ICEC Publications

ICEC develops publications to support improved access to EC in health care service delivery, programming, and advocacy, and to address misperceptions about EC.

FEATURED PUBLICATION

Repeated Use of Emergency Contraceptive Pills: The Facts                                       
October 2015
While emergency contraceptive pills are labeled for single use, medical evidence suggests that they can safely be used multiple times in a cycle. Because ECPs work by delaying ovulation, they will not provide protection from pregnancy if unprotected intercourse occurs after ECPs have been used. Women who want to avoid pregnancy can take ECPs multiple times in each cycle with assurance that such use is safe; however, long-term or on-going methods are more effective at preventing pregnancy, and only condoms can prevent transmission of sexually transmitted infections. This fact sheet reflects the latest version of the World Health Organization’s Medical Eligibility Criteria (MEC), released in 2015.

EC Guidelines

Emergency Contraceptive Pills: Medical and Service Delivery Guidelines, Third Edition
English Русский Français 中国 – 中國 – Magyar
2012
Updated in 2012, the Medical and Service Delivery Guidelines are ICEC’s most widely distributed publication. Designed to serve as a key reference and training document for service provision, it includes a range of medical and service delivery issues in an easy to use format, from screening, dosages, and counseling to EC pill regimens. Local programs can adapt these guidelines as necessary to comply with national or other requirements.

Píldoras Anticonceptivas de Emergencia: Guías médicas y de entrega de servicios en América Latina y el Caribe
Español
July 2013
ICEC’s Emergency Contraceptive Pills Medical and Service Delivery Guidelines have been adapted by the Latin American Consortium for Emergency Contraception (CLAE) and the Latin American Federation of Societies of Obstetrics and Gynecology (FLASOG) to reflect the cultural and political environment in the region. The guidelines address EC pill regimens including levonorgestrel and ulipristal acetate, and also the Yuzpe method, which is still the only choice available in many communities in Latin America and the Caribbean.

Pílulas Anticoncepcionais de Emergência: Orientações médicas e de prestação de serviços
Português
May 2015
ICEC’s Emergency Contraceptive Pills Medical and Service Delivery Guidelines were adapted in 2013 by the Latin American Consortium for Emergency Contraception (CLAE) and the Latin American Federation of Societies of Obstetrics and Gynecology (FLASOG) to reflect the cultural and political environment in the region. The guidelines address EC pill regimens including levonorgestrel and ulipristal acetate, and also the Yuzpe method, which is still the only choice available in many communities in Latin America and the Caribbean.

In 2015 this version of the guidelines were translated into Portuguese by the Rede Brasileira de Promoção de Informações e Disponibilização da Contracepção de Emergência (REDECE), and reviewed and endorsed by the Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (FEBRASGO), the Associação de Obstetrícia e Ginecologia do Estado de São Paulo (SOGESP) and the Sociedade Brasileira de Reprodução Humana (SBRH).

Clinical Summary: Emergency Contraceptive Pills
English – Français
February 2013
The clinical summary of emergency contraceptive pills (ECP) provides a one-page overview of ICEC’s Medical and Service Delivery Guidelines by briefly discussing how ECP regimens work, their efficacy and safety, guidelines on repeat use, and considerations for starting or resuming regular contraceptives following ECP regimens.

EC Fact Sheets: Safety, How EC Works, Q&A, and more

Repeated Use of Emergency Contraceptive Pills: The Facts                                        English – Français                                                                                                                October 2015                                                                                                                       While emergency contraceptive pills are labeled for single use, medical evidence suggests that they can safely be used multiple times in a cycle. Because ECPs work by delaying ovulation, they will not provide protection from pregnancy if unprotected intercourse occurs after ECPs have been used. Women who want to avoid pregnancy can take ECPs multiple times in each cycle with assurance that such use is safe; however, long-term or on-going methods are more effective at preventing pregnancy, and only condoms can prevent transmission of sexually transmitted infections. This fact sheet reflects the latest version of the World Health Organization’s Medical Eligibility Criteria (MEC), released in 2015.

Emergency Contraception: Questions and Answers for Decision-Makers
English – Français – Español
February 2013
This brief is designed to answer decision-makers’ most commonly asked questions about emergency contraception. It provides concise responses to questions such as why EC access is important, how EC works (and how it differs from abortion), and how safe and effective EC is. It also addresses other concerns like provision of EC over the counter and provision of EC to youth.

