Risk of Pregnancy With Levonorgestrel-Releasing Intrauterine System Placement 6–14 Days After Unprotected Sexual Intercourse

Boraas, Christy M.; Sanders, Jessica N.; Schwarz, EB; Thompson, Ivana; Turok, David K.

doi:10.1097/aog.0000000000004118

Cited by 11 publications

(8 citation statements)

References 13 publications

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“…Providers and clients also lacked understanding about the mechanisms of action for each of the EC methods. Specifically, providers were uncertain about how IUDs work for EC, with some incorrectly believing that IUDs can act as an abortifacient to an established pregnancy, and others unsure if it is appropriate to place an IUD when an individual is at risk of being pregnant but has a negative urine pregnancy test (current evidence [ 35 – 37 ] indicates it is appropriate).…”

Section: Resultsmentioning

confidence: 99%

Improving access to highly effective emergency contraception: an assessment of barriers and facilitators to integrating the levonorgestrel IUD as emergency contraception using two applications of the Consolidated Framework for Implementation Research

Simmons

Baayd

Elliott

et al. 2022

Implement Sci Commun

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Background Emergency contraception prevents unwanted pregnancy after sexual intercourse. New evidence has demonstrated that the levonorgestrel 52 mg IUD is a highly effective method of emergency contraception. However, translating this research finding into clinical practice faces existing barriers to IUD access, including costs and provider training, novel barriers of providing IUDs for emergency contraception at unscheduled appointments. The purpose of this study was to identify barriers and facilitators to the utilization of the levonorgestrel IUD as emergency contraception from client, provider, and health systems perspectives. Methods We conducted English and Spanish-speaking focus groups (n=5) of both contraceptive users (n=22) and providers (n=13) to examine how the levonorgestrel IUD as EC was perceived and understood by these populations and to determine barriers and facilitators of utilization. We used findings from our focus groups to design a high-fidelity in-situ simulation scenario around EC that we pilot tested with clinical teams in three settings (a county health department, a community clinic, and a midwifery clinic), to further explore structural and health systems barriers to care. Simulation scenarios examined health system barriers to the provision of the levonorgestrel IUD as EC. We coded both focus groups and in-clinic simulations using the modified Consolidated Framework for Implementation Research (CFIR). We then applied our findings to the CFIR-Expert Recommendations for Implementing Change (ERIC) Barrier Busting Tool and mapped results to implement recommendations provided by participants. Results Ultimately, 9 constructs from the CFIR were consistently identified across focus groups and simulations. Main barriers included suboptimal knowledge and acceptability of the intervention itself, appropriately addressing knowledge and education needs among both providers and contraceptive clients, and adequately accounting for structural barriers inherent in the health system. The CFIR-ERIC Barrier Busting Tool identified eight strategies to improve levonorgestrel IUD as EC access: identifying implementation champions, conducting educational meetings, preparing educational toolkits, involving patients and their partners in implementation, conducting a local needs assessment, distributing educational materials, and obtaining patient feedback. Conclusions To sustainably incorporate the levonorgestrel IUD as EC into clinical practice, education, health systems strengthening, and policy changes will be necessary.

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Section: Resultsmentioning

confidence: 99%

Improving access to highly effective emergency contraception: an assessment of barriers and facilitators to integrating the levonorgestrel IUD as emergency contraception using two applications of the Consolidated Framework for Implementation Research

Simmons

Baayd

Elliott

et al. 2022

Implement Sci Commun

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Recent manuscripts with data contributed from this study report more precise one-month pregnancy risk estimates with copper and levonorgestrel IUDs placed 6-14 days after unprotected intercourse. 8,9 Study strengths supporting internal validity include the relatively large sample and the prospective assessment of pregnancy risk given unprotected intercourse exposure before treatment in the setting of a randomized controlled trial. The inclusion of emergency contraception users randomly assigned to either a copper T380A or the levonorgestrel 52-mg IUS provides point estimates for both types of IUDs for the exposures.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Risk by Frequency and Timing of Unprotected Intercourse Before Intrauterine Device Placement for Emergency Contraception

BakenRa

Gero

Sanders

et al. 2021

Obstetrics &Amp; Gynecology

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“…This extends the window for patients and providers to prevent unplanned pregnancy. 206,207 CONCLUSIONS Abortion and contraception are essential components of reproductive health care. With the restrictions to abortion that were recently implemented in some states in the US, and are expected in others, the demand for EC is anticipated to increase.…”

Section: Therapeutic Advancesmentioning

confidence: 99%

Emergency Contraception: Access and Challenges at Times of Uncertainty

Stein¹,

Deverakonda²,

Katz

et al. 2022

American Journal of Therapeutics

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Background:The UN Commission on Life-Saving Commodities for Women and Children identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation.Areas of uncertainty:Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access.Data Sources:PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetricians and Gynecologists, the World Health Organization, The United Nations.Therapeutic Advances:A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device.Conclusions:EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts, threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.

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Risk of Pregnancy With Levonorgestrel-Releasing Intrauterine System Placement 6–14 Days After Unprotected Sexual Intercourse

Cited by 11 publications

References 13 publications

Improving access to highly effective emergency contraception: an assessment of barriers and facilitators to integrating the levonorgestrel IUD as emergency contraception using two applications of the Consolidated Framework for Implementation Research

Improving access to highly effective emergency contraception: an assessment of barriers and facilitators to integrating the levonorgestrel IUD as emergency contraception using two applications of the Consolidated Framework for Implementation Research

Pregnancy Risk by Frequency and Timing of Unprotected Intercourse Before Intrauterine Device Placement for Emergency Contraception

Emergency Contraception: Access and Challenges at Times of Uncertainty

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