Direct Access to Emergency Contraception Through Pharmacies and Effect on Unintended Pregnancy and Sexually Transmitted Infections: A Randomized, Controlled Trial

Abstract

Possibly half of the 3.5 million unplanned pregnancies occurring each year in the United States could be avoided if emergency contraception (EC) was readily available. A few states have approved pharmacy access permitting women to obtain EC directly without first having to see a physician or obtain a prescription. The value of direct access to EC now has been studied in a randomized, single-blind, controlled trial of women 15 to 24 years of age who, during a 2-year period, attended California clinics providing family planning services. The participants did not want to become pregnant. They were randomly assigned to pharmacy access to EC (n = 814), the advanced provision of 3 packs of levonorgestrel (n = 826), or clinical access as a control condition (n = 310). Approximately half the women used oral contraceptives and the rest relied on condoms. During a mean follow-up interval of 6.9 months, 28% of women in the trial used EC. Those with pharmacy access were no likelier to use EC than control women, but those in the advance provision group were significantly likelier (37%) to use EC at least once. Only 7% of women used EC twice, and 4% used it 3 or more times. Although 15% of women in the advance provision group used EC 2 or more times, this was true for only 6% of control women. The figure for the pharmacy access group was 6%. There were no significant group differences in the frequency of unprotected intercourse, and there were no significant differences in patterns of oral contraceptive use or changes in contraceptive method. The overall pregnancy rate during follow up was 7.7% with no significant group differences. The rate correlated with the frequency of unprotected intercourse. Women using hormonal contraception had a relatively low risk of becoming pregnant. Sexually transmitted infections occurred in 12% of women regardless of group assignment. Although high rates of unprotected intercourse may negate the potential benefit of EC in women who do not want to be pregnant, the investigators believe that access to EC should not be limited to clinics.