In 1995, the first emergency contraception pill was approved in Norway for prescription use only. In October 2000, levonorgestrel was released for over-the-counter sale in pharmacies. Subsequently, there has been a large increase in sales. Statistics from 1997 show that <5,000 doses of emergency contraception were sold. As a response to increased access to the pill, the figures rose steeply to almost 70,000 in 2001. This increase has continued, and in 2007, more than 150,000 pills were sold 1. Over this 10-year period, we have witnessed a more than 30-fold increase. A large number of Norwegian women at least buy these pills. A number of studies also show that emergency contraception has a high efficacy 1. Thus, one should expect a large number of unwanted pregnancies to have been prevented among Norwegian women. The paradox is that there has been almost no change in Norwegian abortion rates in the years following the introduction of these pills. The same pattern has been observed in other countries. A recent review compared the effect of different levels of access to emergency contraception on pregnancy and abortion rates 2. A review of randomised studies, cohort studies and studies which compared population-level statistics before and after improving the access to emergency prevention, was undertaken. None of the studies demonstrated any clear effect of the level of access to emergency prevention on the pregnancy or abortion rates. A recent Norwegian study suggests a possible explanation 3. Drawing on a population-based longitudinal dataset, we compared young adult women who underwent an abortion with those who used emergency contraception, without experiencing an abortion. Note that there is a surprising absence of previous studies based on the normal population, which describe the users of emergency contraception. The findings were striking. Abortions were associated with a problematic family background, dropping out of school, poor further education, early conduct problems, early signs of depression, early alcohol intoxication, and a high number of sexual partners. Many of the young women who underwent an abortion were already vulnerable at an early age. These findings echo a number of earlier population-based longitudinal studies 4, 5. We found that 1 in 3 women had used emergency contraception after the year 2000 – twice as many as those who had undergone an abortion. The unexpected finding, however, was related to the profile of the majority of the users of emergency contraception. They were ordinary young women without any specific risk factors. In addition, an above average number of these women came from families with a high educational level. The conclusion was that young women who undergo an abortion are often vulnerable and in a complicated life situation. On the other hand, the users of emergency contraception are well adjusted, often with strong individual resources. It seems reasonable to hypothesise that they often have a long-term horizon and a will that increases their ability to obtain the emergency pill after unprotected intercourse, and then use it. From the study, it is suggested that women who are most in need of the emergency pills frequently do not use them. This may be the reason why the abortion rates are little influenced by the increased use of these pills. However, the puzzle is not solved. In 2007, more than 150,000 emergency pill dosages were sold in Norway to a population of 900,000 women of fertile age. One could assume that many of the pills are purchased but not used. However, our study shows that a large proportion of the pills are used. However, they are used by women who do not have the typical risk factors for an abortion. Based on our data, we are unable to evaluate the rationality behind their use. Nevertheless, we may speculate that some women may have increased their rate of unprotected sex after the introduction of the pill, and compensated with the use of emergency pills. Another possibility is that a large proportion of these pills are used by anxious women ‘as a matter of caution’, when there is, in fact, little or no risk of pregnancy. In my opinion, the findings are important. The obvious conclusion must be that emergency contraception should be made more accessible and an option for those women who are in real need of it because they find themselves facing a possible unwanted pregnancy. Most of us will agree on this. The problem is that the users today seem to be another group. These pills have become a commercial success and the sales curves still point upwards. However, let us assume that a large proportion of the pills are currently used by women who are not really facing a possible pregnancy. Should we encourage further increases in such use of emergency contraception? I am doubtful.