1. Reduction of abortions following emergency contraception? Dan Apter dan.apter@vaestoliitto.fi The Sexual Health Clinic Family Federation of Finland

2. SEXUAL HEALTH FOR ADOLESCENTS TODAY 1.Recognizing sexual rights 2.Sexuality education and counseling 3.Confidential high quality services

3. Efficacy of emergency contraception n Pregn-anciesPregnancies expected Prevented fraction obser. %about 8% % Mifepristone1359211,5510881 Levonorgestrel single dose 1356201,4711182 Levonorgestrel two doses 1356241,7710677 WHO, Lancet Dec 2002, 360:1803

4. Number Needed to Treat Reported expected number of pregnancies 7%, observed number < 2%. About 5% reduction in the number of unintended pregnancies NNT = 20 for unintended pregnancy Every second unintended pregnancy would end in abortion ??? Reduction in number of abortions 2.5% of EC users, thus NNT for abortion = 40 If EC use 40 000/yr, there are 1000 less abortions However, among EC users, expected number of pregnancies is likely much lower, and accordingly, prevented fraction lower and NNT larger

5. Pregnancy rate and OC use in 18 and 16 yr old girls in Finland E. Kosunen, 1996

6. Abortions and deliveries per 1000 girls 15-19 year old in Finland 1975 to 2002

7. Recent factors affecting sexual health Economical depression Population responsibility led to the close down of contraceptive counseling centers School health services cut Sexuality education in schools became an optional subject in 1994, but will be reintroduced as obligatory in 2004 Price of OC:s increased, OC scare in October 1995 The local municipalities implement health care policy independently, even without necessary qualifications

8. Number of abortions 1998-2002 in the age group 15-19 EC became OTC

9. Contraceptive use in Finland One million women 15-45 yrs= 13 million cycles 12 million condoms sold/year (20% use, 2.6 million of cycles, 5 condoms/cycle?!) 230 000 women use OC = 3 million cycles 75 000 EC packages sold in 2002= 2.5% of OC cycles = 0.5% of total cycles

10. Effects of EC depend on knowledge of EC, attitudes availability (prescription needed, price, health care system) extent of use of modern contraception, e.g. minor effect among iud users, possibly high among non users and condom users

11. Conclusions Total effect of EC rather small, but can be high in subpopulations such as adolescents