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Emergency Contraception | KFF

Emergency contraception (EC) is a type of backup contraception that can be utilized as much as a number of days after unprotected intercourse or contraceptive failure and nonetheless stop a being pregnant. In 1999, Plan B was the primary oral product authorized to be used within the U.S. as an EC by the Meals and Drug Administration (FDA). Since then, extra EC merchandise have been authorized. Many have confused EC capsules with mifepristone, the “abortion capsule,” however EC capsules don’t trigger abortion. EC capsules stop being pregnant by delaying or inhibiting ovulation and won’t work if the being pregnant is established. This reality sheet critiques the strategies of EC, identified mechanisms of motion, use of EC, and present nationwide and state insurance policies affecting EC entry.

What’s EC?

EC is used as a back-up contraception methodology to stop being pregnant within the occasion of unprotected intercourse, sexual assault, or a contraceptive failure, akin to a condom breaking. ECs don’t terminate a being pregnant, cease the implantation of a fertilized egg, or have an effect on a growing embryo. There are a number of strategies of EC which can be obtainable within the U.S. together with progestin-based capsules, ulipristal acetate, and intrauterine gadgets (IUDs) (Desk 1). The copper and levonorgestrel IUDs can be utilized after unprotected intercourse and as ongoing common contraceptive strategies. EC capsules are solely for use after unprotected intercourse and aren’t meant to be used as a daily methodology.

Progestin-Based mostly Capsules

  • Plan B was the primary oral type of EC to be made obtainable within the U.S. as a pre-packaged dose of capsules containing the progestin, levonorgestrel. Now, there are generic alternate options obtainable as effectively. Progestin-based EC capsules use the identical hormones present in every day oral contraceptives and are essentially the most broadly used type of EC. EC capsules are marketed right this moment below the model identify Plan B One-Step and generic names (Desk 1).
  • Progestin-based EC capsules don’t interrupt or adversely affect a longtime being pregnant, nor are they medical abortion medication like mifepristone or methotrexate that finish a longtime being pregnant. Plan B One-Step and the generic variations stop being pregnant by inhibiting or delaying ovulation or by making it tougher for sperm to succeed in an egg.
  • Progestin-based EC is to be taken inside 72 hours of unprotected intercourse with a purpose to be handiest and cut back the probability of being pregnant by 81% to 90% when taken on this timeframe.
  • There are not any identified critical uncomfortable side effects related to progestin-based EC; uncomfortable side effects could embody bleeding or recognizing, complications, nausea, and breast tenderness.
  • Some analysis has steered that efficacy of progestin-based EC is decrease amongst ladies with Physique Mass Index (BMI) ranges larger than 25. Nevertheless, in Could 2016 the FDA introduced that it had reviewed the obtainable scientific knowledge concerning the effectiveness of EC capsules in obese and overweight ladies, and that the information are inconclusive and didn’t advocate a labeling change.
  • Progestin-based capsules will be saved for a number of years, with Plan B One Step having a shelf-life of 4 years when saved as directed. Shoppers ought to all the time verify the expiration date on the packaging previous to taking the capsule.

Ulipristal acetate: ella

  • Ulipristal acetate, marketed as ella, was authorized by the FDA in 2010 on the market and use within the U.S.
  • ella is a single-dose capsule that’s efficient in stopping being pregnant as much as 5 days after unprotected intercourse, giving ladies an extended timeframe to stop unintended being pregnant than Plan B. Its mechanism of motion is much like that of progestin-based EC.
  • Examine findings present that uncomfortable side effects for ella are similar to these for Plan B, and a few analysis means that its effectiveness seems to decrease at BMI thresholds above 35.

Mixed/Mixture Capsules

  • Sure every day oral contraceptive capsules may act as EC when taken in doses 4 or 5 occasions increased than the every day dose, though they aren’t particularly bought as emergency contraception. Oral contraceptive capsules comprise progestin and estrogen and are taken in two doses 12 hours aside to be efficient as EC.
  • Mixed capsules have been discovered to be protected and efficient for stopping being pregnant inside 5 days of intercourse.

Copper-T IUD: Paragard

  • Out there to ladies for the reason that Nineteen Seventies, copper-T IUDs are the best types of EC, decreasing the danger of being pregnant by greater than 99% when inserted inside 5 days of unprotected intercourse. IUDs are inserted into the uterus by a well being care supplier and require a go to to a clinic or supplier’s workplace. In addition they can be utilized to successfully stop subsequent being pregnant for as much as 10 years.
  • The hormone-free copper-T IUD works by interfering with egg fertilization by stopping sperm from reaching the egg. Earlier analysis suggests the copper IUD inhibits implantation of a fertilized egg, however this mechanism of motion has not been conclusively confirmed.
  • Efficacy of copper IUDs doesn’t diminish in ladies who’re obese or overweight.

