Same-day start contraception common, tied to low pregnancy risk

Key takeaways:

• More than 70% of participants initiated a new method of contraception on the same day they presented for care.
• Same-day start contraception resulted in a low risk for pregnancy in the first month of initiation.

Same-day start contraception was common and associated with a low pregnancy risk during the first month of initiation, regardless of emergency contraception use or recent unprotected intercourse, researchers reported.

Same-day start contraception was defined as initiation a new method of contraception the same day the patient presents for care, regardless of the timing of their last menstrual period.

“Providing same-day contraception is not only person-centered, but can also reduce an individual’s risk of unintended pregnancy and may improve the likelihood that they get their desired method,” Erica Torres, MPH, project facilitator with the Family Planning Elevated Program in the division of family planning in the department of obstetrics and gynecology at the University of Utah, and colleagues wrote. “Research so far lacks data assessing same-day start contraception efficacy in the first month of use across a variety of methods when the CDC pregnancy checklist criteria are not adhered to.”

Torres and colleagues evaluated outcomes for 3,568 women (mean age, 24.6 years) from the HER Salt Lake Contraceptive Initiative who initiated a new contraceptive method at four Planned Parenthood Association of Utah health centers in Salt Lake County from September 2015 to March 2017. All participants self-reported last menstrual period data and unprotected intercourse in the past 2 weeks and received contraception regardless of their menstrual cycle day or recent unprotected intercourse.

Researchers obtained information on contraceptive method initiation and oral emergency contraception use from clinical electronic health records. Participants reported pregnancy outcomes in follow-up surveys at 1, 3 and 6 months with clinic verification to identify pregnancies resulting from same-day start contraception initiation.

Primary outcomes were same-day start use frequency and first cycle pregnancy risk among same-day start users of all contraceptive methods. Secondary outcomes were frequency of and pregnancy risk in the first cycle of use among same-day start contraception users by contraceptive method.

Overall, 18.8% of participants used contraceptive implants, 12.5% used copper T 380A IUDs (Paragard, CooperSurgical), 23.2% used levonorgestrel 52 mg IUDs (Liletta, AbbVie/Medicines360), 12.4% used medroxyprogesterone acetate injections, 27.2% used oral hormonal contraceptives and 6% used combined vaginal hormonal contraceptives.

Results, published in the American Journal of Obstetrics and Gynecology, demonstrated that 72.2% of participants were same-day start users, of whom 12.5% reported unprotected intercourse in the past 5 days and 9.9% reported unprotected intercourse 6 to 14 days before contraception initiation.

Researchers observed 11 pregnancies occurring among same-day start users (prevalence = 0.4%; 95% CI, 0.2-0.7) compared with one pregnancy occurring among those who initiated contraception within 7 days from the last menstrual period (prevalence = 0.1%; 95% CI, 0.002-0.6). The greatest pregnancy risk was 1% among oral hormonal contraceptive same-day start users.

Of same-day start users, 6.8% used oral emergency contraception at enrollment in conjunction with another contraceptive method and a total of four pregnancies occurred.

“While most prior studies focused on same-day start of a specific contraception method, our study expands this to a more real-world setting assessing outcomes for a variety of contraceptive methods,” the researchers wrote. “Our results are consistent with the low pregnancy rates with same-day initiation of the contraceptive implant, levonorgestrel IUD, medroxyprogesterone acetate injection and oral contraceptives.”