to fulfill a prescription by giving them emergency contraception pills to have on hand, "and it did not seem to make much difference," said Dr. Teal of the University of Colorado at Denver. "Unintended pregnancy rates among adolescents may not decrease until the cost of adolescent pregnancy is seen by them to be too great. Removal of structural barriers may not he enough."

The subjects came from a prenatal and postnatal care program for adolescent mothers who gave birth to a live infant in 2003-2005. At their first postpartum visit, 210 received a prescription for Plan B emergency contraceptive pills and 199 took home a packet of the pills. They were told that they could get more prescriptions or packets as needed at any time.

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Within 6 months, 41% in the prescription group and 48% in the packet group reported at least one episode of unprotected sexual intercourse, and emergency contraceptive pills were used by 23% in the prescription group and 28% of the packet group. The differences between groups were neither statistically nor clinically significant, Dr. Teal said.

By matching reported episodes of unprotected sex with emergency contraception use, she and her associates determined that 65% of the entire cohort did not use emergency contraception after an episode of unprotected sex, and 7% engaged in "augmented use"--meaning they already were using another form of effective contraception and still took the emergency contraception pills after protected sex.

Those who did not use the emergency contraception after unprotected sex gave classically adolescent reasons for not using the pills. The most common reason was "I just didn't," given by 24%. Another 22% said, "I didn't remember to do it," and 13% said, "I didn't think I needed to."

In the second 6 months of the study, the rate of unprotected sex decreased to 31%, and the use of emergency contraception after unprotected sex decreased to 12%. The rates did not differ significantly between groups.

There were 19 pregnancies in the first 6 months and an additional 32 pregnancies in the second 6 months. "This is typical, historically, for our population as a whole, that about 10% would be pregnant within a year," Dr. Teal said. The pregnancy rates did not differ significantly between groups.

Approximately 30% of the study cohort was using another form of contraception in addition to having emergency contraception available in the first 6 months of the study. In the second 6 months, close to 60% of participants used another contraceptive method besides emergency pills.

In a few cases, adolescents with prescriptions for emergency contraceptive pills were turned away by pharmacies. The prescription group was told at the start that they could come get a packet of emergency contraceptive pills if they could not fill their prescriptions, so there was some slight crossover between groups, and at least one participant was not able to get emergency contraception when needed.

The study cohort was economically disadvantaged--98% of participants were Medicaid patients--and approximately evenly composed of Hispanics, African Americans, and non-Hispanic whites, with around 2% Native Americans.

Dr. Teal reported no association with the company that makes Plan B.

BY SHERRY BOSCHERT

San Francisco Bureau