Fact sheet on the safety of levonorgestrel-alone emergency contraceptive pills (LNG ECPs)
English – Español – Français
April 2010
Emergency contraception has been in use for decades and its safety is well established through monitoring and studies. This fact sheet, produced jointly with the World Health Organization, the International Federation of Obstetrics and Gynecology, and the International Planned Parenthood Federation, is based on a thorough reading of the literature and extensive technical review by medical experts from around the world.

Mechanism of Action: How do levonorgestrel-only emergency contraceptive pills (LNG ECPs) prevent pregnancy?
English – Español – Français – Deutsche
March 2012
The mechanisms through which EC prevents pregnancy after unprotected sex have been extensively researched and over 20 studies have been published on this topic over the last forty years. The overwhelming evidence is that the method works primarily through preventing ovulation with a possible effect on sperm function. The International Federation of Gynecology and Obstetrics (FIGO) has endorsed this statement, which is posted on their website.

Emergency Contraception and Medical Abortion: What’s the Difference?
English/Global – English/U.S. – Français Español
February 2013
Both emergency contraception and medical abortion are crucial components of women’s reproductive health worldwide, but confusion between the two has presented several challenges to broader EC access. This fact sheet explains significant differences between emergency contraceptive pills, which do not terminate or interrupt established pregnancies, and medical abortion regimens.

Using Oral Birth Control Pills as EC
English Español – Français
December 2014
When no products marketed specifically for emergency contraception are available, combined oral contraceptives – regular birth control pills – can also be used as EC. This is known as the “Yuzpe” method. The Yuzpe method offers critical EC access for women without access to dedicated ECPs.

Regimen Update: Dosage and Timing
English Français Español
January 2013
Although certain levonorgestrel-alone emergency contraceptive pills (LNG-ECPs) contain two 0.75 mg pills that are indicated to be taken 12 hours apart up to 72 hours after intercourse, labels for these ECPs do not reflect current scientific information. This short regimen update provides evidence-based conclusions for dosage and timing and recommends that women take LNG-ECPs in a single dose of 1.5 mg LNG — if the package contains two pills of 0.75 mg LNG, women should take both at the same time. Moreover, while ECPs are more effective the sooner they are used, they can provide some protection from unwanted pregnancy as many as five days (120 hours), not just up to 72 hours, after unprotected intercourse.

The Intrauterine Device (IUD) for Emergency Contraception
English
September 2012
The copper IUD for EC is the most effective way to prevent pregnancy after unprotected intercourse and can protect a woman from unintended pregnancy for many years. Because of these advantages, the copper IUD should be regularly offered to women who seek EC. This fact sheet outlines the clinical and service delivery considerations for offering IUDs for EC.

Repeated Use of Emergency Contraception: The Facts
English Español Français Русский
July 2003
EC can safely be used repeatedly; however, studies have found that women rarely rely on EC repeatedly. Easier access to EC also does not increase risky sexual behavior or lead women to abandon their regular contraceptive methods. (Please note: ICEC is currently updating the Repeated Use of EC Policy Statement and a revised version will be released in 2015.)

EC Policies, Access and Awareness

Over-the-Counter Access to Emergency Contraceptive Pills
English – Italiano – Deutsche
December 2013
For women wanting to prevent pregnancy, timely access to ECPs is crucial, since the sooner they are taken, the more likely they are to be effective. Regulatory limitations on the sale of ECPs (including prescription requirements and age restrictions) impede a woman’s ability to get ECPs when she needs them. This fact sheet addresses why unrestricted, over-the-counter (OTC) access to ECPs is essential and safe for women of all ages.

Emergency Contraceptive Pills Registration Status by Country
English
March 2014
Women’s access to ECPs is significantly influenced by the availability of EC products in their country. Many dedicated products – those that are packaged and labeled for EC use specifically – exist, but are only accessible to women if at least one product is registered and/or imported in their country. The ECP Registration Status fact sheet provides an overview of ECP availability by country based on three designations – at least one product registered, no registered product but current or previously imported product, and no registered or imported product.

Emergency Contraception in National Essential Medicines Lists
English
June 2016
National Essential Medicines Lists (EMLs) include medicines that fulfill primary health needs of a country’s population, as determined by its government. This fact sheet provides information regarding the inclusion or non-inclusion of emergency contraceptive pills (ECPs) in all available country EMLs. In addition, it lists which ECP regimens are indicated among those EMLs that include ECPs.

