Direct Access to Emergency Contraception Increases Its Use, but Does Not Increase Risky Sexual Behaviors
Emergency contraception (EC) is a high-dose formulation of hormones taken after unprotected sexual intercourse to prevent the implantation of a fertilized ovum. Also called “morning after” pills, EC must be taken within 72 hours of intercourse, with a second dose taken 12 hours later. When this protocol—the Yuzpe regimen—is followed, EC is 75% effective at preventing pregnancy.
Easy access to EC is controversial since its opponents believe it will increase the rates of unprotected sex, leading to increased risks of unwanted pregnancies and sexually transmitted infections (STIs).
In most states, women can only get EC with a doctor’s prescription. Following the lead of Washington state, five other US states (Alaska, California, Hawaii, Maine, and New Mexico) now allow women to obtain EC directly from a pharmacist without a prescription. The UK has gone even further to increase access; EC is available over the counter just as condoms and cold medicine are.
A study published in the January 5, 2005 issue of the Journal of the American Medical Association examined how women’s sexual behaviors are influenced by differing levels of access to EC. Whether they were given an advance supply of EC, had to see a pharmacist, or had to seek a prescription from a clinic, women reported similar rates of unprotected sex, pregnancy, STIs, and other risky behaviors. The one significant difference was that women with a supply of EC were almost twice as likely to use it as women who had to see a pharmacist or physician to obtain it.
About the Study
The researchers recruited 2,117 women between the ages of 15 and 24 from four health clinics in California. All volunteers were given careful instruction regarding emergency contraception: how to use it, its effectiveness in preventing pregnancy, and that it is not a substitute for other methods of contraception, such as condoms, that protect against STIs.
The women were randomly assigned to one of three groups for six months:
- Pharmacy group – given instructions on how to obtain EC directly from a pharmacist without a prescription
- Advance provision group – given three packets of EC along with directions for use
- Clinic group (control group) – directed to come to the clinic for EC when needed
At the beginning and end of her six months in the study, each woman completed a questionnaire. The women reported their use of EC and other forms of contraception, their frequency of unprotected sex, and any incidences of pregnancy or STIs. Urine and blood tests were also done to check for pregnancy and certain infections.
Women in the advance provision group were significantly more likely than women in the clinic group to report using EC one or more times during the course of the study—37.4% in the advance group vs. 21% in the clinic group. Among the women in the advance provision group, 6.8% used EC twice and 4.1% used it three or more times. There was no difference in EC use between the pharmacy and clinic groups.
While use of EC was greater in the advance provision group, the ease of access did not appear to affect other sexual behaviors. There were no differences in rates of unprotected sex, frequency of condom use, patterns of oral contraceptive use, number of sexual partners, rates of pregnancy, or rates of STIs across the three study groups.
How Does This Affect You?
The results of the study should allay the fear that greater access to EC will lead to irresponsible sexual behaviors. Based on the lack of difference in risky sexual behaviors across the three study groups, the researchers see no obvious downside to increased EC access. Rather, women with unimpeded access to EC are more likely to use it, which may help decrease the high number of unwanted pregnancies in the US each year.
EC is not a substitute for other methods of ongoing birth control. As the author of an accompanying editorial points out, traditional methods of contraception do not conflict with EC. Women should be vigilant about their routine methods of birth control, but they can also be reassured that in the event of an obvious contraceptive failure (e.g., condom mishap), a safe, emergency back-up is easily and quickly available.
The Association of Reproductive Health Professionals
The National Women’s Health Information Center
Planned Parenthood Federation of America
Litt IF. Placing emergency contraception in the hands of women [Editorial]. Journal of the American Medical Association. . 2005;293:98–99.
Raine TR, Harper CC, Rocca CH, et al. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: A randomized controlled trial. Journal of the American Medical Association. . 2005;293:54–62.
Last reviewed Jan 7, 2005 by ]]>Richard Glickman-Simon, MD]]>
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