Fatim Lakha
Speeches:
-
Impact of emergency contraception (EC) on contraception and abortion
Fatim Lakha, MD, Contraceptive Development Network, University of Edinburgh, UK
Emergency contraception (EC) has the potential to reduce the numbers of unintended pregnancies and thus reduce both rates of abortion and total fertility rates. However, this is only if everyone uses it every time the need arises.
A pilot study undertaken in Edinburgh in 1997 demonstrated that having an advanced supply of EC led to increased use of EC and a trend towards a decreased relative risk of unintended pregnancy (relative to not having advanced supplies).
A large Lothian-wide study followed in 1999. Women aged 16 to 29 were offered 5 packets of EC to keep at home.
At the end of 2001 25% of the targeted population had been reached.
A random sample of 11 general practice (GP) clinics and the family planning clinic (FPC) were used to audit data. Women who had supplies from these clinics were asked to complete a questionnaire. 5,543 questionnaires were analysed.
It was estimated that at least 8,800 courses of EC had been used during the study. 75% of women who had used EC had within 24 hours. This indicated increased but responsible use of EC with home supplies. The trend was for women to move to a more effective method of contraception after being supplied with advanced EC.
Disappointingly, whilst advanced provision increased use, it did not result in a reduction in numbers of unintended pregnancy.
74% of those followed-up who had had an unintended pregnancy had not used EC to prevent that pregnancy because they had not recognised the risk.
Regardless of potential efficacy of EC, effectiveness depends on the user and their individual perception and acknowledgement of risk.
-
New perception on contraception
Fatim Lakha, MD, Contraceptive Development Network, University of Edinburgh, UK
Abortion is inevitable. Intuitively, one would hope that numbers of abortions could be reduced by women using contraception more consistently. In practise this is difficult to achieve.
In first world countries where awareness of contraceptive methods is good, correct utilisation, if at all, remains poor.
There are very few data on the effectiveness of counselling to reduce rates of unintended pregnancy.
A small study from Switzerland investigated behaviour modification following professional counselling six months post termination of pregnancy. It demonstrated a high prevalence of contraceptive use after abortion. A similar small UK study of women undergoing repeat abortion indicated inconsistent counselling leading to women opting for less effective methods of contraception. In depth interviews with a group of women following abortion in London described little change in behaviour and contraceptive counselling was shown to have been superficial.
Two randomised control trials have attempted to evaluate counselling as an intervention designed to improve contraceptive use after abortion. One from Iceland showed no significant difference in contraceptive use, the second from Scotland demonstrated an increased uptake of long-acting methods. Follow-up in both these studies was too short to confirm a reduction in repeat abortion rates.
Further studies are needed to evaluate strategies to improve contraceptive uptake and continuation rates, and to determine their effectiveness in reducing unintended pregnancies.