Demographic and Health Surveys (DHS) Data on EC Knowledge and Use: Regional Compilations
Africa – Asia – Latin America and the Caribbean – West Asia/Europe
2012
Demographic and Health Surveys are conducted in many countries and often include questions on whether women are familiar with EC and have ever used it. ICEC compiled all DHS results on EC knowledge and use and found that these indicators are still very low.

EC for Sexual Assault and Crisis Settings

Emergency Contraception for Rape Survivors: A Human Rights and Public Health Imperative
English – Français
September 2013
Emergency contraception is a critical component of comprehensive post-rape care for women. However, sexual assault survivors often face obstacles in accessing EC products and information. Not all public health care systems or police stations, where women often report sexual violence, stock EC. Nor do many front-line rape responders, such as law enforcement officers and social workers, receive training on EC. Global guidance from international policy-making bodies suggests that failure to ensure on-site EC provision to rape survivors jeopardizes women’s health and violates their human rights. In order to increase access to EC in these situations, governments should implement and enforce policies that guarantee EC provision in post-rape care, health care facilities and training institutes should support EC for sexual assault survivors, and where appropriate non-health professionals should be authorized to provide ECPs or referrals.

Emergency Contraceptive Pills: Fast Facts for Decision-Makers and Program Managers in Crisis-Affected Settings                                                                                                       English                                                                                                                                November 2015                                                                                                                     EC is a vital option for women and girls in crisis-affected settings. Women living in crisis settings, such as countries or regions affected by conflicts and natural disasters, face particular challenges that make access to EC essential. Regular contraceptive supplies can be disrupted when a crisis strikes, while sexual assault and transactional sex can often rise; both of these factors result in an increased need for EC. Moreover, the especially harsh living conditions in most crisis-affected settings make pregnancy and childbirth even more difficult and life-threatening. This document, co-authored by ICEC and the Inter-Agency Working Group on Reproductive Health in Crises, provides information for policymakers, decision-makers, and program managers about EC in crisis-affected settings, including how to ensure that women in crisis-affected settings have access to EC.

Emergency Contraceptive Pills: Fast Facts for Health Care Providers in Crisis Settings  English                                                                                                                                November 2015                                                                                                                   This document, co-authored by ICEC and the Inter-Agency Working Group on Reproductive Health in Crises, provides information about EC for health care providers in crisis settings. It discusses information about EC, such as the timeframe during which it can be taken and safety concerns, and provides a chart outlining the different regimens of oral contraceptive pills that can be taken to make EC when a dedicated EC product is not available.

Emergency Contraception for Crisis Settings: Key Resources                                       English
May 2012
This document highlights resources – including websites, technical guidelines, and articles – that provide information on the provision of EC in crisis-settings, including for refugee and internally displaced persons (IDP) populations.

EC Issue Papers and Briefs: Social Marketing for EC, EC and the Catholic Church, and more

Donor Support for Emergency Contraception
English
March 2014
Donors, particularly US-based private foundations, have played a key role in making emergency contraception available around the world, but the dynamics of donor funding have not been well-documented before now. This paper analyzes data on donor funding for EC-focused programs and donor spending for EC procurement.

Emergency Contraception: Catholics in Favor, Bishops Opposed
English – Español
October 2010
This paper, co-authored by ICEC and Catholics for Choice, details how Catholic bishops continue to oppose access to emergency contraception (EC) and lead opposition efforts, going against the beliefs of the majority of their constituents. In the United States and around the world, the church hierarchy has opposed EC access through public statements, involvement in legal cases, and threats to excommunicate women who use EC. This paper outlines the issues and provides examples of Catholic hierarchy opposition from around the world, and how advocates, policymakers, and healthcare professionals are fighting back.

How Social Marketing and NGOs are Expanding Access to Emergency Contraception
English
2012
Social marketing has greatly increased access to emergency contraception in several countries, but a number of factors have hindered the technique from reaching its full potential elsewhere. Social marketing refers to the sales or promotion – via advocacy, advertising, training, and outreach – of EC by the NGO community. Surveying four social marketing organizations and the International Planned Parenthood Federation, ICEC explored the reasons behind the success stories, along with the barriers that have resulted in more limited success in other contexts.

