• This program is sponsored by the Association of Reproductive Health Professionals (ARHP).
• Original content for this program was authored by James Trussell, PhD, with funding from the David and Lucille Packard Foundation.
• This presentation may include information that is not on FDA-required product labels.
• NOTE TO SPEAKER: Please disclose any financial relationship(s) you have with industry.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Emergency contraception (EC) is a therapy for women who have had unprotected sexual intercourse, including sexual assault, and want to avoid pregnancy.
• The two most common reasons for seeking EC are failure of a barrier method (usually condoms) and failure to use any contraceptive method.
• This presentation discusses the clinical issues related to emergency contraception.
• By the end of this presentation, participants should be able to:
• Understand progestin-only ECP product regimen
• Identify mechanism of action of ECPs
• Understand link between EC and risk-taking behavior

• ACOG Practice Bulletin, Number 69: Emergency Contraception. Obstet Gynecol; 2005 Dec; 106(6):1443-51.
• Stewart F, Trussell J, Van Look PFA. Emergency Contraception. In Hatcher RA, Trussell, J Nelson AL, Cates W, Stewart FH, Kowal D (eds). Contraceptive Technology: Nineteenth Revised Edition. Ardent Media: New York NY, 2007. Pp.87--116

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• ACOG Practice Bulletin, Number 69: Emergency Contraception. Obstet Gynecol; 2005 Dec; 106(6):1443-51.
• Stewart F, Trussell J, Van Look PFA. Emergency Contraception. In Hatcher RA, Trussell, J Nelson AL, Cates W, Stewart FH, Kowal D (eds). Contraceptive Technology: Nineteenth Revised Edition. Ardent Media: New York NY, 2007. Pp.87--116

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Plan B is the dedicated progestin-only ECP product available in the United States.
• Two studies have shown that both doses of Plan B (both Plan B pills) can be taken at the same time
• With no reduction in effectiveness
• With no increase in side effects
• One study has shown that two doses of Plan B taken 24 hours apart are just as effective as doses taken 12 hours apart
• Two studies have shown that Plan B is effective up to 120 hours after intercourse

• Arowojolu AO, Okewole IA, Adekunle AO. Comparative evaluation of the effectiveness and safety of two regimens of levonorgestrel for emergency contraception in Nigerians. Contraception 2002;66:269-273.
• von Hertzen H, Piaggio G, Ding J, Chen J, Song S, Bártfai G, Ng E, Gemzell-Danielsson K, Oyunbileg A, Wu S, Cheng W, Lüdicke F, Pretnar-Darovec A, Kirkman R, Mittal S, Khomassuridze A, Apter D, Peregoudov A. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomized trial. Lancet 2002;360:1803-1810.
• Ngai SW, Fan S, Li S, Cheng L, Ding J, Jing X, Ng EHY, Ho PC. A randomized trial to compare 24h versus 12h double dose regimen of levonorgestrel for emergency contraception. Hum Reprod 2004;20:307-311.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• EC may theoretically prevent pregnancy through several mechanisms. The two leading theories which have been the most intensively studied are inhibition of ovulation and prevention of implantation through disruption of the endometrium.
• Other possible mechanisms include:
• Trapping of sperm in cervical mucus
• Inhibition of tubal transport
• Direct effects on the viability of the embryo.
• There has been little specific human research on these last three mechanisms, however, and thus no direct evidence exists to support or refute them. Specifically, theories of post-fertilization effects of EC cannot be studied because there is no test for fertilization itself.
• Today therefore I will only review the data related to effects of the regimen on ovulation and on the endometrium.

• Trussell J, Jordan B. Mechanism of action of emergency contraceptive pills. Contraception. 2006 Aug; 74(2):87-9.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• We know from the clinical evidence that progestin-only ECPs can:
• Inhibit or delay ovulation
• Alter glycodelin in serum and endometrium (but the clinical significance of this finding is unknown)
• Shorten or lengthen the next menstrual period, depending on when in the cycle ECPs were taken
• Interfere with sperm motility and function in the genital tract by altering uterine pH