Levonorgestrel IUD: Mirena and Liletta

  • Levonorgestrel IUDs are a kind of hormonal IUD that comprise the progestin levonorgestrel. To this point, solely levonorgestrel IUDs that comprise 52 mg of levonorgestrel (LNG 52 mg IUDs) have been studied as a type of EC. LNG 52 mg IUDs are marketed below the model names Mirena and Liletta.
  • Like copper-T IUDs, LNG IUDs are inserted into the uterus by a clinician and require a go to to a clinic. LNG IUDs can subsequently be used as a daily type of contraception for as much as seven years.
  • Levonorgestrel IUDs lately began getting used as a way of EC, and analysis has discovered that LNG 52 mg IUDs will be as efficient as copper-T IUDs when inserted inside 5 days after unprotected intercourse or contraceptive failure. The hormonal IUD prevents egg fertilization by making the cervical mucus impenetrable to sperm.
  • Efficacy of levonorgestrel IUDs doesn’t diminish in ladies who’re obese or overweight.

Ladies’s Use of EC

There have been quite a few public well being and academic initiatives to extend use of EC.

  • Use of EC capsules has elevated over the previous 20 years. Between 2017 and 2019, the latest years for which knowledge are presently obtainable, 28% of ladies ages 15 to 44 who’ve ever had intercourse with a male reported that they had used EC capsules at the very least as soon as of their lives, a rise from 4% in 2002 (Determine 1).

  • Youthful ladies usually tend to report that they’ve ever used EC (Determine 2). Multiple third of ladies ages 15-24 (34%) and girls ages 25-34 (36%) say they’ve taken EC capsules, in comparison with 17% of ladies ages 35-44. Roughly one in three Hispanic, Black, and White ladies (30%, 27%, and 28%, respectively) report ever taking EC.

Entry and Availability

At the very least one type of oral EC has been obtainable within the U.S. for over a decade and there have been a number of efforts to broaden ladies’s entry to EC, notably since its effectiveness window is time-limited.

Over the Counter Entry of EC Capsules

  • Previous to 2006, a prescription was wanted for all people in search of EC capsules. Between 2006 and February 2014, Plan B and its generic equal have been obtainable and not using a prescription for women and men 17 and older, however adolescents below 17 wanted a prescription.
  • In 2014, the FDA eliminated point-of-sale age necessities for Plan B obtained over-the-counter (OTC) and generic variations started to enter the OTC market. At present, a number of generic manufacturers of EC capsules, together with Subsequent Alternative One Dose, My Means, Fall Again Solo, Take Motion, levonorgestrel pill, and Aftera can be found OTC to ladies of all ages.
  • A prescription continues to be required for ella for girls of all ages.

Value and Protection

  • The Inexpensive Care Act (ACA) requires most new non-public well being plans (particular person and group) to cowl with out cost-sharing all FDA-approved contraceptive medication and gadgets as prescribed, together with emergency contraception. Which means though OTC formulations are obtainable and not using a prescription, the capsules are solely required to be coated by insurance coverage in the event that they have been prescribed. Personal insurance coverage should additionally cowl the price of IUDs, in addition to providers associated to insertion, observe up and elimination, with out value sharing. Nevertheless, there have been quite a few experiences of people having to pay out-of-pocket for contraception that they imagine ought to have been totally coated, together with for providers associated to the insertion and elimination of IUDs.
  • 12 states and D.C. require non-public medical health insurance plans to cowl over-the-counter contraceptives, with none cost-sharing, together with EC. For employer-sponsored plans, state protection necessities usually apply solely to fully-insured plans and to not self-funded plans.
  • Household planning providers is a required profit below Medicaid. The protection necessities below Medicaid are totally different for states which have expanded eligibility below the ACA. These applications should cowl all prescribed, FDA-approved contraceptives, that means that they have to cowl EC capsules if a lady has a prescription. States have discretion in deciding whether or not they embody EC of their conventional full-scope Medicaid applications or household planning growth applications. A 2021 survey of state Medicaid applications discovered that whereas all responding states cowl at the very least one type of EC of their conventional Medicaid applications, some states impose amount limits. Texas doesn’t cowl EC by its household planning program.
  • With out a prescription or insurance coverage, ladies in most states accessing EC OTC should pay the retail value. Plan B capsules and the generic variations common can vary from $10 to $50 when bought OTC. With out insurance coverage, the price of IUDs can vary from $500 to $1,300.
  • People with out medical health insurance or who’re ineligible for Medicaid could possibly get hold of free or low-cost EC (along with different reproductive well being care providers) by a clinic or neighborhood well being middle taking part within the federal Title X household planning program. The Title X program might also be an possibility for lower-income people coated by employer-sponsored medical health insurance plans that aren’t required to cowl contraception as a result of they existed previous to the ACA (generally known as “grandfathered” plans) or as a result of their employer excludes protection of emergency contraception primarily based on a non secular or ethical objection to it. Whatever the pathway, eligibility for this system is predicated on the person’s family revenue and prices are primarily based on a sliding price scale.

