Same Day Oral EC and Implant Initiation

Completed

Brief Summary: This is a study for clients presenting for emergency contraception (EC). EC is used to prevent pregnancy after unprotected intercourse. Clients presenting for EC may be offered either the copper or hormonal IUD or oral EC. Current guidelines allow for same-day implant initiation at the time of an EC encounter, as long as oral LNG EC is co-administered. This study will look at pregnancy rates and clients willingness to receive same-day implant + oral EC and same-day IUDs.

Detailed Description: Recommended options for EC include oral EC (levonorgestrel (LNG), ulipristal acetate (UPA), or combination oral contraceptive pills), or the copper intrauterine device (IUD). Recent data will also allow women presenting for EC to be offered the LNG IUD. These recommendations leave out the only other long-acting reversible contraceptive (LARC), the ENG implant. Current guidelines allow for same-day ENG implant initiation at the time of an EC encounter, as long as oral LNG EC is co-administered. We lack data on pregnancy risk for the EC-eligible population desiring same-day ENG implant placement and oral EC.

Women presenting for EC often need ongoing contraception, but clinical practice is not standardized in same-day counseling and initiation due to system, provider, and client-level barriers. Interest in LARC use continues to increase as well as same-day contraception initiation at the time of an EC encounter. Women presenting for EC may not have considered LARC options before. Generating estimates and continuation rates for same-day initiation with an EC encounter will improve contraceptive options for women seeking EC.

Recruitment & Eligibility

Inclusion Criteria

Healthy women
Age 18-35 years
Fluent in English and/or Spanish
BMI < 30 kg/m2
No known contraindication to either the ENG contraceptive implant or oral LNG EC using the CDC Medical Eligibility Criteria for Contraceptive Use 2016
Negative urine pregnancy test
Willing to abstain from further UPI in the 7 days following insertion
Know the date of their last menstrual period
Regular menstrual cycle (24-35 days)
Be willing to comply with the study requirements
Desiring to avoid pregnancy for at least 12 months

Exclusion Criteria

Primary Outcome Measures

Name	Time	Method
Pregnancy Rate at One-month	one month	To determine a point estimate for the one-month pregnancy rate following guideline supported same-day initiation of an etonogestrel (ENG) implant plus oral levonorgestrel (LNG) emergency contraception (EC).
Comparing Proportions of EC Clients Desiring ENG Implant With Oral EC vs IUD	2 years	To determine the proportion of EC clients willing to initiate a same-day ENG implant with oral LNG EC compared to same-day initiation of intrauterine devices for EC.

Secondary Outcome Measures

Name	Time	Method
Continuation Rate	12 months	12-month continuation rate of the ENG implant with same-day initiation at an EC encounter.
Discontinuation Rate and Reasons	12 months	Rate and reasons for ENG implant discontinuation in the 12 months following same-day initiation at an EC encounter.