Background: Emergency postcoital contraception prevents pregnancy, but it must be prescribed by a doctor and taken within 72 hours of intercourse. It has been proposed that emergency contraception be made available without a prescription. We undertook a study to learn how women might behave if given a supply of emergency contraceptive pills to keep at home.
Methods: We assigned 553 women to be given a replaceable supply of hormonal emergency contraceptive pills to take home (the treatment group) and 530 women to use emergency contraception obtained by visiting a doctor (the control group). The frequency of use of emergency contraception, the use of other contraceptives, and the incidence of unwanted pregnancy were determined in both groups of women one year later.
Results: The results for 549 women in the treatment group and 522 women in the control group were available for analysis. Three hundred seventy-nine of the women in the treatment group (69 percent) and 326 of the women in the control group (62 percent) contributed detailed information at follow-up. One hundred eighty of the women in the treatment group (47 percent) used emergency contraception at least once. Among those who returned the study questionnaire, 98 percent used emergency contraception correctly. There were no serious adverse effects. Eighty-seven women in the control group (27 percent) used emergency contraception at least once (P<0.001 for the comparison with the treatment group). The women in the treatment group were not more likely to use emergency contraception repeatedly. Their use of other methods of contraception was no different from that of the women in the control group. There were 18 unintended pregnancies in the treatment group and 25 in the control group (relative risk, 0.7; 95 percent confidence interval, 0.4 to 1.2).
Conclusions: Making emergency contraception more easily obtainable does no harm and may reduce the rate of unwanted pregnancies.
PIP: The feasibility of providing women with a supply of emergency contraception to keep on hand in the event of unprotected intercourse was investigated in a comparative study involving 1071 women 16-44 years of age recruited from a family planning clinic and hospital in Edinburgh, Scotland, in 1994-96. 549 women (treatment group) were given a replaceable supply of hormonal emergency contraceptive pills to take home and 522 women (controls) were counseled about the method and instructed to call their physician if it was needed. Emergency contraception was used on a total of 387 occasions during the 4-month study period (248 times by women in the treatment group and 139 times by controls). The women in the treatment group were significantly more likely to use emergency contraception on only one occasion during the study period than those in the control group (36% vs. 14%, p 0.001), but not more likely to use it more than once (12% vs. 13%). Use of other fertility control methods did not differ between study groups. There were 18 unintended pregnancies in the treatment group and 25 in the control group (relative risk, 0.7; 95% confidence interval, 0.4-1.2). 79% of women in the treatment group and 61% of controls believed emergency contraception should be available without a prescription. Support for this strategy was highest among women with a history of an induced abortion prior to study entry. These findings suggest that making emergency contraception more available has the potential to reduce the rate of unintended pregnancies.