Access To Emergency Contraception Research Articles

Emergency contraception in a historic southern city: Mystery caller study in Birmingham, Alabama

BackgroundAlabama's Human Life Protection Act (the Act) signed in 2019 became law in 2022, making provision of abortion a felony offense. ObjectiveIn 2020, we assessed the accessibility of emergency contraception (EC) pills in Birmingham, Alabama prior to the Act's enactment given the probable increased need for EC access due to abortion criminalization. Study designPharmacy staff were asked about availability, price, location, and identification requirements to obtain EC. ResultsOf 69 pharmacies, 59% had levonorgestrel EC and none had ulipristal acetate EC available. ConclusionThere are persistent barriers to EC accessibility that should be addressed as abortion is increasingly restricted.

Knowledge, Attitudes, and Practice About Emergency Contraception Among Saudi Women of Childbearing Age of Eastern Region in Saudi Arabia.

Background and aim Emergency contraception (EC) refers to methods of contraception that are used within 72 hours up to 120 hours after unprotected intercourse to prevent unintended pregnancy. It can postpone ovulation, stopping fertilization. Ella®(progestin receptor modulator), plan B, birth control tablets, and the copper intrauterine device(IUD) are examples of emergency contraception. The aim of the study is to evaluate knowledge, attitudes, and practices of emergency contraception among Saudi women of childbearing age in the eastern province of Saudi Arabia. Methods It is a descriptive cross-sectional study conducted in the eastern region of Saudi Arabia. Data was collected through a pretested online questionnaire after approval from an ethical committee and women's consent to participate in the study. Women between 18 and 49 years old were included in the study. Women aged under 18 and over 49 years were excluded from the study to make the sample population more homogenous. Participants were provided a link to a questionnaire form to be completed from theirdevices (phone or laptop). Results A total of 648 childbearing Saudi women completed the survey. The majority were between 18 and 25 years old. Approximately 263 (40.6%) had no children, and 348 (53.7%) earned less than 5,000 SAR monthly. Four hundred and sixty-seven(72%) of the participants had never used emergency contraception. Four hundred and seventy-eight (73.8%) did not know the maximum acceptable time for using EC. Three hundred and fourteen (48.5%) did not know the potential risks to the baby in case of failure of emergency contraception. Two hundred and twenty-three(34%)patricians wrongly believed that there would be a potential risk to the baby if the patient got pregnant after using emergency contraception. Three hundred and eight (47.5%) participants supported the idea of the availability of emergency contraception without a prescription, and a majority believed that they would not feel shy in asking for emergency contraception. Five hundred and seventy-one (88%)participants did not visit any family planning clinic last year. A significant source of EC information was a doctor or a family planner, 206 (31.8%). A considerable barrier to EC use was fear of side effects and health risks, as reported by382 (59%) respondents. Conclusions The current study reveals that participants have positive attitudes towards emergency contraception, but use is deficient because of poor knowledge and lack of awareness. Our study urges the urgent need for awareness campaigns by health professionals to improve learning and remove wrong fears and beliefs about emergency contraception.

Availability of emergency contraception in large Brazilian municipalities: a guaranteed right?

Introduction: Emergency Contraception (EC) is available in Brazil since 1996, when it was adopted as one if the family planning strategies and, in 1998, for use in services assisting victims of sexual violence. In the country, its use is regulated by guidelines. Its access through SUS (Unified Health System), however, does not seem to occur in a standardized manner.Methods: The aim of the study was to analyze the availability and barriers to accessing emergency contraception (levonorgestrel) in Brazilian municipalities with more than 500 thousand inhabitants. The survey was carried out by a form sent to the Municipal Health Departments (SMS) managers and a search on the list of standardized medicines by the hospitals in the same municipalities.Results: The Basic Health Units were identified as the standard access places to EC. However, one of the obstacles mentioned is the need for a prescription for dispensing in almost 80% of the analyzed cities. Access in emergency situations at night and on weekends is also uncertain, since although 67% of the places stated that they dispense at the hospital level, the item was only standardized in 21% of the hospital lists.Discussion: The difficult access this drug in the public system essentially tends to harm the poorest women, who are the ones who suffer most from the consequences of an unwanted pregnancy.

