CONTRACEPTION

• Pharmacy access (without consulting a physician)
• Advance provision of 3 packs of Plan B
• Clinic access (ie, usual care, which required a clinic visit to obtain emergency contraception)

The study concluded: “While removing the requirement to go through pharmacists or clinics to obtain emergency contraception increases use, the public health impact may be negligible because of high rates of unprotected intercourse and relative underutilization of the method. Given that there is clear evidence that neither pharmacy access nor advance provision compromises contraceptive or sexual behavior, it seems unreasonable to restrict access to emergency contraception to clinics.” The conclusion reflected the following several outcomes, which were assessed after 6 months.

4 key outcomes

1. Use of emergency contraception
   • The advance provision group used emergency contraception at nearly twice the rate (37.4%) of the clinic access group (21.0%).
   • Usage rates were similar in the pharmacy access (24.2%) and the clinic access group (21.0%).
2. New sexually transmitted infection rates were similar in all groups
   Levels of STIs, such as Chlamydia, were similar across all groups, and changes in HSV-2 serology were similar across all groups.
3. Many did not use the EC, even with advance provision
   In this study, advance provision of emergency contraceptives did not lower pregnancy rates. This finding is disappointing; the likely explanation is that women at highest risk do not use emergency contraception often enough or at all. Thus, the overall pregnancy rate is unchanged. Nearly half (45%) of the women in the study who reported having unprotected sex did not use emergency contraception during the study period, even when they received it in advance.
4. High-risk sexual behavior did not increase in any group
   Women who had increased access to emergency contraception did not have sex more frequently. Receiving emergency contraceptives in advance did not affect the number of sex partners, with most women having only one partner. Data on teens in the same study found that teens did not take more sexual risks than women aged 20 to 24.²²

A concern with placing emergency contraception directly in the hands of women has been the theory that it would result in increased high-risk behavior and lower use of regular contraception.

This trial found:

• That women with pharmacy access and women given 3 packs of emergency contraceptives in advance were no more likely to change their regular contraceptive method than women who could obtain emergency contraception only via a clinic visit.
• That women with increased access to emergency contraceptives use their routine contraception with the same consistency as women without increased access.

No downside to easier, wider access to Plan B

This trial adds to the argument for wider and easier access to emergency contraception for women. There is no apparent downside from wide access to the current progestin-only emergency contraception regimen. The latest World Health Organization medical eligibility criteria describe no situation in which the risks of emergency contraception outweigh the benefits.²³ The study by Raine et al²¹ provides evidence against concerns about the potential for increased high-risk sexual behavior.

Eight states (Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Washington) have passed legislation allowing pharmacists to prescribe emergency contraceptives without a prescription. Norway, Sweden, India, and the Netherlands allow emergency contraceptive availability over-the-counter.