Emergency contraception (EC) is a type of backup contraception that can be utilized as much as a number of days after unprotected intercourse or contraceptive failure and nonetheless stop a being pregnant. In 1999, Plan B was the primary oral product permitted to be used within the U.S. as an EC by the Meals and Drug Administration (FDA). Since then, extra EC merchandise have been permitted. Many have confused EC drugs with mifepristone, the “abortion capsule,” however EC drugs don’t trigger abortion. EC drugs stop being pregnant by delaying or inhibiting ovulation and won’t work if the being pregnant is established. This truth sheet critiques the strategies of EC, identified mechanisms of motion, use of EC, and present nationwide and state insurance policies affecting EC entry.
What’s EC?
EC is used as a back-up contraception technique to forestall being pregnant within the occasion of unprotected intercourse, sexual assault, or a contraceptive failure, comparable to a condom breaking. ECs don’t terminate a being pregnant, cease the implantation of a fertilized egg, or have an effect on a creating embryo. There are a number of strategies of EC which might be out there within the U.S. together with progestin-based drugs, ulipristal acetate, and intrauterine gadgets (IUDs) (Desk 1). The copper and levonorgestrel IUDs can be utilized after unprotected intercourse and as ongoing common contraceptive strategies. EC drugs are solely for use after unprotected intercourse and are usually not supposed to be used as a daily technique.
Progestin-Based mostly Drugs
- Plan B was the primary oral type of EC to be made out there within the U.S. as a pre-packaged dose of drugs containing the progestin, levonorgestrel. Now, there are generic options out there as effectively. Progestin-based EC drugs use the identical hormones present in day by day oral contraceptives and are probably the most extensively used type of EC. EC drugs are marketed right now beneath the model title Plan B One-Step and generic names (Desk 1).
- Progestin-based EC drugs don’t interrupt or adversely impression a longtime being pregnant, nor are they medical abortion medicine like mifepristone or methotrexate that finish a longtime being pregnant. Plan B One-Step and the generic variations stop being pregnant by inhibiting or delaying ovulation or by making it tougher for sperm to achieve an egg.
- Progestin-based EC is to be taken inside 72 hours of unprotected intercourse with the intention to be only and scale back the chance of being pregnant by 81% to 90% when taken on this timeframe.
- There aren’t any identified critical unwanted side effects related to progestin-based EC; unwanted side effects might embrace bleeding or recognizing, complications, nausea, and breast tenderness.
- Some analysis has urged that efficacy of progestin-based EC is decrease amongst girls with Physique Mass Index (BMI) ranges better than 25. Nonetheless, in Might 2016 the FDA introduced that it had reviewed the out there scientific knowledge relating to the effectiveness of EC drugs in chubby and overweight girls, and that the information are inconclusive and didn’t suggest a labeling change.
- Progestin-based drugs could be saved for a number of years, with Plan B One Step having a shelf-life of 4 years when saved as directed. Shoppers ought to at all times verify the expiration date on the packaging previous to taking the capsule.
Ulipristal acetate: ella
- Ulipristal acetate, marketed as ella, was permitted by the FDA in 2010 on the market and use within the U.S.
- ella is a single-dose capsule that’s efficient in stopping being pregnant as much as 5 days after unprotected intercourse, giving girls an extended timeframe to forestall unintended being pregnant than Plan B. Its mechanism of motion is just like that of progestin-based EC.
- Research findings present that unwanted side effects for ella are similar to these for Plan B, and a few analysis means that its effectiveness seems to decrease at BMI thresholds above 35.
Mixed/Mixture Drugs
- Sure day by day oral contraceptive drugs also can act as EC when taken in doses 4 or 5 occasions larger than the day by day dose, though they don’t seem to be particularly offered as emergency contraception. Oral contraceptive drugs include progestin and estrogen and are taken in two doses 12 hours aside to be efficient as EC.
- Mixed drugs have been discovered to be protected and efficient for stopping being pregnant inside 5 days of intercourse.
Copper-T IUD: Paragard
- Accessible to girls because the Nineteen Seventies, copper-T IUDs are the simplest types of EC, lowering the danger of being pregnant by greater than 99% when inserted inside 5 days of unprotected intercourse. IUDs are inserted into the uterus by a well being care supplier and require a go to to a clinic or supplier’s workplace. In addition they can be utilized to successfully stop subsequent being pregnant for as much as 10 years.