“A Lot of My Friends Don't Know How It Works”: Student Activists Describe Gaps in College Students' Emergency Contraception Knowledge

IntroductionDespite the high potential need for emergency contraception (EC) among college students, lack of accurate knowledge may decrease the likelihood of its use in this population. We examined knowledge about EC methods, potential outcomes of use, and access among college students in the United States. MethodsWe recruited college students from a listserv devoted to EC campus activism for an online survey about EC knowledge (N = 150) and conducted 24 follow-up in-depth interviews. We describe the share of respondents that correctly answered each question and provide additional context and insight from interview respondents. ResultsGaps in EC knowledge were noted in our sample of college student EC activists. Awareness of different methods of EC was not universal; 38% of the sample was unaware of ulipristal acetate (ella®) and 61% was unaware of the intrauterine device inserted after intercourse as EC. Many respondents also incorrectly perceived additional barriers to acquiring EC such as minimum age or an ID requirement to purchase EC (64% and 49%, respectively). Interview respondents describe how medical providers, such as student health services and pharmacists, can pose barriers to EC access through either their actions or how college students expect they will act. ConclusionsWe document several gaps in knowledge surrounding EC in college students, even in an activist sample. Additional efforts to inform students about the variety of available EC methods and address mistaken perceptions about barriers to access may allow college students to better meet their needs for EC.

Levonorgestrel Emergency Contraception Availability in Louisiana Independent and Chain Pharmacies Post-Dobbs v Jackson Women’s Health Organization [ID: 1376654

INTRODUCTION: Following recent legal changes, there is increased confusion regarding availability of medications for reproductive health, including emergency contraception (EC). We aimed to quantify over-the-counter (OTC) access to levonorgestrel EC in three metropolitan Louisiana parishes (counties) among chain and independent pharmacies. METHODS: This cross-sectional study took place during August and September 2022. Secret shoppers surveyed all retail pharmacies in Jefferson, Orleans, and Terrebonne parishes. Pharmacies were classified as independent or chain based on affiliation with supermarket or drug store chains. Odds ratios (ORs) with 95% CIs were used to compare availability of OTC EC. RESULTS: Among 212 retail pharmacies, 55% (n=117) were large chain pharmacies and 45% were independent stores. Only 67% (n=141) had EC in stock. Chain pharmacies were more likely to offer EC than independent pharmacies (92% versus 35%, OR 22.6, 95% CI [10.1, 50.2]). Independent pharmacies were more likely to keep OTC EC behind the counter (91% versus 11%, OR 80.0, 95% CI [21.2, 302.5]), require identification (45% versus 4%, OR 21.7, 95% CI [6.5, 72.7]), and carry no EC less than $50 (24% versus 2%, OR 17.0, 95% CI [3.4, 84.8]). Among pharmacies without EC available, no chain pharmacies described recent changes in EC stock, while 5 out of 28 (18%) respondent independent pharmacies attributed loss of EC stock to recent legislation. CONCLUSION: Independent pharmacies were less likely to carry OTC EC and more likely to enforce multiple barriers to purchase. Recent legislation has disproportionately further reduced EC availability at these pharmacies.

Free access to emergency oral contraceptives (EOCs) in the European Union: A regulatory vacuum to be filled.

According to the World Health Organization (WHO), any woman in childbearing age who have decided not to take permanently an oral contraceptive but who are sexually active has the right to access emergency contraception (EC). Despite this, in many European countries there are no specific laws governing the criteria for access to emergency oral contraceptives (EOCs) for girls under 18, especially about the need for third party consent. This normative vacuum is dangerous as it risks creating confusion and entrusting the management of the fundamental right of self-determination to the discretion of others. Moreover, in European Union (EU) countries, there is an inequality in terms of access to contraceptive supplies, reimbursement criteria and the availability of information online. Our article compares the criteria for access to EOCs (Ulipristal Acetate-UPA and Levonorgestrel-LNG) in the various EU countries to highlight possible disparities and consequent inequalities. Government and ministerial websites, European agencies websites, and Contraceptive Use by Method 2019 (WHO) have been consulted. There are some differences between the various European countries that could configure inequality in EU countries. It would be appropriate a definitive levelling of the legislation of the European Union on emergency contraception associated with massive information and awareness campaigns.

