Quality statement 2: Emergency contraception

Quality statement

Women asking for emergency contraception are told that an intrauterine device is more effective than an oral method.

Rationale

An intrauterine device (IUD) has a lower failure rate than oral methods of emergency contraception. Also, once in place, it can be used on an ongoing basis. If women use an IUD this will reduce the risk of unplanned pregnancies and avoid the need for emergency contraception. If a woman chooses to have an IUD as a form of emergency contraception, but the healthcare practitioner cannot fit it there and then, they should direct the woman to a suitable service and give her an oral method in the interim.

Quality measures

Structure

Evidence of local processes to ensure that women asking for emergency contraception are told that an intrauterine device is more effective than an oral method.

Data source: Local data collection.

Process

Proportion of requests for emergency contraception where the woman is told that an intrauterine device is more effective than an oral method.

Numerator – the number in the denominator where the woman is told that an intrauterine device is more effective than an oral method.

Denominator – the number of requests for emergency contraception.

Data source: Local data collection. Quality and Outcomes Framework indicator CON003 captures data on the provision of information about long-acting reversible methods of contraception to women who are prescribed emergency hormonal contraception by their GP.

Outcome

a) Intrauterine device use as an emergency contraceptive.

Data source: Local data collection. The Health and Social Care Information Centre's Sexual and Reproductive Health Activity Dataset includes information on methods of contraception for people using dedicated sexual and reproductive health services.

b) Abortion rate.

Data source: Local data collection. The Department of Health's Abortion statistics can be analysed geographically.

What the quality statement means for service providers, healthcare practitioners and commissioners

Service providers (including GPs, community pharmacies and sexual and reproductive health services) ensure that protocols and procedures are in place to tell women asking for emergency contraception that an IUD is more effective than an oral method. Service providers ensure that rapid referral pathways are in place for women who choose an emergency IUD if they are not able to fit one immediately. Service providers also ensure that protocols are in place to offer them an oral emergency method in the interim.

Healthcare practitioners (including GPs, community pharmacists, sexual health consultants and nurses) tell women who ask for emergency contraception that an IUD is more effective than an oral method. Practitioners unable to fit IUDs at presentation refer women to a service that can and offer them an oral emergency method in the interim.

Commissioners (clinical commissioning groups, local authorities and NHS England) ensure that services providing emergency contraception tell women that an IUD is more effective than an oral method. Commissioners ensure that referral pathways are in place for women who choose to have an emergency IUD fitted if the service cannot provide this on presentation, and that the service offers an oral emergency method in the interim.

What the quality statement means for women

Women asking for emergency contraception are told that an intrauterine device (IUD, also known as the coil) is more effective than an oral method (an emergency pill) and can also be used as a long-term method of contraception.

Source guidance

Definitions of terms used in this quality statement

Emergency contraception

If a woman has had sex without using contraception, or thinks that her contraception did not work, an emergency contraceptive can be used. There are 3 different types:

  • emergency contraceptive pill, levonorgestrel 1.5 mg

  • emergency contraceptive pill, ulipristal acetate 30 mg

  • emergency intrauterine device.

Both emergency contraceptive pills are also referred to as the 'morning after pill'.

[Adapted from Emergency contraception (Faculty of Sexual & Reproductive Healthcare)]

Intrauterine device

Also referred to as an IUD or coil, this is a small, T‑shaped copper device that is inserted in the uterus. It has 1 or 2 threads on the end that hang through the entrance of the uterus (the cervix).

[Adapted from Intrauterine contraception (Faculty of Sexual & Reproductive Healthcare)]

Equality and diversity considerations

Age, religion and culture may affect which contraceptive methods the woman considers suitable. When discussing contraception, healthcare practitioners should give information and allow the woman to choose the one that suits her best.

If a healthcare practitioner's beliefs do not let them supply contraception, they should ensure that the woman can see another practitioner as soon as possible.