It is estimated that half of the 3.5 million unintended pregnancies that occur each year in the United States could be averted if emergency contraception (EC) were easily accessible and used, according to background information in the article. In efforts to increase access to EC, six states (Alaska, California, Hawaii, Maine, New Mexico, and Washington) have implemented pharmacy access legislation whereby women can obtain EC directly from pharmacists without having to see a clinician or obtain a prescription first. An important element in policy debates over making EC more widely available is the concern that it will lead to increased risk-taking, that women would have more unprotected intercourse, increase their risk for STIs, and abandon more effective forms of regular contraception.

Tina R. Raine, M.D., M.P.H., of the University of California, San Francisco, and colleagues conducted a randomized controlled trial to evaluate the effect on pregnancy and STIs of access to EC through pharmacies on receiving the medication in advance. The trial included 2,117 women, ages 15 to 24 years, attending 4 California clinics providing family planning services, who were not desiring pregnancy, using long-term hormonal contraception, or requesting EC. The participants were assigned to one of the following groups: (1) pharmacy access to EC; (2) advance provision of 3 packs of levonorgestrel EC; or (3) clinic access (control).

The researchers found that women in the pharmacy access group were no more likely to use EC (24.2 percent) than controls (21.0 percent). Women in the advance provision group (37.4 percent) were almost twice as likely to use EC than controls (21.0 percent) even tho
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JAMA and Archives Journals
4-Jan-2005