• Kesseru E, Garmendia F, Westphal N, Parada J. The hormonal and peripheral effects of d-norgestrel in postcoital contraception. Contraception 1974;10:411-424.
• Durand M, del Carmen Cravioto M, Raymond EG, Durán-Sánchez O, De la Luz Cruz-Hinojosa L, Castell-Rodríguez A, Schiavon R, Larrea F. On the mechanisms of action of short-term levonorgestrel administration in emergency contraception. Contraception 2001;64:227-234.
• Croxatto HB, Devoto L, Durand M, Ezcurra E, Larrea F, Nagle C, Ortiz ME, Vantman D, Vega M, von Hertzen H. Mechanism of action of hormonal preparations used for emergency contraception: a review of the literature. Contraception 2001;63:111-121.
• Hapangama D, Glasier AF, Baird DT. The effects of peri-ovulatory administration of levonorgestrel on the menstrual cycle. Contraception 2001;63:123-129.
• Marions L, Hultenby K, Lindell I, Sun X, Ståbi B, Gemzell Danielsson K. Emergency contraception with mifepristone and levonorgestrel: mechanism of action. Obstet Gynecol 2002;100:65-71.
• Croxatto HB, Ortiz ME, Müller AL. Mechanisms of action of emergency contraception. Steroids 2003;68:1095-1098.
• Marions L, Cekan SZ, Bygdeman M, Gemzell-Danielsson K. Effect of emergency contraception with levonorgestrel or mifepristone on ovarian function. Contraception 2004;69:373-377.
• Croxatto HB, Brache V, Pavez M, Cochon L, Forcelledo ML, Alvarez F, Massai R, Faundes A, Salvatierra AM. Pituitary-ovarian function following the standard levonorgestrel emergency contraceptive dose or a single 0.75-mg dose given on the days preceding ovulation. Contraception 2004;70:442-450.
• Durand M, Sépala M, del Carmen Cravioto M, Koistinen H, Koistinen R, González-Macedo J, Larrea F. Late follicular phase administration of levonorgestrel as an emergency contraceptive changes the secretory pattern of glycodelin in serum and endometrium during the luteal phase of the menstrual cycle. Contraception 2005;71:451-457.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• We know that LNg ECPs can inhibit ovulation, but does not always do so even when given before ovulation. Inhibiting ovulation may be the only mechanism of action.
• The evidence regarding the effect of LNg ECPs on the endometrium is mixed and is hard to interpret - older studies seem to show profound effects, but more recent studies do not. It’s unclear also whether the effects that are seen are sufficient to prevent implantation.
• One study has also shown incidentally that the regimen may affect levels of various hormones, but again exactly how these changes prevent pregnancy is unclear.

• Kesseru E, Garmendia F, Westphal N, Parada J. The hormonal and peripheral effects of d-norgestrel in postcoital contraception. Contraception 1974;10:411-424.
• Durand M, del Carmen Cravioto M, Raymond EG, Durán-Sánchez O, De la Luz Cruz-Hinojosa L, Castell-Rodríguez A, Schiavon R, Larrea F. On the mechanisms of action of short-term levonorgestrel administration in emergency contraception. Contraception 2001;64:227-234.
• Croxatto HB, Devoto L, Durand M, Ezcurra E, Larrea F, Nagle C, Ortiz ME, Vantman D, Vega M, von Hertzen H. Mechanism of action of hormonal preparations used for emergency contraception: a review of the literature. Contraception 2001;63:111-121.
• Hapangama D, Glasier AF, Baird DT. The effects of peri-ovulatory administration of levonorgestrel on the menstrual cycle. Contraception 2001;63:123-129.
• Marions L, Hultenby K, Lindell I, Sun X, Ståbi B, Gemzell Danielsson K. Emergency contraception with mifepristone and levonorgestrel: mechanism of action. Obstet Gynecol 2002;100:65-71.
• Croxatto HB, Ortiz ME, Müller AL. Mechanisms of action of emergency contraception. Steroids 2003;68:1095-1098.
• Marions L, Cekan SZ, Bygdeman M, Gemzell-Danielsson K. Effect of emergency contraception with levonorgestrel or mifepristone on ovarian function. Contraception 2004;69:373-377.
• Croxatto HB, Brache V, Pavez M, Cochon L, Forcelledo ML, Alvarez F, Massai R, Faundes A, Salvatierra AM. Pituitary-ovarian function following the standard levonorgestrel emergency contraceptive dose or a single 0.75-mg dose given on the days preceding ovulation. Contraception 2004;70:442-450.
• Durand M, Sépala M, del Carmen Cravioto M, Koistinen H, Koistinen R, González-Macedo J, Larrea F. Late follicular phase administration of levonorgestrel as an emergency contraceptive changes the secretory pattern of glycodelin in serum and endometrium during the luteal phase of the menstrual cycle. Contraception 2005;71:451-457.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Study done in the rat and the Cebus monkey
• Levonorgestrel administered in doses that inhibit ovulation has no postfertilization effect that impairs fertility

