AMERICAN ACADEMY OF PEDIATRICS

POLICY STATEMENT Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of All Children

Committee on Adolescence

Emergency Contraception

ABSTRACT. Teen birth rates in the have ods of contraception.7–10 Estimates of use suggest declined during the last decade but remain much higher that emergency contraception has contributed substan- than rates in other developed countries. Reduction of tially to the decrease in reported rates in recent unintended during adolescence and the asso- years.5 Yet, comparison of teen birth rates in the United ciated negative consequences of early pregnancy and States with those of other developed countries suggests early childbearing remain public health concerns. Emer- that US rates are still 2 to 10 times higher.11 The birth gency contraception has the potential to significantly reduce teen-pregnancy rates. This policy statement pro- rate for 15- to 17-year-olds in the United States remains vides pediatricians with a review of emergency contra- twice that of Canada and England and 10 times higher ception, including a definition of emergency contracep- than the rates in France and Sweden.12 Thus, unin- tion, formulations and potential adverse effects, efficacy tended pregnancy and its consequences for the adoles- and mechanisms of action, typical use, and safety issues, cent age group and society remain a focus of individual including contraindications. This review includes teens’ and public health concern.12 and young adults’ reported knowledge and attitudes Reduction of unintended pregnancy is best achieved about hormonal emergency contraception and issues by strategies that include developing and implement- of access and availability. The American Academy of ing effective programs to delay and reduce sexual ac- Pediatrics, as well as other professional organizations, tivity, increasing the use of effective contraceptives, supports over-the-counter availability of emergency con- traception. In previous publications, the American Acad- and improving knowledge about the correct use of emy of Pediatrics has addressed the issues of adolescent different contraceptive methods. Strategies to reduce pregnancy and other methods of contraception. Pediat- unplanned should include improving the rics 2005;116:1026–1035; contraception, emergency contra- knowledge, accessibility, and availability of contracep- ception, adolescent pregnancy. tive services, including emergency contraception.1,13 It is estimated that appropriate use of emergency contra- ABBREVIATIONS. FDA, US Food and Drug Administration; OC, ception could reduce the number of unintended preg- oral contraceptive. nancies each year by half and thereby similarly reduce the abortion rate.5 BACKGROUND ost teen pregnancies are unplanned and DEFINITION OF EMERGENCY CONTRACEPTION pose a significant societal cost and potential “Emergency contraception” in this policy refers to Mindividual risk. For 15- to 19-year-old teens the use of hormonal medications within 72 to 120 who become pregnant in the United States, 74% to hours after unprotected or underprotected coitus for 95% describe their pregnancies as unintended.1,2 In the prevention of unintended pregnancy.14,15 This 1999 (the most recent data available), approximately includes the products labeled and dedicated for use 56.5% of teenage pregnancies ended in live births, as emergency contraception by the US Food and 28.5% in induced abortion, and 15% in or Drug Administration (FDA) and the “off-label” use stillbirth.3 Since 1990, birth rates for 15- to 19-year- of combination oral contraceptives (OCs) described olds in the United States have declined by 28% to a in the literature since 1974.16 In the United States l