Temporal Changes in Counseling for and Use of Emergency Contraception.

Our objective was to evaluate changes in the prevalence of emergency contraception counseling and use after policy changes in the United States between 2011 and 2019. This was a serial cross-sectional study using the National Survey of Family Growth data set from two survey windows: 2011-2013 (4,177 women) and 2017-2019 (4,477 women). The incidence of emergency contraception counseling in the prior year did not differ between the 2011-2013 and 2017-2019 survey windows (3.3% vs 2.5%; adjusted odds ratio [aOR] 0.73, 95% CI 0.51-1.05). There was a significant increase in ever use of emergency contraception between the 2011-2013 and 2017-2019 survey windows (19.0% vs 26.1%; aOR 1.44, 95% CI 1.22-1.72). This suggests that changes facilitating access to care may have a larger effect on emergency contraception access and uptake than health care professional counseling.

Emergency Contraception: Access and Challenges at Times of Uncertainty.

The UN Commission on Life-Saving Commodities for Women and Children identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation. Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access. PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetricians and Gynecologists, the World Health Organization, The United Nations. A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device. EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts , threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.

Oral Emergency Contraception Provision in the Veterans Health Administration: a Retrospective Cohort Study

ABSTRACTBackgroundIn the USA, oral emergency contraception (EC) use to prevent unintended pregnancy is increasing. Oral EC methods include levonorgestrel (LNG) and ulipristal acetate (UPA), with increased UPA efficacy over LNG in high BMI users and those beyond 3 days post intercourse. The Veterans Health Administration (VHA) provides oral EC at low or no cost, yet prescription-level Veteran data are lacking.ObjectiveTo describe oral EC provision in VHA, including method type and Veteran user and prescriber characteristics.DesignA retrospective cohort study using VHA administrative data.ParticipantsAll VHA oral EC prescriptions from January 1, 2016, to December 31, 2020.Main MeasuresWe linked Veteran-level sociodemographic and military characteristics and provider-level data with each prescription to identify variables associated with oral EC method.Key ResultsA total of 4280 EC prescriptions (85% LNG) occurred for 3120 unique Veterans over 5 years. While prescriptions remained low annually, the proportion of UPA prescriptions increased from 12 to 19%. Compared to LNG users, UPA users were older (34% vs 25% over age 35 years, p <0.001); more likely to identify as white (57% vs 46%) and non-Hispanic (84% vs 79%) (p <0.001); and more likely to have a BMI ≥ 25 (76% vs 67%, p <0.001). UPA prescriptions originated most frequently from VA Medical Centers (87%) and women’s health clinics (76%) compared to community-based or other clinic types. In multivariable regression models, race, ethnicity, BMI ≥30, and prescriber facility type of a VA Medical Center or a women’s clinic location were predictive of UPA prescription.ConclusionsOral EC provision in VHA remains low, but UPA use is increasing. LNG prescription occurs frequently in high BMI Veterans who would benefit from increased efficacy of UPA. Interventions to expand oral EC access in VHA are essential to ensure Veterans’ ability to avert unwanted pregnancies.

The impact of caller characteristics on levonorgestrel emergency contraception access in West Virginia community pharmacies

ObjectiveAccess to levonorgestrel (LNG) emergency contraception (EC) has increased since the FDA removed age restrictions on over-the-counter (OTC) LNG EC in 2013, but availability is highly variable and numerous barriers to access remain. The purpose of this study was to assess availability and accessibility of LNG EC at community pharmacies in West Virginia (WV). MethodsA mystery caller cross-sectional study was conducted to assess availability and accessibility of LNG EC. Inquiries were made by identified ‘research’ staff and by staff presenting as a 16 y/o. ResultsNearly half of community pharmacies reported having LNG EC in stock. Pharmacy staff were significantly more likely to tell research callers LNG EC was in stock (53%) and more likely to report willingness to order it (50%) than ‘teen’ callers (45% and 34%, respectively). There was no significant difference between caller types on the five barriers assessed. ConclusionLack of availability may contribute to teen and unintended pregnancies.