• Müller AL, Llados CM, Croxatto HB. Postcoital treatment with levonorgestrel does not disrupt postfertilization events in the rat. Contraception 2003;67:415-419.
• Ortiz ME, Ortiz RE, Fuentes MA, Parraguez VH, Croxatto HB. Postcoital administration of levonorgestrel does not interfere with post-fertilization events in the new-world monkey Cebus apella. Hum Reprod 2004;19:1352-1356.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Based on what we know about the mechanisms of action for ECPs, hormonal contraceptives, IUDs, and the contraceptive effects of breastfeeding – all of these methods may prevent a fertilized egg from implanting in the uterine lining and becoming a pregnancy.

• Statement on Contraceptive Methods. Washington DC: American College of Obstetricians and Gynecologists, July 1998.
• Díaz S, Cárdenas H, Brandeis A, Miranda P, Salvatierra AM, Croxatto HB. Relative contributions of anovulation and luteal phase defect to the reduced pregnancy rate of breastfeeding women. Fertil Steril 1992;58:498-503.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• ECPs—like all regular hormonal contraceptives such as the birth control pill, the implant Implanon, the vaginal ring NuvaRing, the OrthoEvra patch, and the injectable Depo-Provera, and even breastfeeding—may prevent pregnancy by delaying or inhibiting ovulation, inhibiting fertilization, or inhibiting implantation of a fertilized egg.

• Davidoff F, Trussell J. Plan B and the politics of doubt. J Am Med Assoc 2006;296:1775-8177.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Women should be informed that the best available evidence is consistent with the hypothesis that Plan B’s ability to prevent pregnancy can be fully accounted for by mechanisms that do not involve interference with post-fertilization events.

• Davidoff F, Trussell J. Plan B and the politics of doubt. J Am Med Assoc 2006;296:1775-8177.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Studies have been conducted around the world to examine whether ECPs impact risk-taking behavior.
• We have empirical evidence from 1 study in Scotland, 3 in San Francisco, 1 in Pittsburgh, 1 in Hong Kong, 1 in China, 2 in Los Angeles, and 1 in Nevada & North Carolina; results from each of these studies can be found in the appendix of this presentation.

• Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998;339:1-4.
• Raine T, Harper C, Leon K, Darney P. Emergency contraception: advance provision in a young, high-risk clinic population. Obstet Gynecol 2000;96:1-7.
• Jackson RA, Schwarz EB, Freedman L, Darney P. Advance supply of emergency contraception: effect on use and usual contraception?a randomized trial. Obstet Gynecol 2003;102:8-16.
• Gold MA, Wolford JE, Smith KA, Parker AM. The effects of advance provision of emergency contraception on Adolescent women’s sexual and contraceptive behaviors. J Pediatr Adolesc Gynecol 2004;17:87-96.
• Lo SS, Fan SYS, Ho PC, Glasier AF. Effect of advanced provision of emergency contraception on women’s contraceptive behavior: a randomized controlled trial. Hum Reprod 2004;19:2404-2410.
• Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial. JAMA 2005;293:54-62.
• Hu X, Cheng L, Hua X, Glasier A. Advanced provision of emergency contraception to postnatal women in China makes no difference in abortion rates: a randomized controlled trial. Contraception 2005;72:111-116.
• Raymond EG, Stewart F, Weaver M, Monteith C, Van Der Pol B. Impact of increased access to emergency contraceptive pills: a randomized controlled trial. Obstet Gynecol 2006;108:1098-1106
• Belzer M, Sanchez K, Olson J, Jacobs AM, Tucker D. Advance supply of emergency contraception: a randomized trial in adolescent mothers. J Pediatr Adolesc Gynecol 2005; 18(5):347-54.
• Trussell J, Raymond E, Stewart FH. Re: Advance supply of emergency contraception. J Pediatr Adolesc Gynecol 2006;19(3):251.
• Walsh TL, Frezieres RG. Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only. Contraception. 2006; 74(2):110-7

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• In these studies, women were randomized to receive either: (1) counseling and access to ECPs on demand, or (2) ECPs in advance for later use should the need arise.

• Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998;339:1-4.
• Raine T, Harper C, Leon K, Darney P. Emergency contraception: advance provision in a young, high-risk clinic population. Obstet Gynecol 2000;96:1-7.
• Jackson RA, Schwarz EB, Freedman L, Darney P. Advance supply of emergency contraception: effect on use and usual contraception?a randomized trial. Obstet Gynecol 2003;102:8-16.
• Gold MA, Wolford JE, Smith KA, Parker AM. The effects of advance provision of emergency contraception on Adolescent women’s sexual and contraceptive behaviors. J Pediatr Adolesc Gynecol 2004;17:87-96.
• Lo SS, Fan SYS, Ho PC, Glasier AF. Effect of advanced provision of emergency contraception on women’s contraceptive behavior: a randomized controlled trial. Hum Reprod 2004;19:2404-2410.
• Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial. JAMA 2005;293:54-62.
• Hu X, Cheng L, Hua X, Glasier A. Advanced provision of emergency contraception to postnatal women in China makes no difference in abortion rates: a randomized controlled trial. Contraception 2005;72:111-116.
• Raymond EG, Stewart F, Weaver M, Monteith C, Van Der Pol B. Impact of increased access to emergency contraceptive pills: a randomized controlled trial. Obstet Gynecol 2006;108:1098-1106
• Belzer M, Sanchez K, Olson J, Jacobs AM, Tucker D. Advance supply of emergency contraception: a randomized trial in adolescent mothers. J Pediatr Adolesc Gynecol 2005; 18(5):347-54.
• Trussell J, Raymond E, Stewart FH. Re: Advance supply of emergency contraception. J Pediatr Adolesc Gynecol 2006;19(3):251.
• Walsh TL, Frezieres RG. Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only. Contraception. 2006; 74(2):110-7

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• In Nevada and North Carolina: 71% of women receiving ECPs in advance used them versus 32% of women who received only counseling (p<.001)
• 2 studies in Los Angeles found that women who received ECPs in advance were more likely to use them than women who received only counseling:
• 86% vs 11% at 6 months and 64% vs 17% at 12 months in Study 1 (p<.01)
• 19% vs 12% in Study 2 (p<.05)
• In Hong Kong: 30% of women receiving ECPs in advance used them versus 13% of women who received only counseling (p<.001)
• In Pittsburgh: 15% of women receiving ECPs in advance used them versus 8% of women who received only counseling (p<.05)
• 3 studies in San Francisco found that women who received ECPs in advance were more likely to use them than women who received only counseling:
• 22% vs 7% in Study 1 (p=.006)
• 17% vs 4% in Study 2 (p=.006)
• 37% vs 21% in Study 3 (p<.001)
• In Scotland: 47% of women receiving ECPs in advance used them versus 27% of women who received only counseling (p<.001)

• Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998;339:1-4.
• Raine T, Harper C, Leon K, Darney P. Emergency contraception: advance provision in a young, high-risk clinic population. Obstet Gynecol 2000;96:1-7.
• Jackson RA, Schwarz EB, Freedman L, Darney P. Advance supply of emergency contraception: effect on use and usual contraception?a randomized trial. Obstet Gynecol 2003;102:8-16.
• Gold MA, Wolford JE, Smith KA, Parker AM. The effects of advance provision of emergency contraception on Adolescent women’s sexual and contraceptive behaviors. J Pediatr Adolesc Gynecol 2004;17:87-96.
• Lo SS, Fan SYS, Ho PC, Glasier AF. Effect of advanced provision of emergency contraception on women’s contraceptive behavior: a randomized controlled trial. Hum Reprod 2004;19:2404-2410.
• Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial. JAMA 2005;293:54-62.
• Hu X, Cheng L, Hua X, Glasier A. Advanced provision of emergency contraception to postnatal women in China makes no difference in abortion rates: a randomized controlled trial. Contraception 2005;72:111-116.
• Raymond EG, Stewart F, Weaver M, Monteith C, Van Der Pol B. Impact of increased access to emergency contraceptive pills: a randomized controlled trial. Obstet Gynecol 2006;108:1098-1106
• Belzer M, Sanchez K, Olson J, Jacobs AM, Tucker D. Advance supply of emergency contraception: a randomized trial in adolescent mothers. J Pediatr Adolesc Gynecol 2005; 18(5):347-54.
• Trussell J, Raymond E, Stewart FH. Re: Advance supply of emergency contraception. J Pediatr Adolesc Gynecol 2006;19(3):251.
• Walsh TL, Frezieres RG. Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only. Contraception. 2006; 74(2):110-7

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Women who received ECPs in advance were not more likely to:
• Use ECPs repeatedly
• Have unprotected sex
• Change to less effective contraception
• Use contraception less consistently
• Acquire an STI (in the three studies that measured STIs)

• Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998;339:1-4.
• Raine T, Harper C, Leon K, Darney P. Emergency contraception: advance provision in a young, high-risk clinic population. Obstet Gynecol 2000;96:1-7.
• Jackson RA, Schwarz EB, Freedman L, Darney P. Advance supply of emergency contraception: effect on use and usual contraception?a randomized trial. Obstet Gynecol 2003;102:8-16.
• Gold MA, Wolford JE, Smith KA, Parker AM. The effects of advance provision of emergency contraception on Adolescent women’s sexual and contraceptive behaviors. J Pediatr Adolesc Gynecol 2004;17:87-96.
• Lo SS, Fan SYS, Ho PC, Glasier AF. Effect of advanced provision of emergency contraception on women’s contraceptive behavior: a randomized controlled trial. Hum Reprod 2004;19:2404-2410.
• Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial. JAMA 2005;293:54-62.
• Hu X, Cheng L, Hua X, Glasier A. Advanced provision of emergency contraception to postnatal women in China makes no difference in abortion rates: a randomized controlled trial. Contraception 2005;72:111-116.
• Raymond EG, Stewart F, Weaver M, Monteith C, Van Der Pol B. Impact of increased access to emergency contraceptive pills: a randomized controlled trial. Obstet Gynecol 2006;108:1098-1106
• Belzer M, Sanchez K, Olson J, Jacobs AM, Tucker D. Advance supply of emergency contraception: a randomized trial in adolescent mothers. J Pediatr Adolesc Gynecol 2005; 18(5):347-54.
• Trussell J, Raymond E, Stewart FH. Re: Advance supply of emergency contraception. J Pediatr Adolesc Gynecol 2006;19(3):251.
• Walsh TL, Frezieres RG. Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only. Contraception. 2006; 74(2):110-7

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Women who received ECPs in advance:
• Took ECPs sooner after sex
• Had the same contraceptive use patterns as women who received counseling and had access to ECPs on demand
• HOWEVER, women who received ECPs in advance were also NOT less likely to become pregnant as women who received only counseling and had access to ECPs on demand.

• Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998;339:1-4.
• Raine T, Harper C, Leon K, Darney P. Emergency contraception: advance provision in a young, high-risk clinic population. Obstet Gynecol 2000;96:1-7.
• Jackson RA, Schwarz EB, Freedman L, Darney P. Advance supply of emergency contraception: effect on use and usual contraception?a randomized trial. Obstet Gynecol 2003;102:8-16.
• Gold MA, Wolford JE, Smith KA, Parker AM. The effects of advance provision of emergency contraception on Adolescent women’s sexual and contraceptive behaviors. J Pediatr Adolesc Gynecol 2004;17:87-96.
• Lo SS, Fan SYS, Ho PC, Glasier AF. Effect of advanced provision of emergency contraception on women’s contraceptive behavior: a randomized controlled trial. Hum Reprod 2004;19:2404-2410.
• Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial. JAMA 2005;293:54-62.
• Hu X, Cheng L, Hua X, Glasier A. Advanced provision of emergency contraception to postnatal women in China makes no difference in abortion rates: a randomized controlled trial. Contraception 2005;72:111-116.
• Raymond EG, Stewart F, Weaver M, Monteith C, Van Der Pol B. Impact of increased access to emergency contraceptive pills: a randomized controlled trial. Obstet Gynecol 2006;108:1098-1106
• Belzer M, Sanchez K, Olson J, Jacobs AM, Tucker D. Advance supply of emergency contraception: a randomized trial in adolescent mothers. J Pediatr Adolesc Gynecol 2005; 18(5):347-54.
• Trussell J, Raymond E, Stewart FH. Re: Advance supply of emergency contraception. J Pediatr Adolesc Gynecol 2006;19(3):251.
• Walsh TL, Frezieres RG. Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only.Contraception. 2006; 74(2):110-7

