Emergency birth control not linked to risk behavior

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Readily available emergency contraception does not increase the rate of unprotected intercourse among young women or affect the spread of sexually transmitted infections, according to a report in the Journal of the American Medical Association.

Six states in the US have implemented legislation enabling women to obtain emergency contraception directly from pharmacists without a prescription, lead author Dr. Tina R. Raine, of the University of California, San Francisco, told AMN Health. There has been concern, however, that easy access will increase risk behaviors.

Raine, and her team therefore evaluated the effect of direct access to emergency contraception on reproductive health outcomes of 1,950 women ages 15 to 24 years.

Women were randomly assigned to one of three treatment groups: pharmacy access without a prescription, advance provision at a clinic visit, or instructions to return to a clinic for emergency contraception if needed.

At six-month visits, the authors documented self-reported emergency contraception use, pregnancy, and sexually transmitted disease test results.

Compared with the group instructed to return to the clinic if emergency contraception was needed, pharmacy access was not associated with a significantly increased use of emergency contraception. In contrast, those in the advance provision group were almost twice as likely to use emergency contraception.

The rates of unprotected intercourse, unintended pregnancies, sexual risk behavior, or sexually transmitted diseases did not differ significantly among the groups.

“We found no evidence of increased risk taking in women who had increased access,” Raine said. “It therefore seems unreasonable to restrict access to emergency contraception through clinics.”

However, pregnancy rates were not reduced by easy access, which suggests that women may need more ongoing education to increase their use of emergency contraception when they have had unprotected sex, she added.

“Women may not feel comfortable using (emergency contraception). They may not feel it’s safe or they may not have it with them when they need it,” she said.

A big deterrent, she added, is that they may believe they will not get pregnant. “If a person has unprotected sex one time and she doesn’t get pregnant, it’s reinforced that she may not get pregnant in the future,” she explained.

In an accompanying editorial, Dr. Iris F. Litt, at Stanford University School of Medicine points out that making emergency contraception available over-the-counter “precludes the need for insurance, offers timely access, and eliminates the need for a physician visit for women who would find seeking emergency contraception embarrassing or otherwise difficult to accomplish.”

JAMA 2005;293:54-62,98-99.

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