On-line Contraceptive Platforms

  • New markets have emerged, notably for the reason that begin of the COVID-19 pandemic, that enable individuals to acquire well being care providers with out the necessity for an in-person go to, together with a number of on-line reproductive well being providers platforms and smartphone apps the place a person can get hold of hormonal contraceptives, together with EC capsules, exterior of conventional well being care settings.
  • These on-line platforms and apps usually make use of licensed medical professionals to find out a consumer’s eligibility and to prescribe contraception in an analogous method to a clinic. The affected person is then both mailed their contraceptives or their prescription is distributed to a close-by pharmacy for pick-up.
  • Some, however not all, of those platforms settle for non-public insurance coverage and/or Medicaid, and there may be appreciable variation in out-of-pocket prices for individuals who self-pay.

Provision of EC in Well being Care Settings

  • A number of main medical and public well being organizations, such because the American Academy of Pediatrics, American Faculty of Obstetricians and Gynecologists, and the American Public Well being Affiliation, endorse using EC and advocate for broader entry to EC.
  • Counseling and protection of EC is included as a regular of care within the federal necessities for offering High quality Household Planning Companies (QFP). Suppliers are inspired to debate EC with their sufferers, inform them of its availability, and supply them with a complicated provide of EC capsules if the affected person requests them. Advance provision of EC can enhance the possibilities that somebody can have EC readily available and use it when wanted, however analysis has discovered that few clinicians repeatedly present advance provision of EC capsules.
  • There have been ongoing efforts to make EC extra available to survivors of sexual assault. At present, 16 states and the District of Columbia require that emergency room employees present EC to ladies after sexual assault (Determine 3). Nevertheless, some research have documented {that a} sizable share of clinicians aren’t totally knowledgeable about EC choices, security, and efficacy. Moreover, some neighborhood well being facilities have reported challenges stocking IUDs attributable to excessive prices.
  • In 2015, Indian Well being Service (IHS) clarified its coverage on entry to the OC capsule for Native American ladies, together with {that a} prescription or age verification to entry Plan B isn’t required.

Availability and Entry in Pharmacies

  • Seven states – CA, HI, MA, ME, NH, NM, and WA – have legal guidelines that enable pharmacists to immediately prescribe EC to ladies of all ages with out acquiring a clinician’s prescription.
  • 4 states – CA, NJ, WA, WI– have measures that require pharmacies or pharmacists to fill all legitimate prescriptions. These insurance policies have been enacted, partially, in response to experiences of pharmacists refusing to fill prescriptions for EC capsules as a result of they oppose its use on ethical or non secular grounds.
  • Seven states – AR, AZ, GA, ID, IL, MS, SD – have legal guidelines permitting pharmacies and/or pharmacists to refuse to dispense EC capsules on the premise of ethical or non secular objections.
  • Pharmacies aren’t required to inventory EC capsules and a few research present that EC capsules that could be bought OTC aren’t persistently stocked on retailer cabinets and are generally stored behind the counter or in a locked show because of the excessive value of the product. This report additionally documented misinformation regrading age and ID necessities amongst pharmacy employees and shoppers.

***

Three in ten ladies of reproductive age within the U.S. report that they’ve used EC capsules. Emergency contraception’s use has elevated considerably because it first got here to market within the U.S. over 20 years in the past, and IUDs have been discovered to be efficient as emergency contraception as effectively. Entry to EC has expanded because of the FDA granting over-the-counter standing for progestin-based EC capsules plus the contraceptive protection necessities below the ACA. On the similar time, EC has been the thing of intensive misinformation, with some misrepresenting it as an abortifacient. Entry to EC continues to be debated by policymakers at each the state and federal ranges and can possible proceed to be a spotlight of coverage discussions within the years to return.

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