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• In August 2006, James Trussell, Elizabeth Raymond and Chelsea Polis systematically reviewed data on effects of increased access to emergency contraceptive pills on pregnancy rates and use of the pills.
• Data sources included MEDLINE, POPLINE, EMBASE, and LILACS, and study authors consulted with experts.
• Authors included studies that compared the effect of different levels of access to emergency contraceptive pills on pregnancy rates, use of the pills, and other outcomes.
• Eight of the ten studies conducted to test whether easy assess to ECPs increased risk taking also measured pregnancies
• In none of the eight did advance provision of ECPs reduce pregnancy rates
• However, only three studies were powered to detect a decrease in pregnancy rates

• Raymond EG, Trussell J, Polis C. Population effect of increased access to emergency contraceptive pills: a systematic review. Obstet Gynecol 2007;109:181-188.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• In San Francisco almost half of the women in the advance provision group who had unprotected intercourse did not use ECPs
• In China, 30 of the 38 pregnancies in the advance provision group occurred to women who did not use ECPs in that cycle
• In Nevada/NC, 57 of the 74 pregnancies in the advance provision group occurred to women who did not use ECPs in that cycle
• Note that only three trials were designed to study the impact of increased availability of ECPs on pregnancy.

• Lo SS, Fan SYS, Ho PC, Glasier AF. Effect of advanced provision of emergency contraception on women’s contraceptive behavior: a randomized controlled trial. Hum Reprod 2004;19:2404-2410.
• Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial. JAMA 2005;293:54-62.
• Hu X, Cheng L, Hua X, Glasier A. Advanced provision of emergency contraception to postnatal women in China makes no difference in abortion rates: a randomized controlled trial. Contraception 2005;72:111-116.
• Raymond EG, Stewart F, Weaver M, Monteith C, Van Der Pol B. Impact of increased access to emergency contraceptive pills: a randomized controlled trial. Obstet Gynecol 2006;108:1098-1106

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• In Scotland:
• About 1 in 5 women aged 16-29 got ECPs in advance to take home
• About half of these used ECPs at least once

• Glasier A, Fairhurst K, Wyke S, Ziebland S, Seaman P, Walker J, Lakha F. Advanced provision of emergency contraception does not reduce abortion rates. Contraception 2004;69:361-366

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• In Scotland:
• No effect on abortion rates was observed
• 78% of women with advance supplies who got pregnant did not use ECPs.
• Women most at risk probably did not get ECPs

• Glasier A, Fairhurst K, Wyke S, Ziebland S, Seaman P, Walker J, Lakha F. Advanced provision of emergency contraception does not reduce abortion rates. Contraception 2004;69:361-366

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Two trials in which women were randomly assigned to Plan B or Yuzpe regimen.
• Pregnancy rate in Plan B arm was 51% of the rate in the Yuzpe arm.
• Plan B is 49% effective if Yuzpe regimen is completely ineffective.
• If, for example, Yuzpe regimen is 60% effective, then Plan B is 79% effective.

• Raymond E, Taylor D, Trussell J, Steiner MJ. Minimum effectiveness of the levonorgestrel regimen of emergency contraception. Contraception 2004;69:79-81

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Women underestimate their risk of pregnancy
• More education is needed
• OTC switch is necessary – but not sufficient – for solving this problem
• Major public health impact is unlikely
• ECPs are not used frequently enough!