The availability of emergency contraception from family health centers in Turkey

Reproductive health care, including contraception, is a fundamental aspect of any public health care system and it is important to reduce barriers to access to all forms of contraception, including emergency contraception. In recent years, the rhetoric of pronatalism in Turkey has come to dominate and raises questions about the availability of reproductive health care services, in particular contraception, from state run facilities. This study aimed to determine the availability of dedicated emergency contraception (EC) from government run Family Health Centers (FHCs) in Turkey. In 2019, a team of trained researchers called a random sample of 583 FHCs located in the largest cities in twelve regions across Turkey asking for dedicated EC. Dedicated EC is largely unavailable from government supported FHCs. Only 6.1% stated that they provided EC while 53.8% stated that it was not available and that they could provide no alternative. A further 28.3% declared that they could provide an alternative to dedicated EC that almost always consisted of oral contraceptives. We found statistically significant variations in response rate and availability among cities as well as the rate of referral to pharmacies. There is little access to EC from government sponsored health clinics designated to provide family planning services, which hinders access to an essential reproductive health care service that should be available to women everywhere.

97. Misinformation About Levonorgestrel Emergency Contraception in West Virginia Community Pharmacies

Levonorgestrel (LNG) emergency contraception (EC)—commonly known as Plan B®--became available in the United States (US) without a prescription in 2013, but barriers to access remain. One barrier is misinformation about the medication and who can obtain it. To assess the accuracy of information provided by community pharmacies in West Virginia (WV), a state with particularly low LNG EC access and high teen pregnancy rate, we conducted a mystery caller study to ask pharmacies questions about the requirements for purchasing LNG EC and when it should be taken for maximum effectiveness.

Identity and the Availability of Emergency Contraception from Pharmacies in Istanbul

Emergency contraception (EC) has been and remains available in Turkey without prescription since 2002. This study attempted to determine the availability of emergency contraception from pharmacies in Istanbul, Turkey and whether the identity of the purchaser had any impact on availability. More specifically, we sought to understand if young women feel shamed or denied access to EC. This study employed a mystery patient/shopper approach where mystery patients attempted to purchase emergency contraception from a random sample of 352 pharmacies in Istanbul. Mystery shoppers, ages 18-22, were trained and provided a standard scenario and identity. The identities included: conservative/ religious female; secular/modern female; and male. After each pharmacy visit, the mystery patients recorded the details of their attempts to purchase EC. In 95.4% of visits mystery shoppers were able to purchase EC. Despite the availability of several types of EC, little choice was given to shoppers. Male mystery shoppers were given more choice of EC than their female counterparts and were more often able to purchase the less expensive form of EC. In the majority of transactions, pharmacists offered no medical instructions or recommendations. EC is widely available from pharmacies in Istanbul but lack of choice and information from pharmacists result in a less than ideal health care experience.

Emergency Contraception Access and Counseling in Metropolitan and Nonmetropolitan Pharmacies in Georgia

Background: Emergency contraception (EC) efficacy is dependent on timing of administration. Adequate pharmacy stock information and accurate patient counseling are important to ensure timely access. Objective: This study evaluates pharmacist reported availability and counseling for levonorgestrel (LNG) and ulipristal acetate (UPA), and identifies differences between caller type and pharmacies in metropolitan vs nonmetropolitan areas of Georgia. Methods: This prospective, randomized, telephone-based study included 25% of Georgia community pharmacies, stratified by geographic location. Calls were made by investigators, first posing as a mystery shopper inquiring about EC stock and efficacy, then 3–6 weeks later as a researcher inquiring about EC stock. Analysis utilized descriptive statistics, chi Square, and logistic regression. Results: Of 600 pharmacies, the mystery shopper caller reached 86%: 74% of pharmacists initially discussed LNG, 57.1% had it stocked, more often in metropolitan areas (OR 1.7, 95% CI 1.08–2.6). Ulipristal acetate was discussed by 1.9% and reported in-stock < 1%. Of those who discussed window of efficacy, 79% indicated LNG would either not work 4 days after intercourse or they were unsure. The research caller successfully completed a second call for 64% of pharmacies: 57% stocked LNG, 3% stocked UPA, and UPA was more likely to be stocked in metropolitan pharmacies. Conclusion: In Georgia, UPA availability is poor, and nonmetropolitan pharmacies were less likely to stock LNG and UPA. A minority of pharmacists correctly indicated that LNG may work up to 120 hours after intercourse. Strategies are needed to overcome barriers to EC availability in community pharmacies and support pharmacists’ EC counseling.

