Journal of Pediatric and Adolescent Gynecology
Volume 22, Issue 2 , Pages 111-119, April 2009

Emergency Contraception Services for Adolescents: a National Survey of Children's Hospital Emergency Department Directors

  • Megan L. Kavanaugh, DrPH

      Affiliations

    • Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
    • Corresponding Author InformationAddress correspondence to: Megan L. Kavanaugh, DrPH, Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038
    • ,
  • Richard A. Saladino, MD

      Affiliations

    • Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
    • ,
  • Melanie A. Gold, DO

      Affiliations

    • Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

Abstract 

Study Objective

To assess emergency contraception (EC) counseling and prescribing practices of children's hospital emergency department (ED) directors and the use of EC protocols in these settings.

Design

Cross-sectional study of children's hospital ED directors responding to a 15-minute 44-item semi-structured survey during telephone interviews.

Participants

50 of 96 eligible directors of children's hospital EDs in the United States.

Main Outcome Measures

EC protocols, EC counseling processes, EC prescribing practices.

Results

Most (80%) ED directors reported always offering EC as part of sexual assault care; 66% were more likely to provide onsite EC in these situations. Only 52% identified the progestin-only regimen as the EC dispensed in their ED, and most (96%) limited provision to fewer than 120hours after sex. Although 58% of ED directors reported ever prescribing ongoing contraception when providing EC, none had prescribed EC for future use. Written ED protocols for providing EC were more common for sexual assault care (76%) than for non-sexual assault care (14%). Directors who worked at hospitals with a sexual assault program were less likely to discuss all the recommended topics for EC counseling.

Conclusions

The recommended standard of care for providing EC to adolescents in children's hospital EDs is not being met. Although risk of pregnancy following sexual assault and consensual unprotected sex is identical, discrepant practices emerged from this survey of pediatric ED directors. Increased education and policy initiatives within children's hospital EDs are needed to standardize EC services for adolescents in this setting.

Keywords: Emergency contraception, Emergency departments, Adolescents, Hospital protocols, Children's hospitals, Sexual assault

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 Research is partially supported by the Association of Reproductive Health Professionals Gary Stewart Scholarship for Public Health Research and by the University of Pittsburgh Women's Studies Student Research Fund Award.

 Presented as an oral abstract at Reproductive Health 2007, Minneapolis, MN, September 27, 2007.

PII: S1083-3188(08)00141-1

doi:10.1016/j.jpag.2008.04.002

Journal of Pediatric and Adolescent Gynecology
Volume 22, Issue 2 , Pages 111-119, April 2009

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