1. Kennedy, Maureen Shawn MA, RN

Article Content

Emergency contraception," a method of preventing pregnancy after intercourse, is used in any number of situations, from the failure of a condom to the aftermath of rape. And even though hundreds of thousands of teenage girls and young women become pregnant every year in the United States, opinions vary widely on whether they should have easy access to emergency contraception-contraceptive hormones or hormone receptor inhibitors that can prevent the implantation of a fertilized egg.


The controversy.

Proponents view facilitating access as an opportunity to cut down on the number of unwanted pregnancies. Opponents fear increases in high-risk sexual behavior and rates of sexually transmitted infections or decreases in the frequency of contraceptive use. Now researchers in San Francisco may have put those fears to rest.


The study.

More than 2,100 young women, 15 to 24 years of age, seeking family-planning information at Bay Area health clinics were randomized into three groups: a pharmacy-access group, who could receive emergency contraception at nearby pharmacies; an advance-provision group, who were given emergency contraception at the clinic before it was needed; and a clinic-access (control) group, who were required to go to a clinic to get emergency contraception. Baseline data on age, race and ethnic background, and contraceptive use and history were obtained, and screening for chlamydia and herpes simplex virus type 2 infections was performed. Follow-up lasted for six months.


The results.

After six months, women in the advance-access group were almost twice as likely to use emergency contraception as those in either the pharmacy-access or clinic-access (control) group (37% versus 24% and 21%, respectively). There were no significant differences, however, in rates of high-risk sexual practices or sexually transmitted infections, nor were there differences in self-reported rates of contraceptive use, all of which support the notion that increasing young women's access to emergency contraception will not lead to unfavorable changes in this regard. On the other hand, an interesting finding was that there were no significant differences among the three groups in rates of pregnancy. The authors speculate that this might be a result of the short duration of follow-up.

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In May 2004 the Food and Drug Administration (FDA) declined to approve over-the-counter sales of an emergency contraceptive despite recommendations of its advisory committee to do so. On January 21 Barr Pharmaceuticals, manufacturer of the emergency contraceptive levonorgestrel (Plan B), announced that the FDA had delayed its decision on whether the drug would be available over the counter to women ages 16 and older. -Doug Brandt


Raine TR, et al. JAMA 2005;293(1):54-62.