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Ob-Gyns: Too Many Barriers to EC

October 22, 2012

Washington, DC -- Emergency contraception (EC) should be widely available and easily accessible to all women, according to a Committee Opinion issued today by The American College of Obstetricians and Gynecologists (The College). Age restrictions, cost, insurance coverage, and misconceptions about EC are all unnecessary barriers that continue keeping women from using this safe and effective method to prevent unwanted pregnancies in the first few days after unprotected sex, sexual assault, or contraceptive failure.

EC use can reduce the risk of pregnancy up to 120 hours (five days) after unprotected intercourse, but is most effective if used in the first 24 hours. Although oral EC is more common, the copper intrauterine device (IUD) is the most effective form of EC. Currently, the progestin-only oral EC methods are available over the counter (OTC) without a prescription to women age 17 and older. However, the antiprogestin oral EC method requires a prescription. The College continues advocating for the US Food and Drug Administration to remove the OTC age restriction because there is no scientific or medical reason for it. Ob-gyns are advised to write advance prescriptions for EC for adolescents under age 17 to prevent delayed access.

Private and public insurers are encouraged to cover all forms of EC and to publicize this coverage to their members. Any physician or pharmacist who objects to prescribing or dispensing EC should offer referrals to women who request the contraceptive.

The College stresses that EC does not cause abortion as evidence shows that it inhibits or delays ovulation. Additionally, women’s access to EC is not associated with less contraceptive use, less condom use, or more unprotected sex.

Committee Opinion #542 “Access to Emergency Contraception is published in the November issue of Obstetrics & Gynecology.

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Other recommendations issued in this month’s Obstetrics & Gynecology:

Committee Opinion #540 “Risk of Venous Thromboembolism Among Users of Drospirenone-Containing Oral Contraceptive Pills” (NEW!)
ABSTRACT: Although the risk of venous thromboembolism is increased among oral contraceptive users compared with nonusers who are not pregnant and not taking hormones, and some data have suggested that use of drospirenone-containing pills has a higher risk of venous thromboembolism, this risk is still very low and is much lower than the risk of venous thromboembolism during pregnancy and the immediate postpartum period. When prescribing any oral contraceptive, clinicians should consider a woman’s risk factors for venous thrombo­embolism and refer to the U.S. Medical Eligibility Criteria for Contraceptive Use issued by the Centers for Disease Control and Prevention. Patient education materials, including product labeling, should place information regarding oral contraceptive use and venous thromboembolism risks in context by also providing information about overall venous thromboembolism risks and venous thromboembolism risks during pregnancy and the postpartum period. Decisions regarding choice of oral contraceptive should be left to clinicians and their patients, taking into account the possible minimally increased risk of venous thromboembolism, patient preference, and available alternatives

Committee Opinion #541 “Professional Relationships with Industry” (NEW!)
ABSTRACT: The American College of Obstetricians and Gynecologists (the College) has a long history of leadership in ensuring that its educational mission is evidence based and unbiased. A predecessor to this Committee Opinion was published in 1985, making the College one of the first professional associations to pro­vide guidance on this issue. The College has continued to update the ethical guidance on physician interactions with industry periodically. Obstetrician–gynecologists’ relationships with industry should be structured in a manner that will enhance, rather than detract from, their obligations to their patients. The ideal behaviors set forth in this Committee Opinion will contribute toward maintaining patient trust in the specialty and avoiding conflicts of inter­est by College members

Practice Bulletin #131 “Screening for Cervical Cancer” (Revised)
ABSTRACT: The incidence of cervical cancer in the United States has decreased more than 50% in the past 30 years because of widespread screening with cervical cytology. In 1975, the rate was 14.8 per 100,000 women. By 2008, it had been reduced to 6.6 per 100,000 women. Mortality from the disease has undergone a similar decrease from 5.55 per 100,000 women in 1975 to 2.38 per 100,000 women in 2008 (1). The American Cancer Society (ACS) estimates that there will be 12,170 new cases of cervical cancer in the United States in 2012, with 4,220 deaths from the disease (2). Cervical cancer is much more common worldwide, particularly in countries without screening programs, with an estimated 530,000 new cases of the disease and 275,000 resultant deaths each year (3, 4). When cervical cancer screening programs have been introduced into communities, marked reductions in cervical cancer incidence have followed (5, 6). New technologies for cervical cancer screening continue to evolve as do recommendations for managing the results. In addition, there are different risk–benefit considerations for women at different ages, as reflected in age-specific screening recommendations. The ACS, the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) have recently updated their joint guidelines for cervical cancer screening (7), and an update to the U.S. Preventive Services Task Force recommendations also has been issued (8). The purpose of this document is to provide a review of the best available evidence regarding screening for cervical cancer.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 56,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org

 

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