Monday, December 11, 2017

Morning After Pill promotion fails in stated aims

 

In 2000, under-16 conceptions stood at 8.3 per Thousand.

In 1999, The Teenage Pregnancy strategy1 committed the Labour government to a target of halving the number of conceptions occurring in women under 18 by the year 2010 (compared with 1999). To achieve this aim it relied on ‘better’ sex education, both in and out of schools, and improved access to contraception.

Please find this link from the Times which gives a good summary of the end result of the Labour teenage pregnancy strategy launched in 1999:

 http://www.timesonline.co.uk/tol/news/politics/article7038565.ece

Evidence against the use of Emergency Hormonal Contraception (EHC)

Summary: Increased use of EHC is well known when improved access to supply is made available but this does not to translate to a reduction in unwanted pregnancies and abortions.

  1. 1.       A study of 240 teenagers who became pregnant found that 93% had seen a health professional at least once during the previous year, and 71% had discussed contraception.3

The researchers concluded that:

  •          ‘Most teenagers who become pregnant do access general practice in the year before pregnancy, suggesting that potential barriers to care are less than often supposed;
  •          ‘Teenagers who become pregnant have higher consultation rates than their age-matched peers, and most of the difference is owing to consultation for contraception; and
  •          ‘Teenagers whose pregnancies end in termination are more likely to have received emergency contraception.’
  1. 2.       The authors looked at free over-the-counter access to emergency birth control for teenagers at pharmacies in England and constructed matching estimates of the impact of this scheme on the under-18 conception rate in local authorities.4

Conclusion: Irrespective of either the matching or the adjustment procedure, we find no evidence that over-the-counter emergency birth control schemes lead to lower teenage pregnancy rates.

  1. 3.       The authors included studies that compared the effect of different levels of access to emergency contraceptive pills on pregnancy rates, use of the pills, and other outcomes.5 Of the 717 articles identified, they selected 23 for review. The studies included randomized trials, cohort studies, and evaluations of community interventions. The quality of these studies varied. In all but one study, increased access to emergency contraceptive pills was associated with greater use. However, no study found an effect on pregnancy or abortion rates.

Conclusion: Increased access to emergency contraceptive pills increases use but has not been shown to reduce unintended pregnancy rates.

  1. 4.       The authors reviewed randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors.6Eleven randomized controlled trials met their criteria for inclusion, representing 7695 patients.

Conclusion: the chance of pregnancy was similar regardless of whether or not women have emergency contraception on hand before unprotected sex, even though women who had a standby supply were more likely to use it, and to use it sooner after sex.

  1. 5.       Of a population of around 85,000 women in this age group, the study showed that an estimated 17,800 women took a supply of EC home and over 4500 of them gave at least one course to a friend.7 It was found that nearly half (45%) of women who had a supply used at least one course during the 28 months that the study lasted. In total, an estimated 8081 courses of EC were used. EC was used within 24 h after intercourse on 75% of occasions. Abortion rates in Lothian were compared with those from three other health board areas of Scotland.

Conclusion: No effect on abortion rates was demonstrated with advanced provision of EC. The results of this study suggest that widespread distribution of advanced supplies of EC through health services may not be an effective way to reduce the incidence of unintended pregnancy in the UK.

  1. 6.       In this single-blind, controlled trial8 conducted between July 2001 and June 2003, 2117 Californian women, aged15 to 24 years, were randomly assigned to 1 of the following groups: pharmacy access to emergency hormonal contraception (EHC); advance provision of 3 packs ofEHC; or clinic access (control).

Women in the pharmacy access and advance provision groups did not experience a significant reduction in pregnancy rate (pharmacy access group: adjusted OR, 0.98; 95% CI, 0.58-1.64; P =0.93; advance provision group: OR, 1.10; 95% CI, 0.66-1.84, P = 0.71)

Conclusion: Although removing the inconvenience of going to a pharmacy or clinics to obtain EHC increases use, the public health impact is insignificant

In summary, there is a number of robust, peer reviewed papers which show that EHC has no impact on unwanted pregnancies and abortions. The Pharmaceutical Companies will not be able to provide you with any papers that show the opposite because there arent any! They will only be able to show that increased access leads to greater use of EHC and used earlier, but as we have seen with the papers above this does not translate into reductions.

References

  1. 1.       Teenage Pregnancy, Cm 4342, Social Exclusion Unit, June 1999.
  2. 2.       The Health of the Nation: A Strategy for Health in England, Cm 1986, July 1992, p.95.
  3. 3.       Churchill D, Allen J, Pringle M, Hippisley-Cox J, Ebdon D, Macpherson M et al. ‘Consultation patterns and provision of contraception in general practice before teenage pregnancy’, BMJ 2000; 321:486–489.
  4. 4.       Professor D. Paton et al. Matching estimates of the impact of over-the-counter emergency birth control on teenage pregnancy. Health Econ. 15: 1021–1032 (2006)
  5. 5.       Raymond, E. et al. Population effect of increased access to Emergency contraceptive pills – a systematic review. Obstet Gynaecol 2007; 109:181-8
  6. 6.       Polis CB, Schaffer K, Blanchard K, Glasier A, Harper C, Grimes DA. Advance provision of emergency contraception for pregnancy prevention. Cochrane Database of Systematic Reviews 2007, Issue 2 (reviewed and published in Issue 3, 2010).
  7. 7.       Glasier, A et al. Advanced provision of emergency contraception does not reduce abortion rates. Contraception [2004, 69(5):361-6]
  8. 8.       Bissell, P etEHC through pharmacies and effect on unintended pregnancy and STI's. JAMA. 2005;293:54-62