How Does Advance Provision of Emergency Contraceptives Affect Contraceptive Use and Sexual Activity Among Adolescents? Systematic Review and Meta-Analysis

Kyungsoon Ryu; Misoon Lee; Younghae Kim; Seonhwa Ban; Mihyang Choi

doi:10.4040/jkan.2018.48.3.255

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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

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J Korean Acad Nurs 2018;48(3):255-265.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.3.255

How Does Advance Provision of Emergency Contraceptives Affect Contraceptive Use and Sexual Activity Among Adolescents? Systematic Review and Meta-Analysis

Kyungsoon Ryu¹, Misoon Lee^1,, Younghae Kim¹, Seonhwa Ban¹, Mihyang Choi²

¹College of Nursing, Pusan National University, Yangsan

²Department of Nursing, Changshin University, Changwon, Korea

Address reprint requests to : Lee, Misoon College of Nursing, Pusan National University, 49, Busandaehak-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Korea Tel: +82-55-250-3180 Fax: +82-55-250-3185 E-mail: lms3021@hanmail.net

Received 19 January 2018 Revised 14 June 2018 Accepted 14 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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.

Keywords: Postcoital Contraceptives, Adolescent, Review, Meta–Analysis

References

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Figure 1.

Flow diagram of study selection process.

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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