Framework for Introducing EC
English
2003
Consortium members developed a 9-step framework for introducing EC into national programs, describing a carefully planned process designed to be participatory and responsive to client needs.

Adapting Resource Materials for Local Use
English
ICEC provides guidance for adapting materials, taking into account such issues as local culture, language and literacy levels; local misperceptions or misinformation about EC; products used and distribution mechanisms.

What’s Next for EC?

The Unfinished Agenda: Next Steps to Increase Access to Emergency Contraception
English 
December 2013
Twenty years of global partnerships have resulted in a dramatic increase in the availability of emergency contraception products, yet closer examination reveals that access remains limited, especially in developing countries. This brief describes current access to EC, identifies access gaps and barriers, and investigates root causes of these gaps. Eight recommendations are made for advocates, policymakers and other partners working to improve access to EC.

Emergency Contraception: How far have we come? What’s new? What’s next?
Final Report: Online Discussion Forum, held March 2nd-16th, 2011
English
2011
ICEC, together with the World Health Organization’s Department of Reproductive Health and Research and their Implementing Best Practices (IBP) Initiative, hosted an on-line forum on EC in March 2011. Aimed at reproductive health and family planning service providers, academic/research professionals and country-level advocates, the forum explored EC access around the world, EC and post-rape care, EC’s mechanism of action and effectiveness, religious and legal opposition to EC, emerging and underutilized methods, and repeat use of EC. This report contains key information that was generated by the forum.

Improving Access to Emergency Contraception 
English Español Français Русский
July 2003
Despite endorsements of EC by the World Health Organization and others, and greater worldwide availability of dedicated ECPs, women’s access to this contraceptive method remains limited. This Policy Statement describes the need for improved access, reviews barriers, and recommends steps to improve access.

Country and Regional Fact Sheets and Case Studies

Bangladesh
Counting What Counts: Tracking Access to Emergency Contraception (2013)

Democratic Republic of the Congo                                                                             Counting What Counts: Tracking Access to Emergency Contraception (2015)
EnglishFrançais

Ethiopia
Counting What Counts: Tracking Access to Emergency Contraception (updated 2015)

Ghana
Counting What Counts: Tracking Access to Emergency Contraception (2013)

India
Counting What Counts: Tracking Access to Emergency Contraception (2013)

Indonesia
Involving Professional Associations and Religious Groups (updated 2006)

Kenya
Counting What Counts: Tracking Access to Emergency Contraception (2013)
Collaboration Is the Key to Success
(updated 2006)
Like Chocolate: Adolescent Emergency Contraception Use in Nairobi, PPT. (2006)

Latin America
Building Regional Alliances to Promote Emergency Contraception (2006)

Malawi
Counting What Counts: Tracking Access to Emergency Contraception (2014)

Mexico
Navigating a Politically Sensitive Landscape (updated 2006)

Nigeria
Counting What Counts: Tracking Access to Emergency Contraception (updated 2014)
Ensuring Access and Correct Use through Social Marketing (2006)

Niger
Counting What Counts: Tracking Access to Emergency Contraception (2014)
EnglishFrançais

Pakistan
Counting What Counts: Tracking Access to Emergency Contraception (2013)

Peru
Counting What Counts: Tracking Access to Emergency Contraception (updated 2013)

Rwanda
Counting What Counts: Tracking Access to Emergency Contraception (updated 2015)
EnglishFrançais

Senegal
Counting What Counts: Tracking Access to Emergency Contraception (updated 2015)
English Français

Sierra Leone                                                                                                               Counting What Counts: Tracking Access to Emergency Contraception (2014)

Sri Lanka
Ensuring Program Sustainability (2006)

Tanzania
Counting What Counts: Tracking Access to Emergency Contraception (2014)

Uganda
Counting What Counts: Tracking Access to Emergency Contraception (updated 2015)

Zambia
Partnerships Provide EC Access for Sexual Assault Victims (2006)
Emergency Contraception for Rape Survivors (Brochure) (2006)

ICEC Journal articles

Workforce interventions to improve access to emergency contraception pills: a systematic review of current evidence in low- and middle-income countries and recommendations for improving performance

Angela Dawson, Nguyen-Toan Tran, Elizabeth Westley, Viviana Mangiaterra, and Mario Festin

BMC Health Services Research, April 2015

This paper presents a narrative synthesis of research to: identify provider factors that facilitate and constraint access to ECP; assess the effectiveness of associated interventions and; explore associated health system issues in LMIC. The analysis revealed provider knowledge gaps, less than favorable attitudes, and practice issues. The findings provide limited insight into products prescribed and/or dispensed, the frequency of provision, and information and advice offered to consumers. As the provision of ECPs shifts from the clinic-based health sector to increasing provision by the private sector, the limited understanding of provider performance and the practice gaps revealed in this review highlight the need to further examine provider performance to inform the development of appropriate workforce interventions.

