Emergency Contraception: Why It Matters and How Nurses Can Improve Access

Family planning counseling, by Dick Schmidt / Sacramento Bee / Zuma Press

Unintended pregnancy can, in some circumstances, be detrimental to the health of both the women who become pregnant and the children born as a result. And such pregnancies happen far more often than you might think, accounting for nearly half of all pregnancies in this country, with even higher rates among women ages 18 to 24 and low-income women. Yet we have had the means to safely prevent such pregnancies for decades, through emergency contraception. Why isn’t emergency contraception used more often?

That’s a question author Kit Devine explores in “The Underutilization of Emergency Contraception,” one of April’s CE features. First, Devine describes the four methods currently available: conventional oral contraceptives and the copper intrauterine device (IUD)—both are used for birth control and can also be used to prevent pregnancy after intercourse has occurred—and the agents levonorgestrel and ulipristal acetate, which are FDA-approved for emergency contraception. Effectiveness ranges from 51% to 62% (for conventional oral contraceptives) to as high as 99% (for IUDs).

Known and likely barriers to their use include

• lack of provider and patient awareness.
• lack of communication between providers and patients.
• concerns about safety of use.
• religious or moral objections.
• access restrictions (such as restricted funding).

Devine incorporates the relevant research where applicable, and debunks several myths along the way—such as the belief that giving women access to emergency contraception will make them more likely to become repeat users. Research shows that it won’t.

Overcoming barriers. Devine describes numerous ways that these barriers can be overcome. For instance, she recounts a creative compromise reached between hospital administrators and religious leaders in one Texas health care system, noting that it exemplifies “the compromises that are possible when each side is willing to be educated by the other.” And she offers specific guidance for RNs and NPs; emphasizing the importance of patient education, she writes:

Advanced practice nurses, particularly those who care for adolescents, can improve patient understanding of and access to emergency contraceptives by explaining to both male and female patients, at every visit, how emergency contraception works and how to obtain it.

The article is free online, as is this podcast conversation between the author and Karen Roush, AJN’s clinical managing editor.