Messaging and access strategies for improving emergency contraceptive knowledge and uptake among Italians

Objectives Over-the-counter emergency contraception (EC) purchase was legalised in Italy in 2015. Knowledge and access gaps, however, remain. The goal of this study was to explore women’s and men’s EC informational and access needs. Methods As part of a larger reproductive study, researchers conducted 42 in-depth interviews (May–June 2019) with English-speaking women and men aged 18–50 years (mean ± standard deviation, 29.1 ± 7.9 years) living in or near Florence, Italy, and using the Italian health care system. Researchers completed qualitative data analysis to identify emergent themes related to EC knowledge, attitudes and access. HyperRESEARCH aided data organisation and analysis. Researchers used a comparative method to contextualise data and identify emergent themes. Results Findings demonstrated that peer communication and experiences served as influential factors in others’ EC use. This propagated misinformation, reducing participants’ confidence in EC efficacy and safety. Women described the relevance of relationship type in whether to engage men in EC discussion, while men desired an active supportive role. Finally, participants described various messaging and access channels to increase EC knowledge and access. Conclusion Findings offer practical recommendations to guide social marketing and behaviour change interventions to increase EC access among women and men in Italy. The utility of pharmacists to individuals wishing to access EC is explored.

Sexual Assault Nurse Examiner and Emergency Contraception Access in Emergency Departments in the United States: A National Survey

Background: Despite the rise in sexual assault presentations in emergency departments (ED) in the United States, real-world access to sexual assault nurse examiners (SANE) and emergency contraception medication is unknown. We aimed to determine the real-world access of emergency sexual assault care by surveying EDs in the United States. Methods: EDs listed in the Centers for Medicare & Medicaid Services database were contacted telephonically by anonymous callers trained to collect responses from ED personnel. The study employed a cross-sectional survey to ascertain the availability of SANE and emergency contraception in EDs nationwide. Additional variables collected included regional demographics, urban status, hospital size, faith affiliation, academic affiliation, and existence of legislative requirements to offer emergency contraception to sexual assault patients. Findings: Of the 4360 eligible hospitals, 960 (22.0%) were contacted. SANE availability and emergency contraception access were reported to be available in 48.9% (95%CI: 45.5, 52.0) and 42.5% (95%CI: 39.4, 45.7) of hospitals, respectively. Emergency contraception access was a strong predictor of SANE availability. Hospitals reporting SANE availability were more likely to be large, rural, and academic affiliation. Hospitals reporting patient access to emergency contraception in the ED were more likely to be located in the Northeast, large, rural, academic affiliation, and in states with legislative requirements. Interpretation: Our results suggest that access to sexual assault services including emergent SANE and contraceptive medication in EDs remains poor with disparities. Geographic region, hospital size, and legislative status of the state are important predictors. Funding: None to declare. Declaration of Interest: None to declare.

BARRIERS TO EMERGENCY CONTRACEPTION ACCESS NOT ALLEVIATED WITH BRIEF PHARMACY EDUCATIONAL INTERVENTION

Levonorgestrel (LNG) emergency contraception (EC) was completely accessible in 24% of pharmacies shortly after the Food and Drug Administration (FDA) approved EC as an over the counter (OTC) product. No data exists on efforts to improve access to OTC EC with pharmacy staff education. We sought to evaluate whether OTC EC access has improved, and to evaluate if a brief educational intervention improved the ability of pharmacy staff to answer routine EC questions.

