1. Provision of Emergency Contraception in an STD Clinic Evaluation of a pilot project in New York City New York City Department of Health and Mental Hygiene (NYCDOHMH) Bureau of Maternal, Infant and Reproductive Health Bureau of Sexually Transmitted Disease Control

2. Background Emergency Contraception (EC) Definition -- Use of a drug or device to prevent pregnancy after intercourse Action -- prevents ovulation disrupts fertilization inhibits transport of the egg or sperm or implantation in the uterus EC IS NOT A MEDICAL ABORTION

3. Background Emergency Contraception (EC) Types: Insertion of a copper intrauterine device (IUD) Emergency contraceptive pills (ECPs) Preven (estrogen and progestin) – FDA approved 98 Plan B (progestin only) – FDA approved 99 Two doses: 1 tablet within 72 hours of unprotected intercourse 2nd tablet taken 12 hours later

4. Background New York City (NYC) March 2003 the NYCDOHMH designated staff to conduct a pilot project evaluating integration of EC into STD clinic services March 18, 2003 NYC Council passed local law 19 requiring the integration of EC into public STD clinic services Local law 19 took effect July 18, 2003

5. Objectives of EC Pilot Project Assess ability to integrate EC services into STD clinic services Determine the value of integrating EC services into STD clinic services

6. Outcomes of Interest Assess number of women eligible to receive EC at a NYC STD clinic Assess number of women eligible to receive EC that were offered EC Assess number of women accepting EC Compare the characteristics of women attending for EC only to those seeking an STD exam

7. Methods Evaluation Design Pilot site: Jamaica, Queens STD clinic Population: women attending Jamaica, Queens clinic for first visit between 4/16/03 – 11/10/03 Data collection: data extracted from clinic medical record, database developed to capture information

8. Methods Determining Eligibility Women –first visit to clinic (not follow up) –not surgically sterilized –not pregnant, and did not desire pregnancy –had unprotected vaginal intercourse in the 72 hours before clinic visit

9. Methods Offered EC/Accepting EC Offered EC – eligible women who were offered EC Accepting EC – eligible women who accepted the offer of EC

10. Methods STD Morbidity STD Morbidity – diagnosed with, or contact to any of the following: Chlamydia, Gonorrhea, genital Herpes infection, Human papillomavirus, Mucopurulent cervicitis, Non gonococcal urethritis, Pelvic inflammatory disease, pubic lice, Syphilis, Trichomonas vaginalis

11. Reason for Visit EC Only HIV Test Only STD evaluation –Routine exam / pap smear –Symptoms –Contact –Women listing EC, HIV testing among reasons for visit

12. Results EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03 Age (Years)N% <14 8 0.5 15 – 1939126.0 20 – 2448432.2 25 – 2922515.0 30 – 34127 8.4 35 – 39121 8.0 40 – 44 68 4.5 > 45 80 5.3 Missing 1 0.1 Total1505100

13. Results EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03 Race / EthnicityN% Black Non-Hispanic105670.2 Hispanic/Latino 24716.4 White Non-Hispanic 664.4 Asian Pacific-Islander 432.9 American Indian/Alaskan Native 120.8 Other 724.8 Missing 90.6 Total1505100

14. Results EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03 Usual Method of ContraceptionN% None / Natural60440.1 Barrier54736.3 Hormonal1197.9 IUD 70.5 Hormonal and Barrier140.9 Surgical Sterilization 473.1 Missing16711.1 Total1505100

15. Results - EC Eligibility EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03 1 st time female visits N = 1505 STD Evaluation N = 1160 Repro hx present N = 1103 EC Eligible N = 192 (17%) Repro hx missing N = 57 EC Only N = 91 Repro hx present N = 88 EC eligible N = 58 (66%) Repro hx missing N = 3 HIV C&T Only N = 56 Reason Missing N = 198 Total = 250 women eligible

16. Results - EC Acceptance EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03 N% Assessed for EC Eligibility 1191 Eligible to Receive EC 25021.0 Offered EC 14658.4 Accepted EC 9565.1

17. Comparison of EC-only to STD Evaluation Age EC only (n=91) STD Evaluation (n=1098) Total (n=1198) < 19 years 43 (12%)303 (88%)346 > 20 years48 (6%)795 (94%)843 p <.01 Contraception None/Natural/Barrier 86 (9%) 916 (91%)1002 Hormonal/IUD 1 (0.9%) 112 (99.1%) 113 p <.01 Race / Ethnicity Black Non-Hispanic 57 (16%)837 (94%)894 All Other Races33 (9%)319 (91%)352 p =.085

18. Comparison of EC-only to STD Evaluation STD Morbidity 1 EC Only (n=27) STD Evaluation (n=839) Total (n=866) 1 (.2%)495 (99.8%)496 p <.01 1 STD morbidity assessed among women who had a physical exam

19. Conclusions Of the 1505 women attending the Jamaica clinic during the pilot, 6% attended the clinic for EC only 40% of women reported using no contraception and 36% reported use of barrier as usual method 21% of women were eligible to receive EC 58% of women EC eligible were offered EC EC accepted by majority of eligible women offered EC 1 of 27 women attending for EC only, who had a physical exam, were diagnosed with an STD

20. Implications Clinic utilization should be monitored to assure introduction of EC does not reduce the number of women seen for STD evaluation STD morbidity should be monitored among women seeking EC only to guide decisions regarding the value of screening in this group

21. Acknowledgements Bureau of STD Control Julia A. Schillinger Susan Blank Susan Wright Maushumi Mavinkurve Linda Kupferman Robin Recant Bureau of Maternal Infant & Reproductive Health Nalda Mussington Lili Farhang Deborah Kaplan