Journal List > J Korean Acad Nurs > v.48(3) > 1108863

Ryu, Lee, Kim, Ban, and Choi: How Does Advance Provision of Emergency Contraceptives Affect Contraceptive Use and Sexual Activity Among Adolescents? Systematic Review and Meta-Analysis

Abstract

Purpose

The purpose of this study was to analyze the effect of emergency contraceptive pill on adolescent sexuality and contraceptive behaviors through a meta - analysis of intervention studies on advance provision of emergency contraceptives. This study aimed to provide objective data on the transition of general medicines to be discussed in relation to the reclassification of emergency contraceptive pills.

Methods

Using electronic database, 1,820 studies written in Korean or English without limitation of the year were reviewed and for analysis, 5 studies were selected, in which emergency contraceptives were provided to adolescents.

Results

The advance provision of emergency contraceptives has increased their use and shortened the time it takes to take contraceptive pills after unprotected sex. There was no change in the frequency of engaging in sexual intercourse and unprotected sex or in existing contraceptive behavior, pregnancy rates decreased, but there was no increase in sexually transmitted infection.

Conclusion

The results of this study provide objective grounds for the reclassification of emergency contraceptive pills and propose effective interventional programs on contraceptive education, such as on efficacy and side effects of the contraceptive drug and its proper use among the youth who engage in sexual activity, to improve their reproductive health.