Improving Access to Emergency Contraception Pills through Strengthening Service Delivery and Demand Generation: A Systematic Review of Current Evidence in Low and Middle-Income Countries

Angela Dawson, Nguyen-Toan Tran, Elizabeth Westley, Viviana Mangiaterra, and Mario Festin

PLOS One, October 2014

This paper reports the results of a review to synthesize the current evidence on service delivery strategies to improve access to ECP. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models, and investment cases for ECP.

Emergency Contraception Review: Evidence-based Recommendations for Clinicians

Kelly Cleland, Elizabeth G. Raymond, Elizabeth Westley, and James Trussell

Clinical Obstetrics and Gynecology, September 2014

This article describes the methods of emergency contraception available in the United States, including efficacy, mode of action, safety, side effect profile, and availability. The most effective emergency contraceptive is the copper intrauterine device (IUD), followed by ulipristal acetate and levonorgestrel pills. Levonorgestrel is available for sale without restrictions, whereas ulipristal acetate is available with prescription only, and the copper IUD must be inserted by a clinician. Although EC pills have not been shown to reduce pregnancy or abortion rates at the population level, they are an important option for individual women seeking to prevent pregnancy after sex.

What some women want? On-demand oral contraception

Elizabeth G. Raymond, Tara Shochet, Jennifer Kidwell Drake, and Elizabeth Westley

Contraception, August 2014

This review summarized evidence regarding current demand for on-demand oral contraception from 19 studies across 16 countries. In these studies, 9–97% of women in the analysis populations reported using the pills on demand as main method, although frequency and consistency of use varied. Reported reasons for interest in or use of this contraceptive approach included convenience, ease of remembering, ability to conceal use, lack of coital interruption, and infrequent sexual activity. Data from a variety of settings suggest that demand for an on-demand oral contraceptive may be widespread. The effectiveness of this potential method is not established, however.

Knowledge and Use of Emergency Contraception: A Multicountry Analysis

Tia Palermo, Jennifer Bleck, and Elizabeth Westley

International Perspectives on Sexual and Reproductive Health, June 2014

This study examined knowledge and use of emergency contraception in 45 countries using population-based survey data. In every country surveyed but Colombia, fewer than 50% of women have ever heard of EC and fewer than 6% have ever used it. In general, the more educated women were or the wealthier they were, the more likely they were to have known about or used emergency contraception.

New Research in Emergency and Postcoital Contraception

Elizabeth Westley, Sarah Rich, and Hilary Lawton

Current Obstetrics and Gynecology Reports, April 2014

This publication reviews new developments in emergency contraception research, including women’s weight and EC effectiveness, repeat use of EC, and the need for EC as part of comprehensive post-rape care. Clinicians can play an important role in making EC information and services available to women by providing accurate information about EC generally and the specific options that may be most effective for each woman, including levonorgestrel, ulipristal acetate and the copper IUD.

A review of global access to emergency contraception

Elizabeth Westley, Nathalie Kapp, Tia Palermo, and Jennifer Bleck

International Journal of Gynecology and Obstetrics, June 2013

Although dedicated EC products have been on the market for close to 20 years, access remains limited, particularly for women in low-resource settings. This article reviews relevant policies, regulations and other factors related to EC access worldwide. While supportive policies and regulations are in place and EC products are registered in many countries around the world and included in many countries’ essential medicines lists, analysis of demographic data and health provider surveys shows that accessibility remains limited.

Social Marketing of emergency contraception: Are we missing a valuable opportunity?