Louisiana Pharmacies' Availability of Emergency Contraception and Counseling Accuracy to Adolescent and Physician Callers.

Adolescents face many barriers to obtaining emergency contraception (EC), despite it being an approved and recommended method to prevent unintended pregnancy. This study examined pharmacy-related barriers to adolescents' access to EC in Louisiana. Prospective, telephone-call secret shopper study to pharmacies to assess same-day EC availability and barriers to purchase. A total of 182 pharmacies in 5 Louisiana cities. Responses provided by pharmacists or other pharmacy staff assessed between July 2018 and November 2019. Collected data from secret shopper phone calls and compared responses provided to callers between male and female callers and physician and adolescent callers. Same-day levonorgestrel (LNG) availability, same-day ulipristal acetate (UPA) availability, age restrictions on purchase, requirement of parental consent for purchase, and type of staff member that advised the caller. Of 364 calls to 182 pharmacies, 66% of pharmacists or other pharmacy staff reported same-day LNG access and 5% reported same-day UPA access. An inaccurate age restriction regarding EC purchase was reported in 15% of calls. Female callers were cited this age restriction more frequently than their male counterparts (20% vs 10%). Pharmacists were more likely than other pharmacy staff to counsel female callers compared to male callers (52% vs 27%) and physician callers compared to adolescents (50% vs 30%). Many pharmacies in Louisiana have limited same-day availability of EC and often report inconsistent and inaccurate age and consent regulations for its use. Continued outreach and education to pharmacies is necessary to address these barriers to adolescent EC access.

Pharmacy availability of emergency contraception in southwestern Pennsylvania: A simulated patient study

ObjectiveTo assess the availability of oral emergency contraception in southwestern Pennsylvania pharmacies. Study designWe conducted a simulated patient study to assess on-the-shelf availability of levonorgestrel emergency contraception and immediate availability of ulipristal acetate emergency contraception. ResultsOnly 44% of pharmacies stocked levonorgestrel on-the-shelf and only 5% of pharmacies had ulipristal acetate immediately available. ConclusionsWe found significant barriers to obtaining timely oral emergency contraception in southwestern Pennsylvania. Implications statementTimely access to emergency contraception is important for people's ability to determine if, when, how, and under what circumstances to have children. Pharmacies in southwestern Pennsylvania need to expand access to oral emergency contraception.

Rural-urban residence and emergency contraception use, access, and counseling in the United States, 2006-2017

ObjectiveTo estimate differences in emergency contraception (EC) use, access, and counseling by rural-urban residence among reproductive age women in the United States. Study designWe examined respondent data (2006–2017) from the National Survey of Family Growth for women ages 15-44 (n = 28,448) to estimate EC use, access, and counseling by rural-urban county of residence. Rural-urban prevalence ratios for EC outcome measures were estimated using predicted margins from logistic regression models, which were adjusted for demographic differences and current contraceptive method use. Changes in ever-use of EC over time were estimated for rural and urban respondents, separately, using Chi-square tests and trends were estimated using inverse variance weighted linear regression models. ResultsDuring 2006 to 2017, 10% of rural and 19% of urban women who had ever had sex reported ever using EC pills. Among rural women, ever-use increased from 6% in 2006-2008 to 15% in 2015-2017 (Chi-square p < 0.01; trend p-value < 0.01); among urban women, ever-use increased from 11% to 27% (Chi-square p < 0.01; trend p-value < 0.01). Rural and urban women were similarly likely to have obtained EC without a prescription and from a drug store. Rural women were less likely to have received EC counseling than urban women; however, counseling rates were low among all women. ConclusionWe observed differences in EC ever-use and receipt of EC counseling by rural-urban residence among US women ages 15 to 44, adding to the evidence that rural-urban residence is an important factor in reproductive health. More research is needed to explore factors contributing to rural-urban differences in EC use. ImplicationsOur key finding that EC use varied by rural-urban county residence offers additional evidence that rural-urban residence should be considered in reproductive health practice and policy. We discuss areas for future research into potential barriers to EC use in rural populations.