Easy Access to Emergency Contraception Not Likely To Encourage Unprotected Sex, Study Says

Women who have ready access to emergency contraception are no more likely to engage in unprotected sex or abandon use of other contraception methods than women who do not have easy access to the pills, according to a study published in the Jan. 5 issue of the Journal of the American Medical Association, USA Today reports (Rubin, USA Today, 1/5). Dr. Tina Raine of the Center for Reproductive Health Research & Policy at the University of California-San Francisco and colleagues evaluated the effect of "direct access" to EC -- which can prevent pregnancy if taken within 72 hours of unprotected sex -- on the reproductive health behaviors and outcomes of 2,117 sexually active women ages 15 to 24, none of whom planned to become pregnant.

The women were randomly assigned to one of three EC access groups: one group received advance provision of three doses of EC; one group was told they could access EC without a prescription at a nearby pharmacy; and the control group was required to make an appointment at a clinic to obtain EC. After six months, participants reported their EC use and the results of any pregnancy or sexually transmitted disease tests over the study period (Gale, Reuters Health, 1/4).

According to the researchers, women who had home access to EC were most likely to report using the pills over the six-month period, with 37.4% taking EC, compared with 24.2% of participants in the pharmacy group and 21% of participants in the clinic group. Women in the home access group were no more likely to have unprotected intercourse than women in the other groups. In addition, women in the home access group were no more likely to have contracted STDs during the study period than women in either of the other two groups (Raine et al., JAMA, 1/5).

"Our findings were that women don't change their sexual behavior when the drug is easily available, but rather that they're more likely to use it if access is easier," Raine said (Kaufman, Washington Post, 1/5).

Although the researchers had expected that easier access to EC would lower pregnancy rates, the study showed that women had similar pregnancy rates whether they were provided with EC or had to go to a clinic to access the drug, the Washington Times reports. "That was definitely a disappointing finding," Raine said (Wetzstein, Washington Times, 1/5). Raine said that pregnancy rates were the same among the three groups because many women did not always use EC after unprotected sex, according to USA Today.

"Very few women used it more than once," Raine said, adding, "They may not think they're going to get pregnant. They may not feel comfortable using it. They may not actually have it at the time they need it." Although some critics of EC have said that women will "come to depend" on the drug if it were more widely available, Raine said that "we're seeing the exact opposite." In an accompanying JAMA editorial, Iris Litt of Stanford University said that it was "significant that no apparent downside of EC was demonstrated."

The study findings "refute one of the main objections" to making EC available without a prescription, USA Today reports (USA Today, 1/5). FDA in May issued a "not approvable" letter to Barr Laboratories -- the manufacturer of Plan B -- citing inadequate data on the use of the pills among girls under age 16. The agency's decision was unusual because it contradicted the recommendations of two FDA advisory panels, which in December 2003 voted 23-4 to recommend that Plan B be sold without a doctor's prescription.

In addition, Steven Galson, acting director of FDA's Center for Drug Evaluation and Research, said he made the decision to reject the application on his own and did not follow the recommendations of his staff. FDA scientists disagreed particularly with the agency's finding that there was not enough information on how Plan B would affect the sexual behavior of younger women (California Healthline, 6/18/04).

Raine said, "The concept that this could be harmful or that young women would misuse it is a notion with no evidence to date to support it," adding, "We know that if a woman takes the pill after one instance of unprotected sex, it reduces her chance of pregnancy by 89%. Clearly it has the potential to work for some women" (Buchanan, San Francisco Chronicle, 1/5). Since the initial rejection, Barr has submitted a modified version of its application that would allow EC to be sold without a prescription to women older than 16 and require a prescription for the drug to be sold to younger women (Washington Post, 1/5).

Barr spokesperson Carol Cox on Tuesday said that the company expects FDA to make a decision on the revised application by Jan. 20 (USA Today, 1/5). EC advocates are planning a "sit-in" at FDA headquarters in Bethesda, Md., on Friday, and some are calling for civil disobedience if Galson refuses to meet with them (Washington Post, 1/5). The study is available online.