Elizabeth Westley, Tara Shochet

Contraception, June 2013

Unmet need for family planning remains high globally, and women and men face challenges accessing both accurate information about contraception and contraceptive supplies. Contraceptive social marketing programs offer creative, effective and successful strategies to provide reproductive health (RH) products and services. Yet, the peer-reviewed literature contains few evaluations of social marketing of contraceptives, particularly those focused on emergency contraception (EC). These programs have the potential to reach women with affordable, quality emergency contraceptive products when and where they need them, and they can contribute substantially to women’s ability to access a range of contraceptive options.

Emergency contraception: global challenges, new opportunities

Elizabeth Westley, Eleanor Bimla Schwarz

Contraception, May 2012

Concerns continue about emergency contraception pills’ mechanism of action, impact on behavior, and safety, in spite of growing evidence refuting each of these claims. What is rarely discussed is the fact that few women anywhere in the world consistently have easy access to EC. Moreover, for those who are aware of EC, numerous access challenges remain, including concerns about privacy, cost, and in some settings, the ability to find a pharmacy with pills in stock. Policy and regulatory barriers also exist. These challenges point to a number of promising opportunities to expand global access to EC.

Emergency contraception: Update for pharmacists

Linda Dominguez, Donald F. Downing, Beth Jordan, Deborah Kurnik,
Eleanor B. Schwarz, James Trussell, and Elizabeth Westley

Pharmacy Today, June 2010

This article reviews published literature and websites of national organizations dedicated to EC to provide an update to pharmacists on EC. It highlights the unique role that pharmacists play in providing information access to EC to patients and provides technical information regarding EC including EC methods available in the U.S., effectiveness and safety, and the mechanism of action, as well as information on the impact of risk taking and unintended pregnancy, barriers to access, and over-the-counter regulatory availability.

Emergency contraception: dispelling the myths and misperceptions

Elizabeth Westley and Anna Glasier

World Health Organization Bulletin, 2010

This article discusses low global knowledge and use of EC and the role of the media in perpetuating misperceptions about EC. It encourages advocates to be prepared with the facts about EC to counter these myths.

Emergency contraception: have we come full circle?

Francine Coeytaux, Elisa S. Wells, and Elizabeth Westley

Contraception, July 2009

This article responds to analyses suggesting that EC is not as effective in reducing unwanted pregnancy rates at a population level as once hoped, and to the argument that women are “abusing” EC by using it repeatedly instead of using other more effective methods. The authors’ respond that EC still fills a unique and important role in the mix of available contraceptive methods, that it is effective enough to be promoted as a contraceptive option, and that women’s use of the method does not constitute a problem but rather contributes in a positive way to every woman’s challenge of how to avoid unplanned pregnancies.

From pilot to mainstream: a decade of working in partnerships to expand access to emergency contraception in Mexico

Raffaela Schiavon and Elizabeth Westley

Global Public Health, 2008

Mexico was one of the earliest countries working to expand EC access. Partners came together to pursue a synergistic four-pronged strategy, including product registration, health care provider training and orientation, awareness raising among the general public, and policy change. By 2006, five EC products were registered and sold in Mexico, EC was widely available through pharmacies and included in the public sector contraceptive options, and knowledge of the method had increased substantially.

Expanding access to emergency contraception

Elizabeth Westley, Helena von Hertzen, and Anibal Faundes

International Journal of Gynaecological Obstetrics, June 2007 (Epub April 2007)

Although EC is safe and has the potential to prevent unwanted pregnancies, its use remains low in most settings, due to a range of barriers to access. This paper reviews key issues related to EC and describes recommendations reached during the Women’s Health Alliance pre-Congress workshop, held in advance of the International Federation of Gynecology and Obstetrics (FIGO) 2006 World Congress. The working group concluded that national societies of obstetrics and gynecology can play an important role in increasing access to this unique contraceptive method.

Risk of pregnancy and external validity in clinical trials of emergency contraception

Elizabeth Westley, Alison Bigrigg, Anne Webb, Sue Haskell, Kelly Blanchard, Becca Loftus-Granberg, Annik Sorhaindo, Karen Johnston, Aileen Spiers, Katrina Abuabara, Charlotte Ellertson

Journal of Family Planning and Reproductive Health Care, July 2006

This article reviews a comparison of women who enroll in emergency contraception (EC) trials with those who decline and seeks to understand why eligible women decline to participate. Data were collected from nearly 6,000 women seeking EC at three clinics in the USA and UK during a period of nearly 1 year (from September 1997 to August 1998). The study found that women in EC trials are likely to face higher pregnancy risk than the general population.

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