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Jump-starting contraception after taking EC provides better pregnancy protection
• If a woman waits until her next period to start contraception she may have additional instances of unprotected sex and get pregnant

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Two studies specifically designed to assess the effects of ECPs containing 1.5 mg levonorgestrel taken in a single dose on bleeding patterns

• Raymond EG, Goldberg A, Trussell J, Hays M, Roach E, Taylor D. Bleeding Patterns after Use of Levonorgestrel Emergency Contraceptive Pills. Contraception. 2006 Apr;73(4):376-81.
• Gainer E, Kenfack B, Mboudou E, Doh AS, Bouyer J. Menstrual bleeding patterns following levonorgestrel emergency contraception. Contraception 2006;74:118-124

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• The first study found that when taken in the first three weeks of the menstrual cycle, ECPs significantly shortened that cycle compared both to the usual cycle length and to the cycle duration in a comparison group of similar women who had not taken ECPs.
• The magnitude of this effect was greater the earlier the pills were taken.
• This regimen taken later in the cycle had no effect on cycle length, but it did cause prolongation of the next menstrual period.
• The ECPs had no effect on the duration of the post-treatment menstrual cycle, but the second period was prolonged.
• Intermenstrual bleeding was uncommon after ECP use, although more common than among women who had not taken ECPs.

• Raymond EG, Goldberg A, Trussell J, Hays M, Roach E, Taylor D. Bleeding Patterns after Use of Levonorgestrel Emergency Contraceptive Pills. Contraception. 2006 Apr;73(4):376-81.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• The second study compared the baseline cycle with the treatment and post-treatment cycles.
• Cycle length was significantly shortened by one day when ECPs were taken in the preovulatory phase of the cycle and was significantly lengthened by two days when ECPs were taken in the postovulatory phase. No difference in cycle length was observed for women who took ECPs during the periovulatory phase of the cycle (from two days before to two days after the expected day of ovulation).
• Menstrual period duration increased significantly when ECPs were taken in the periovulatory or postovulatory phase in both the treatment and post-treatment cycles.
• The duration of the post-treatment menstrual cycle remained significantly longer when ECPs were taken in the postovulatory phase.
• During the treatment cycle, 15% of women experienced intermenstrual bleeding; this was significantly more common when ECPs were taken in the preovulatory phase.

• Gainer E, Kenfack B, Mboudou E, Doh AS, Bouyer J. Menstrual bleeding patterns following levonorgestrel emergency contraception. Contraception 2006;74:118-124

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• The EC Hotline and Website are operated by the Office of Population Research at Princeton University and by the Association of Reproductive Health Professionals.
• These resources are not connected with any companies that manufacture or sell emergency contraceptives.
• The EC Hotline and Website were developed to increase women's knowledge about and timely access to EC.
• Each month there are about 6,000 calls to the hotline and 120,000 visits to the Web site.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• The EC Hotline and Website includes hundreds of health care providers in private practice, family planning clinics, hospitals, pharmacies, and other types of health care settings who offer information about and prescriptions for emergency contraception (for females under age 18).

• www.not-2-late.com

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• On August 24, 2006, the FDA approved Plan B to be sold without a prescription to women and men 18 and older in the United States.
• A government-issued ID is required for proof of age to purchase Plan B OTC.
• When Plan B is purchased OTC, insurance does not longer cover the cost.
• Women age 17 and younger still need a prescription from a health care professional except in states with pharmacy access
• “Pharmacy access” means specially trained pharmacists can decide if EC is medically appropriate for the woman requesting it and can dispense ECPs without an advance prescription in those cases. No proof of age is necessary in those states.
• States that currently have pharmacy access in place: AK, CA, HI, NH, NM, MA, ME, MT, VT, and WA.