- The hormone-free copper-T IUD works by interfering with egg fertilization by stopping sperm from reaching the egg. Earlier analysis suggests the copper IUD inhibits implantation of a fertilized egg, however this mechanism of motion has not been conclusively confirmed.
- Efficacy of copper IUDs doesn’t diminish in girls who’re chubby or overweight.
Levonorgestrel IUD: Mirena and Liletta
- Levonorgestrel IUDs are a kind of hormonal IUD that include the progestin levonorgestrel. Up to now, solely levonorgestrel IUDs that include 52 mg of levonorgestrel (LNG 52 mg IUDs) have been studied as a type of EC. LNG 52 mg IUDs are marketed beneath the model names Mirena and Liletta.
- Like copper-T IUDs, LNG IUDs are inserted into the uterus by a clinician and require a go to to a clinic. LNG IUDs can subsequently be used as a daily type of contraception for as much as seven years.
- Levonorgestrel IUDs lately began getting used as a technique of EC, and analysis has discovered that LNG 52 mg IUDs could be as efficient as copper-T IUDs when inserted inside 5 days after unprotected intercourse or contraceptive failure. The hormonal IUD prevents egg fertilization by making the cervical mucus impenetrable to sperm.
- Efficacy of levonorgestrel IUDs doesn’t diminish in girls who’re chubby or overweight.
Ladies’s Use of EC
There have been quite a few public well being and academic initiatives to extend use of EC.
- Use of EC drugs has elevated over the previous 20 years. Between 2017 and 2019, the latest years for which knowledge are at the moment out there, 28% of ladies ages 15 to 44 who’ve ever had intercourse with a male reported that they had used EC drugs a minimum of as soon as of their lives, a rise from 4% in 2002 (Determine 1).
- Youthful girls usually tend to report that they’ve ever used EC (Determine 2). A couple of third of ladies ages 15-24 (34%) and ladies ages 25-34 (36%) say they’ve taken EC drugs, in comparison with 17% of ladies ages 35-44. Roughly one in three Hispanic, Black, and White girls (30%, 27%, and 28%, respectively) report ever taking EC.
Entry and Availability
A minimum of one type of oral EC has been out there within the U.S. for over a decade and there have been a number of efforts to broaden girls’s entry to EC, notably since its effectiveness window is time-limited.
Over the Counter Entry of EC Drugs
- Previous to 2006, a prescription was wanted for all people looking for EC drugs. Between 2006 and February 2014, Plan B and its generic equal have been out there with no prescription for women and men 17 and older, however adolescents beneath 17 wanted a prescription.
- In 2014, the FDA eliminated point-of-sale age necessities for Plan B obtained over-the-counter (OTC) and generic variations started to enter the OTC market. Presently, a number of generic manufacturers of EC drugs, together with Subsequent Alternative One Dose, My Approach, Fall Again Solo, Take Motion, levonorgestrel pill, and Aftera can be found OTC to girls of all ages.
- A prescription continues to be required for ella for girls of all ages.
Price and Protection
- The Reasonably priced Care Act (ACA) requires most new non-public well being plans (particular person and group) to cowl with out cost-sharing all FDA-approved contraceptive medicine and gadgets as prescribed, together with emergency contraception. Because of this though OTC formulations are out there with no prescription, the drugs are solely required to be coated by insurance coverage in the event that they have been prescribed. Personal insurance policy should additionally cowl the price of IUDs, in addition to providers associated to insertion, observe up and removing, with out value sharing. Nonetheless, there have been quite a few experiences of people having to pay out-of-pocket for contraception that they consider ought to have been absolutely coated, together with for providers associated to the insertion and removing of IUDs.
- 12 states and D.C. require non-public medical insurance plans to cowl over-the-counter contraceptives, with none cost-sharing, together with EC. For employer-sponsored plans, state protection necessities typically apply solely to fully-insured plans and to not self-funded plans.
- Household planning providers is a required profit beneath Medicaid. The protection necessities beneath Medicaid are completely different for states which have expanded eligibility beneath the ACA. These packages should cowl all prescribed, FDA-approved contraceptives, that means that they have to cowl EC drugs if a girl has a prescription. States have discretion in deciding whether or not they embrace EC of their conventional full-scope Medicaid packages or household planning growth packages. A 2021 survey of state Medicaid packages discovered that whereas all responding states cowl a minimum of one type of EC of their conventional Medicaid packages, some states impose amount limits. Texas doesn’t cowl EC via its household planning program.
