Feature Articles

Characteristics of women requesting emergency contraception from the FPAHK

Ref Number: ESEAOR201208

  • Date1 Aug 2012
  • Category FPA Message
  • Targets Women
  • AuthorFPAHK
  • Topic Family Planning and Contraception

The August issue of the Hong Kong Medical Journal and the September issue of the International Journal of Gynecology and Obstetrics published two retrospective reviews on emergency contraceptive users in FPAHK.

Between 2006 and 2008, FPAHK had prescribed 11,014 courses of emergency contraception (EC) to 9,201 women, including 10,845 courses of levonorgestrel-only pills, 168 intrauterine contraceptive devices, and one course of pills plus intrauterine contraceptive device. The mean age of the users was 30 years old. Around two-thirds were nulliparous (65.6%) and did not have previous abortion (64.9%). Their three main reasons for requesting EC were: forgot to use contraceptive at the index intercourse (38.9%), condom accidents such as breakage and slippage (37.9%), and not using any regular contraceptives (20.6%). Those who forgot to use contraceptives and those who did not use regular contraceptives were more likely to have had a previous abortion. Out of the 11,014 episodes of EC use, 4,728 episodes (4,163 women) had completed one year follow-up. Among these 4,163 women, 89.4% of them had used EC only once in a year, 8.5% used it twice, 1.6% used it thrice and 0.5% used it four times and more. Repeat use (more than twice in a year) was significantly more prevalent in women with less stable relationship.

In all, 97.9% of women took EC within 72 hours of their unprotected intercourse; 97.8% had had a single act of unprotected intercourse. None of the intrauterine contraceptive device users became pregnant. The failure rate for emergency contraceptive pills was 1.8%. There was no significant association between emergency contraceptive pill failure and whether single or multiple episodes of unprotected intercourse had ensued before taking the pills (P=0.396) and whether pills were taken within or beyond 72 hours after the first episode of unprotected intercourse (P=0.222).

In this review, a positive change in contraceptive choice was observed among those who returned for follow-up. Out of the 11,014 episodes of EC use, contraceptive use data was available in 47.0% (5,181/11,014) at 6th months and 41.9% (4,615/11,014) at 12th month. The proportion of no regular contraceptives reduced from 20.6% at pre-EC visit to 4.5% at first follow-up, 3.9% at 6th month and 3.3% at 12th month. The proportion using more effective contraceptives increased from 3.5% at pre-EC visit to 19.9%, 26.9% and 27.0% at first follow-up, 6th and 12th month, respectively.

This study showed that many women who had unprotected sex were aware of the need to approach FPAHK early for emergency contraception, which led to satisfactory outcomes. The low rate of repeat use of EC and positive change in contraceptive choice after EC use is reassuring.