• Food and Drug Administration. Plan B®: Questions and Answers: August 24, 2006, updated December 14, 2006. Available at http://www.fda.gov/cder/drug/infopage/planB/planBQandA20060824.htm. Accessed April 13, 2007.
• Pharmacy Access Partnership. What Consumers Need to Know about Obtaining Plan B® Over-the-Counter in Pharmacies. January 2007. Available at http://www.pharmacyaccess.org/pdfs/ConsumerFAQsOTC.pdf. Accessed April 4, 2007.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• In states with pharmacy access, women and men of any age (including those age 17 and younger) can access ECPs directly from the pharmacy, without a prescription.
• “Pharmacy access” means specially trained pharmacists can decide if EC is medically appropriate for the woman requesting it and can dispense ECPs without an advance prescription in those cases. No proof of age is necessary in those states.
• States that currently have pharmacy access in place: AK, CA, HI, NH, NM, MA, ME, MT, VT, and WA.
• Several countries also allow access to ECPs directly from a pharmacist without a prescription.

• www.not-2-late.com

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• This map shows the current locations of pharmacies in states with pharmacy access to ECPs, regardless of age.

• www.not-2-late.com

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998;339:1-4

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998;339:1-4

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Raine T, Harper C, Leon K, Darney P. Emergency contraception: advance provision in a young, high-risk clinic population. Obstet Gynecol 2000;96:1-7

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Raine T, Harper C, Leon K, Darney P. Emergency contraception: advance provision in a young, high-risk clinic population. Obstet Gynecol 2000;96:1-7

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Jackson RA, Schwarz EB, Freedman L, Darney P. Advance supply of emergency contraception : effect on use and usual contraception?a randomized trial. Obstet Gynecol 2003;102:8-16.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Jackson RA, Schwarz EB, Freedman L, Darney P. Advance supply of emergency contraception : effect on use and usual contraception?a randomized trial. Obstet Gynecol 2003;102:8-16.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial. JAMA 2005;293:54-62.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial. JAMA 2005;293:54-62.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial. JAMA 2005;293:54-62.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial. JAMA 2005;293:54-62.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Gold MA, Wolford JE, Smith KA, Parker AM. The effects of advance provision of emergency contraception on Adolescent women’s sexual and contraceptive behaviors. J Pediatr Adolesc Gynecol 2004;17:87-96.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Lo SS, Fan SYS, Ho PC, Glasier AF. Effect of advanced provision of emergency contraception on women’s contraceptive behavior: a randomized controlled trial. Hum Reprod 2004;19:2404-2410.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Lo SS, Fan SYS, Ho PC, Glasier AF. Effect of advanced provision of emergency contraception on women’s contraceptive behavior: a randomized controlled trial. Hum Reprod 2004;19:2404-2410.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Hu X, Cheng L, Hua X, Glasier A. Advanced provision of emergency contraception to postnatal women in China makes no difference in abortion rates: a randomized controlled trial. Contraception 2005;72:111-116.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Belzer M, Sanchez K, Olson J, Jacobs AM, Tucker D. Advance supply of emergency contraception: a randomized trial in adolescent mothers. J Pediatr Adolesc Gynecol. 2005;18:347-354.
• Trussell J, Raymond E, Stewart FH. Letter to the editor. J Pediatr Adolesc Gynecol. 2006;19:251-252.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Belzer M, Sanchez K, Olson J, Jacobs AM, Tucker D. Advance supply of emergency contraception: a randomized trial in adolescent mothers. J Pediatr Adolesc Gynecol. 2005;18:347-354.
• Trussell J, Raymond E, Stewart FH. Letter to the editor. J Pediatr Adolesc Gynecol. 2006;19:251-252.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Walsh TL, Frezieres RG. Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only. Contraception 2006;74:110-117.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Walsh TL, Frezieres RG. Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only. Contraception 2006;74:110-117.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Raymond EG, Stewart F, Weaver M, Monteith C, Van Der Pol B. Impact of increased access to emergency contraceptive pills: a randomized controlled trial. Obstet Gynecol 2006;108:1098-1106.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.

• Raymond EG, Stewart F, Weaver M, Monteith C, Van Der Pol B. Impact of increased access to emergency contraceptive pills: a randomized controlled trial. Obstet Gynecol 2006;108:1098-1106.

- - -
Original content for this slide submitted by James Trussell, PhD, in May 1999. Original funding
received from the David and Lucille Packard Foundation. Revised content for this slide
submitted by James Trussell, PhD, in April 2007. Last reviewed/updated by Linda Dominguez,
RN-C, NP, Don Downing, RPh, and James Trussell, PhD, in April 2007. This slide is available at
www.arhp.org/core.