Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Unwanted pregnancy frequently leads women to seek abortion. In British Columbia, 14,000-16,000 abortion procedures are performed each year, representing 25-28% of all pregnancies. Hormonal emergency contraceptives (ECs), also known as "morning after pills," can prevent pregnancy before it starts and have the potential to lower the abortion rate. The most commonly used ECs are: (1) the Yuzpe regimen (containing estrogen and progestin), and (2) the progestin-only levonorgestrel regimen. In Canada and the United States, the levonorgestrel regimen is available without a prescription and is widely considered by members of the clinical and scientific communities to be more effective than the Yuzpe regimen, even though it has not consistently been shown to be more effective in clinical studies. In December 2000, the provincial government in British Columbia expanded women's access to ECs by granting pharmacists authority to prescribe them. Women who sought ECs from pharmacists provided written consent for treatment on standardized consent forms. Using a process that ensures the women's anonymity, we have linked the information from over 8000 forms to corresponding prescription records in the provincial prescription database and other health databases containing diagnostic information. The linkage will allow us to compare the effectiveness of the two ECs based on the frequency of abortion and other pregnancy-related events among women who received each regimen from pharmacists in the community. In addition, we will study utilization patterns of ECs and oral contraceptives in clinics and physicians' offices. The proposed investigation is designed to study the health outcomes of ECs on a larger scale than ever before. Therefore, the results will enrich the body of research in this area and better inform women and health professionals on optimal EC use.