Provision of Emergency Contraception in an STD

ClinicEvaluation of a pilot project in

New York City

New York City Department of Health and Mental Hygiene (NYCDOHMH)

Bureau of Maternal, Infant and Reproductive Health

Bureau of Sexually Transmitted Disease Control

Background Emergency Contraception (EC)

• Definition -- Use of a drug or device to prevent pregnancy after intercourse

• Action --• prevents ovulation• disrupts fertilization • inhibits transport of the egg or sperm or

implantation in the uterus

• EC IS NOT A MEDICAL ABORTION

BackgroundEmergency Contraception (EC)

Types:• Insertion of a copper intrauterine device (IUD)

• Emergency contraceptive pills (ECPs)

Preven (estrogen and progestin) – FDA approved 98’

Plan B (progestin only) – FDA approved 99’• Two doses:• 1 tablet within 72 hours of unprotected intercourse • 2nd tablet taken 12 hours later

Background New York City (NYC)

• March 2003 the NYCDOHMH designated staff to conduct a pilot project evaluating integration of EC into STD clinic services

• March 18, 2003 NYC Council passed local law 19 requiring the integration of EC into public STD clinic services

• Local law 19 took effect July 18, 2003

Objectives of EC Pilot Project

• Assess ability to integrate EC services into STD clinic services

• Determine the value of integrating EC services into STD clinic services

Outcomes of Interest• Assess number of women eligible to receive

EC at a NYC STD clinic

• Assess number of women eligible to receive EC that were offered EC

• Assess number of women accepting EC

• Compare the characteristics of women attending for EC only to those seeking an STD exam

MethodsEvaluation Design

• Pilot site: Jamaica, Queens STD clinic

• Population: women attending Jamaica, Queens clinic for first visit between 4/16/03 – 11/10/03

• Data collection: data extracted from clinic medical record, database developed to capture information

MethodsDetermining Eligibility

• Women– first visit to clinic (not follow up)– not surgically sterilized– not pregnant, and did not desire pregnancy– had unprotected vaginal intercourse in the

72 hours before clinic visit

MethodsOffered EC/Accepting EC

• Offered EC – eligible women who were offered EC

• Accepting EC – eligible women who accepted the offer of EC

MethodsSTD Morbidity

• STD Morbidity – diagnosed with, or contact to any of the following:

Chlamydia, Gonorrhea, genital Herpes infection, Human papillomavirus, Mucopurulent cervicitis, Non gonococcal urethritis, Pelvic inflammatory disease, pubic lice, Syphilis, Trichomonas vaginalis

Reason for Visit

• EC Only

• HIV Test Only

• STD evaluation– Routine exam / pap smear– Symptoms– Contact– Women listing EC, HIV testing among

reasons for visit

Results EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03

Age (Years) N %

<14 8 0.5

15 – 19 391 26.0

20 – 24 484 32.2

25 – 29 225 15.0

30 – 34 127 8.4

35 – 39 121 8.0

40 – 44 68 4.5

> 45 80 5.3

Missing 1 0.1

Total 1505 100

Results EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03

Race / Ethnicity N %

Black Non-Hispanic 1056 70.2

Hispanic/Latino 247 16.4

White Non-Hispanic 66 4.4

Asian Pacific-Islander 43 2.9

American Indian/Alaskan Native 12 0.8

Other 72 4.8

Missing 9 0.6

Total 1505 100

Results

EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03

Usual Method of Contraception N %

None / Natural 604 40.1

Barrier 547 36.3

Hormonal 119 7.9

IUD 7 0.5

Hormonal and Barrier 14 0.9

Surgical Sterilization 47 3.1

Missing 167 11.1

Total 1505 100

Results - EC Eligibility

EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03

1st time female visitsN = 1505

STD EvaluationN = 1160

EC OnlyN = 91

HIV C&T OnlyN = 56

Repro hx present

N = 1103

Repro hx missingN = 57

Repro hx presentN = 88

Repro hx missingN = 3

EC EligibleN = 192(17%)

EC eligibleN = 58(66%)

Reason MissingN = 198

Total = 250 women eligible

Results - EC Acceptance EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03

N %

Assessed for EC Eligibility 1191

Eligible to Receive EC 250 21.0

Offered EC 146 58.4

Accepted EC 95 65.1

Comparison of EC-only to STD Evaluation

Age

EC only

(n=91)

STD Evaluation

(n=1098)Total

(n=1198)

< 19 years 43 (12%) 303 (88%) 346

> 20 years 48 (6%) 795 (94%) 843

p < .01

Contraception

None/Natural/Barrier 86 (9%) 916 (91%) 1002

Hormonal/IUD 1 (0.9%) 112 (99.1%) 113

p < .01

Race / Ethnicity

Black Non-Hispanic 57 (16%) 837 (94%) 894

All Other Races 33 (9%) 319 (91%) 352

p =.085

Comparison of EC-only to STD Evaluation

STD Morbidity1

EC Only

(n=27)

STD Evaluation

(n=839)Total

(n=866)

1 (.2%) 495 (99.8%) 496

p < .01

1 STD morbidity assessed among women who had a physical exam

Conclusions• Of the 1505 women attending the Jamaica clinic during the pilot, 6% attended

the clinic for EC only

• 40% of women reported using no contraception and 36% reported use of barrier as usual method

• 21% of women were eligible to receive EC

• 58% of women EC eligible were offered EC

• EC accepted by majority of eligible women offered EC

• 1 of 27 women attending for EC only, who had a physical exam, were diagnosed with an STD

Implications

• Clinic utilization should be monitored to assure introduction of EC does not reduce the number of women seen for STD evaluation

• STD morbidity should be monitored among women seeking EC only to guide decisions regarding the value of screening in this group

Acknowledgements

Bureau of STD Control

Julia A. Schillinger

Susan Blank

Susan Wright

Maushumi Mavinkurve

Linda Kupferman

Robin Recant

Bureau of Maternal Infant & Reproductive Health

Nalda Mussington

Lili Farhang

Deborah Kaplan