References

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Figure 1.
Flow diagram of study selection process.
jkan-48-255f1.tif
Table 1.
Descriptive Summary of the Included Studies (N=5)
Author, Year, Country Study design Characteristics N (age, M±SD) Intervention Outcome measures (p-Value)
Belzer et al. RCT 160 Ig: 82 levonorgestrel ECP use: 6m-Ig: 83.0%/Cg:11% (p<.001), 12m-Ig: 64.0%/Cg: 17.0%
2005 adolescents (17.2±1.24) 1.5 mg (p=.002)
USA mothers Cg: 78 Sexually active Past 6 months
13~20 years (17.2±1.37) 6m-Ig: 69.0%/Cg: 80.0% (p=.262), 12m-Ig: 89.0%/Cg: 93.0% (p=.563)
Unprotected intercourse within past 6 months
6m-Ig: 68.0%/Cg: 54.0% (p=.299), 12m-Ig: 69.0%/Cg: 45.0% (p=.043)
Condom use 6m-Ig: 44%/Cg: 39.0%, 12m-Ig: 44%/Cg: 47.0%
Oral contraceptives 6m-Ig: 24.0%/Cg: 18.0%, 12m-Ig: 12.0%/Cg: 22.0%
Depo provera 6m-Ig: 20.0%/Cg: 21.0%, 12m-Ig: 12.0%/Cg: 18.0%
→ Method of Contraception 6 and 12m: NS
Pregnancies past 6 months: 6m-Ig: 7.0%/Cg: 18.0%(p=.068), 12m-Ig:
14.0%/Cg: 6.0% (p=.219)
Ekstrand RCT 420 girls Ig: 214 levonorgestrel ECP use: 3m-Ig: 24.0%/Cg: 13.0% (p=.020), 6m-Ig: 31.0%/Cg: 19.0%
et al. 15~19 years (17±1.3) 1.5 mg (p=.010)
2008 Cg: 206 + ten Time interval(h)-M: 3m-Ig: 13.61/Cg: 25.47 (p=.007), 6m-Ig: 15.57/Cg:
Sweden (17±1.3) condoms 26.38 (p=.006)
+ leaflet on Intercourse without any contraception
EC 3m-Ig: 35.8%/Cg: 31.7% (p=.510), 6m-Ig: 23.7%/Cg: 22.1% (p=.780)
Condom use at last intercourse
3m-Ig: 32.2%/Cg: 38.1% (p=.330), 6m-Ig: 29.3%/Cg: 34.6% (p=.380)
OC use at last intercourse
3m-Ig: 51.7%/Cg: 44.2% (p=.200), 6m-Ig: 56.7%/Cg: 49.3% (p=.240)
Condom use at first intercourse with new partner
3m-Ig: 47.4%/Cg: 60% (p=.290), 6m-Ig: 51.4%/Cg: 46.7% (p=.830)
Partner change: 3m-Ig: 21.5%/Cg: 33% (p=.030), 6m-NS
Number of partners-M: 3m-Ig: 1.19/Cg: 1.59 (p=.014), 6m-NS
Pregnancy 6m-Ig: 4/ Cg: 3 (NS)
Sexually transmitted infection 6m-Ig: 5/Cg: 2 (NS)
Ekstrand RCT Data from the Ig: 142 Ekstrand et Time interval(h)-M 12m-Ig: 15.3/Cg: 25.8 (p=.019)
et al. Ekstrand et al., Cg: 119 al., 2008: Intercourse without any contraception during the last 3 months
2013 2008 the mean same 12m-Ig: 18.3%/Cg: 23.7% (NS)
Sweden age was Condom use at latest intercourse 12m-Ig: 27.5%/Cg: 31.1% (NS)
18 years in Oral contraceptive use at latest intercourse
both groups 12m-Ig: 55.6%/Cg: 58.0% (NS)
Unprotected latest intercourse 12m-Ig: 9.2%/Cg: 10.9% (NS)
Gold et al. RCT 301 Ig: 150 levonorgestrel ECP use: 1m-Ig: 15.0%/Cg: 8.0% (p=.050), 6m-Ig: 8.0%/Cg: 6.0%
2004 adolescents (17.2±1.5) 1.5 mg or (p=.540)
USA women age Cg: 151 Yuzpe(ethinyl Time to ECP use(h)-M : Ig: 11.4,/Cg: 21.8 (p=.005)
15~20 years (17.1±1.5) estradiol Unprotected intercourse, past month
200 mcg and 1m-Ig: 28.0%/Cg: 32.0% (p=.680), 6m-Ig: 26.0%/Cg: 260% (p=.980)
norgestrel Condom use, past month: 1m-Ig: 68.0%/CG: 70.0% (p=.730), 6m-Ig:
2 mg) 77.0%/Cg: 62.0% (p=.020)
+ EC OCP use, past month: 1m-Ig: 39.0%/CG: 42.0% (p=.370), 6m-Ig:
information 36.0%/Cg: 48.0% (p=.110)
Any hormonal contraception use, past month
1m-Ig: 39.0%/Cg: 42 (p=.370), 6m-Ig: 44.0%/Cg: 53.0% (p=.190)
Pregnancy 6m-Ig: 13/Cg: 18 (NS)
Sexually transmitted diseases 6m-Ig: 12/Cg: 12 (NS)
Schreiber RCT 50 Ig: 23 levonorgestrel ECP use: 12m-Ig: 60.0%/Cg: 37.0% (p=.158)
et al. postpartum (17.6±NR) 1.5 mg Unprotected sex during study periods-always/most
2010 teens Cg: 27 12m-Ig: 17.0%/Cg:23.0% (p=.245)
USA 14~19years (17.6±NR) Sexually active during study 12m-Ig: 83%/Cg:81% (p>.999)
Condom use 12m-Ig: 87.0%/Cg: 81.0% (p=.711)
OCP use 12m-Ig: 17.0%/Cg: 19.0% (p>.999)
Pregnancy 12m-Ig: 13.0%/Cg: 30.0% (p=.296)
Sexually active during study 12m-Ig: 83.0%/Cg: 81.0% (p>.999)

RCT=randomised controlled trial; Ig=intervention group; Cg=control group; M±SD=mean standard deviation; N= Participants; M=median; ECP=emergency contraceptive pills; OCP=oral contraceptive pills; 3m=3 month follow up; 6m=6 month follow up; NS=not significant; STI=sexually transmitted infections; NR=not recorded.

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