- And not using a prescription or insurance coverage, girls in most states accessing EC OTC should pay the retail worth. Plan B drugs and the generic variations common can vary from $10 to $50 when bought OTC. With out insurance coverage, the price of IUDs can vary from $500 to $1,300.
- People with out medical insurance or who’re ineligible for Medicaid might be able to receive free or low-cost EC (along with different reproductive well being care providers) via a clinic or group well being middle taking part within the federal Title X household planning program. The Title X program may additionally be an choice for lower-income people coated by employer-sponsored medical insurance plans that aren’t required to cowl contraception as a result of they existed previous to the ACA (generally known as “grandfathered” plans) or as a result of their employer excludes protection of emergency contraception primarily based on a non secular or ethical objection to it. Whatever the pathway, eligibility for this system relies on the person’s family revenue and prices are primarily based on a sliding payment scale.
On-line Contraceptive Platforms
- New markets have emerged, notably because the begin of the COVID-19 pandemic, that permit folks to acquire well being care providers with out the necessity for an in-person go to, together with a number of on-line reproductive well being providers platforms and smartphone apps the place a person can receive hormonal contraceptives, together with EC drugs, exterior of conventional well being care settings.
- These on-line platforms and apps sometimes make use of licensed medical professionals to find out a consumer’s eligibility and to prescribe contraception in the same method to a clinic. The affected person is then both mailed their contraceptives or their prescription is distributed to a close-by pharmacy for pick-up.
- Some, however not all, of those platforms settle for non-public insurance coverage and/or Medicaid, and there may be appreciable variation in out-of-pocket prices for individuals who self-pay.
Provision of EC in Well being Care Settings
- A number of main medical and public well being organizations, such because the American Academy of Pediatrics, American School of Obstetricians and Gynecologists, and the American Public Well being Affiliation, endorse the usage of EC and advocate for broader entry to EC.
- Counseling and protection of EC is included as a regular of care within the federal necessities for offering High quality Household Planning Companies (QFP). Suppliers are inspired to debate EC with their sufferers, inform them of its availability, and supply them with a complicated provide of EC drugs if the affected person requests them. Advance provision of EC can improve the probabilities that somebody can have EC available and use it when wanted, however analysis has discovered that few clinicians recurrently present advance provision of EC drugs.
- There have been ongoing efforts to make EC extra available to survivors of sexual assault. Presently, 16 states and the District of Columbia require that emergency room employees present EC to girls after sexual assault (Determine 3). Nonetheless, some research have documented {that a} sizable share of clinicians are usually not absolutely knowledgeable about EC choices, security, and efficacy. Moreover, some group well being facilities have reported challenges stocking IUDs attributable to excessive prices.
- In 2015, Indian Well being Service (IHS) clarified its coverage on entry to the OC capsule for Native American girls, together with {that a} prescription or age verification to entry Plan B just isn’t required.
Availability and Entry in Pharmacies
- Seven states – CA, HI, MA, ME, NH, NM, and WA – have legal guidelines that permit pharmacists to instantly prescribe EC to girls of all ages with out acquiring a clinician’s prescription.
- 4 states – CA, NJ, WA, WI– have measures that require pharmacies or pharmacists to fill all legitimate prescriptions. These insurance policies have been enacted, partially, in response to experiences of pharmacists refusing to fill prescriptions for EC drugs as a result of they oppose its use on ethical or spiritual grounds.
- Seven states – AR, AZ, GA, ID, IL, MS, SD – have legal guidelines permitting pharmacies and/or pharmacists to refuse to dispense EC drugs on the idea of ethical or spiritual objections.
- Pharmacies are usually not required to inventory EC drugs and a few research present that EC drugs which may be offered OTC are usually not constantly stocked on retailer cabinets and are generally stored behind the counter or in a locked show as a result of excessive value of the product. This report additionally documented misinformation regrading age and ID necessities amongst pharmacy employees and customers.
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Three in ten girls of reproductive age within the U.S. report that they’ve used EC drugs. Emergency contraception’s use has elevated considerably because it first got here to market within the U.S. over 20 years in the past, and IUDs have been discovered to be efficient as emergency contraception as effectively. Entry to EC has expanded on account of the FDA granting over-the-counter standing for progestin-based EC drugs plus the contraceptive protection necessities beneath the ACA. On the similar time, EC has been the item of intensive misinformation, with some misrepresenting it as an abortifacient. Entry to EC continues to be debated by policymakers at each the state and federal ranges and can seemingly proceed to be a spotlight of coverage discussions within the years to return.
