Selection and correct use of emergency contraception by race and ethnicity

Introduction: In an over-the-counter simulation study, approximately 90% of women aged 13-17 were able to appropriately self-select and correctly use single-dose 1.5 mg levonorgestrel emergency contraception (EC). Previous studies have found adolescents’ contraceptive use and unintended pregnancies vary by race/ethnicity (Abma, December 2004; Finer, November 2011). This post-hoc analysis examines appropriate self-selection and correct EC use by race/ethnicity.

Methods: This noncomparative case series enrolled adolescents from reproductive health clinics in 5 metropolitan areas. Participants self-reported race/ethnicity and reason(s) for requesting EC. After reviewing package information, participants indicated whether they would use EC. Study staff reviewed information provided by participants to determine whether they had appropriately self-selected in accordance with package labeling and whether they had correctly used EC (within 72 hours following unprotected sex).

Results: Appropriate self-selection rates in each group were: Latina—90.5% (133/147), Asian/Pacific Islander—89.7% (61/68), African American—81.3% (39/48), White—97.4% (38/39), Multiracial—91.3% (21/23), Other—94.4% (17/18). Percentages of women who correctly used EC (after appropriate self-selection and dispensing) were: Latina—90.7% (117/129), Asian/Pacific Islander—88.5% (54/61), African American—84.8% (28/33), White—86.8% (33/38), Multiracial—85.7% (18/21), Other—86.7% (13/15).

Conclusions: Percentages of participants who appropriately self-selected and correctly used EC were high (81%-97%). The reports of incorrect use are consistent with prior research demonstrating variation in contraceptive adherence by race/ethnicity. Although the single-dose 1.5 mg levonorgestrel EC is now available over-the-counter to women of all ages, pharmacists should serve as resources for teens who request guidance on appropriate self-selection and correct use.