Baird Aisling Susan, Trussell James, Webb Anne
Consultant in Sexual and Reproductive Health, Abacus Community Sexual Health Service, Liverpool Community Health, Liverpool, UK.
Professor of Economics and Public Affairs, Office of Population Research, Princeton University, Princeton, NJ, USA and Visiting Professor, Hull York Medical School, University of Hull, Hull, UK.
J Fam Plann Reprod Health Care. 2015 Apr;41(2):116-21. doi: 10.1136/jfprhc-2013-100733. Epub 2014 May 28.
Previously we showed that increasing the choice of emergency contraception (EC) guided by medical eligibility did not result in wholesale large-scale usage of ulipristal acetate (UPA). This further 12-month study aimed to answer three questions. (1) Does offering choice of EC lead to change in methods used? (2) Are women who choose UPA more likely than those who choose levonorgestrel (LNG) to continue using condoms for subsequent contraception or to decline any ongoing contraception? (3) Do more women choosing LNG 'quick start' hormonal contraception?
A retrospective study of EC episodes (1 April 2012 to 31 March 2013) by quarters. Among women offered all three methods of EC (49.1%) we noted the method chosen, and decisions on ongoing contraception among those choosing either LNG or UPA. Differences were tested for statistical significance.
In 6110 episodes of EC, LNG was issued in 69.2%, UPA in 26.0%, and a copper intrauterine device (Cu-IUD) was fitted in 4.8%. Quarter by quarter, the data show a small decline in LNG use, suggesting plateauing by the last quarter, and a significant increase in UPA use between the first and the other three quarters (p<0.001). Use of the Cu-IUD remained static. The percentage of women offered three methods rose to 54.2%. In women offered full choice (3000; 49.1%) we saw a significant increase in choice of UPA, from 39.3% to 48.6% (p<0.001). Women who chose LNG were more likely to quick start (p=0.02) or be continuing contraception already used (p<0.001). Overall, those choosing UPA were more likely to use condoms (p<0.001) but were no more likely to decline ongoing contraception (p=0.13).
There was a significant increase in women using UPA for EC compared with our previous study, particularly among those wishing to use condoms for continuing contraception. Women choosing LNG were more likely to quick start pills or to continue current hormonal contraception. Detailed attention to continuing contraception following EC may be an important factor in the prevention of unwanted pregnancy.
此前我们发现，在医学适用性指导下增加紧急避孕（EC）方法的选择，并不会导致醋酸乌利司他（UPA）的大规模广泛使用。这项为期12个月的进一步研究旨在回答三个问题。（1）提供紧急避孕方法的选择是否会导致所使用方法的改变？（2）选择UPA的女性比选择左炔诺孕酮（LNG）的女性更有可能在后续避孕中继续使用避孕套或拒绝任何正在进行的避孕措施吗？（3）选择LNG的女性中，采用“快速启动”激素避孕法的人更多吗？
对2012年4月1日至2013年3月31日期间按季度进行的紧急避孕事件进行回顾性研究。在提供了所有三种紧急避孕方法的女性中（49.1%），我们记录了她们选择的方法，以及选择LNG或UPA的女性在持续避孕方面的决定。对差异进行统计学显著性检验。
在6110次紧急避孕事件中，LNG的发放率为69.2%，UPA为26.0%，铜宫内节育器（Cu-IUD）的放置率为4.8%。逐季度来看，数据显示LNG的使用略有下降，表明到最后一个季度趋于平稳，而UPA的使用在第一季度和其他三个季度之间显著增加（p<0.001）。Cu-IUD的使用保持稳定。提供三种方法的女性比例上升到54.2%。在提供了全部选择的女性中（3000人；49.1%），我们发现UPA的选择显著增加，从39.3%增至48.6%（p<0.001）。选择LNG的女性更有可能快速启动（p=0.02）或继续使用已有的避孕方法（p<0.001）。总体而言，选择UPA的女性更有可能使用避孕套（p<0.001），但拒绝正在进行的避孕措施的可能性并没有更高（p=0.13）。
与我们之前的研究相比，使用UPA进行紧急避孕的女性显著增加，尤其是在那些希望使用避孕套进行持续避孕的女性中。选择LNG的女性更有可能快速启动避孕药或继续使用当前的激素避孕法。在紧急避孕后对持续避孕给予详细关注可能是预防意外怀孕的一个重要因素。
