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Over-the-counter provision of emergency contraceptive pills: a systematic review.
Atkins, Kaitlyn; Kennedy, Caitlin E; Yeh, Ping Teresa; Narasimhan, Manjulaa.
  • Atkins K; Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Kennedy CE; Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Yeh PT; Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Narasimhan M; Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland narasimhanm@who.int.
BMJ Open ; 12(3): e054122, 2022 03 14.
Article in English | MEDLINE | ID: covidwho-1741631
ABSTRACT

OBJECTIVE:

To synthesise evidence around over-the-counter (OTC) emergency contraceptive pills (ECPs) to expand the evidence base on self-care interventions.

DESIGN:

Systematic review (PROSPERO# CRD42021231625). ELIGIBILITY CRITERIA We included publications comparing OTC or pharmacy-access ECP with prescription-only ECPs and measuring ECP uptake, correct use, unintended pregnancy, abortion, sexual practices/behaviour, self-efficacy and side-effects/harms. We also reviewed studies assessing values/preferences and costs of OTC ECPs. DATA SOURCES We searched PubMed, CINAL, LILACS, EMBASE, clinicaltrials.gov, WHO International Clinical Trials Registry Platform, Pan African Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, Cochrane Fertility Regulation and International Consortium for Emergency Contraception through 2 December 2020. RISK OF BIAS For trials, we used Cochrane Collaboration's tool for assessing risk of bias; for other studies, we used the Evidence Project risk of bias tool. DATA EXTRACTION AND

SYNTHESIS:

We summarised data in duplicate using Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence Profile tables, reporting findings by study design and outcome. We qualitatively synthesised values/preferences and cost data.

RESULTS:

We included 19 studies evaluating effectiveness of OTC ECP, 56 on values/preferences and 3 on costs. All studies except one were from high-income and middle-income settings. Broadly, there were no differences in overall ECP use, pregnancy or sexual behaviour, but an increase in timely ECP use, when comparing OTC or pharmacy ECP to prescription-only ECP groups. Studies showed similar/lower abortion rates in areas with pharmacy availability of ECPs. Users and providers generally supported OTC ECPs; decisions for use were influenced by privacy/confidentiality, convenience, and cost. Three modelling studies found pharmacy-access ECPs would lower health sector costs.

CONCLUSION:

OTC ECPs are feasible and acceptable. They may increase access to and timely use of effective contraception. Existing evidence suggests OTC ECPs do not substantively change reproductive health outcomes. Future studies should examine OTC ECP's impacts on user costs, among key subgroups and in low-resource settings.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pharmacies / Contraceptives, Postcoital / Contraception, Postcoital Type of study: Experimental Studies / Prognostic study / Qualitative research / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Female / Humans / Pregnancy Country/Region as subject: Oceania Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2021-054122

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pharmacies / Contraceptives, Postcoital / Contraception, Postcoital Type of study: Experimental Studies / Prognostic study / Qualitative research / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Female / Humans / Pregnancy Country/Region as subject: Oceania Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2021-054122