Summary

A study released in the July 11th edition of the British Medical Journal Online First indicates that the availability of emergency contraception over the counter does not increase unsafe sexual behavior or decrease use of other contraceptive methods.

Emergency contraception pills (EC), marketed in the United States under the names Plan B and Preven, can prevent pregnancy if taken within 72 hours of unprotected vaginal intercourse. In Britain, EC has been available without a prescription to young women ages 16 and older since January 2001 at a cost of £20-25 ($36-46).

For this study, researchers used data from the Omnibus Survey conducted in 2000, 2001, and 2002, in which female respondents ages 16-49 reported their contraceptive use.

EC Use Remained Stable

The study found that use of EC remained stable over the three year period and that availability without a prescription did not increase the number of women using EC more than once in a year.

• The proportion of women using EC did not change significantly after it was made available over the counter: 7.3% of women reported using EC in 2002, compared to 7.8% in 2001 and 8.5% in 2000.
• The proportion of women using EC more than once in a year did not increase over the three year period: 1.7% of women reported using EC more than once in 2002, compared to 1.5% in 2001 and 2.0% in 2000.

Contraceptive Use Remained Stable

The survey also indicated that the use of other contraceptive methods remained stable over the three year period. Researchers concluded that increased access to EC does not, as some have feared, increase the likelihood that women will stop using other methods of birth control.

• 31.9% of women reported using oral contraceptives, IUDs, injections, or implants in 2002, compared to 33.7% in 2001 and 31.8% in 2000.
• 24.3% of women reported sterilization (either themselves or a partner) in 2002, compared to 24.7% in 2001 and 24.8% in 2000.
• 20% of women reported using condoms, caps, or diaphragms in 2002, compared to 20.5% in 2001 and 21% in 2000.
• 3.7% of women reported using the withdrawal or rhythm method in 2002, compared to 4.7% in 2001 and 3.9% in 2000.
• .8% of women reported using another method of contraception in 2002, compared to 1% in 2001 and 1.2% in 2000.
• 14% reported not having a heterosexual relationship in 2002, compared to 12% in 2001 and 12.4% in 2000.
• 8% indicated ‘other reasons’ (including abstinence) for not using a method in 2002, compared to 8.6% in 2001 and 10.6% in 2000.

Where Women Obtain EC

The research indicated that the only significant change in Britain has been where women seek EC. According to the researchers, women prefer to obtain emergency contraception over the counter rather than through a general practitioner.

• 32.6% of women using EC in 2002 purchased it from a pharmacy without a prescription.
• Only 48.8% of women who used EC in 2002 sought it from a general practitioner, compared to 51.2% in 2001 and 62% in 2000.

In addition, while neither income nor education was significantly related to the likelihood of using EC, the researchers found that income level is related to where women seek EC. They argue that for some women cost is a barrier to purchasing emergency contraception without a prescription.

• Women in the highest income bracket were five times more likely than women in the lowest income bracket to report purchasing EC without a prescription.

SIECUS Analysis

SIECUS applauds the researchers for examining critical issues raised in the heated debate over emergency contraception. In the United States, efforts to gain FDA (Food & Drug Administration) approval for making EC available over the counter are currently stalled because of an ongoing political battle.

Those fighting to gain over-the-counter status for EC argue that since this method needs to be taken quickly, it is imperative that women have the ease of access that pharmacies-which are often open on weekends and evenings when doctors are less available-provide.

Opponents argue that easier access to EC will increase its use and the likelihood that women (particularly teenagers) will engage in unsafe sexual practices, such as having sex without using contraception. This study confirms that these fears are unfounded.

SIECUS hopes that U.S. policymakers will consider the implications of this study when determining whether to make emergency contraception available without a prescription. It is time that this crucial pregnancy prevention method is widely available and easily accessible.

For the complete findings, see "Impact on contraceptive practice of making emergency hormonal contraception available over the counter in Great Britain: repeated cross sectional surveys" British Medical Journal Online First. BMJ, 11 July 2005. Available online at: http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38519.440266.8Fv2.

This information update was written by Kirsten deFur, SIECUS intern.