Does emergency contraception promote teen sex?

September 1, 2005

The scientific evidence to date-including the authors' recent RCT-says no. Were EC to be available over-the-counter, it would not encourage risky sex nor increase rates of STI.

Emergency contraception (EC) or the "morning after pill" consists of high doses of the same hormones used in oral contraceptives (OC). Taken after an act of unprotected sex, it could potentially avert many of the millions of unintended pregnancies that occur in the United States every year.1 Yet American women's access to and use of EC remain limited, despite major efforts by medical organizations, advocacy groups, and some states to loosen regulatory restrictions. In 2002, only 4.2% of sexually active women reported having ever used EC.2

EC has been technically available since the 1960s through off-label use of OCs. In 1998, Preven (ethinyl estradiol and levonorgestrel, also known as the Yuzpe regimen), the first of two products for that specific indication, gained FDA approval. While Preven is no longer commercially available, Plan B (levonorgestrel) is available, either by prescription or directly through a pharmacist without a prescription, depending on the state.

As of now, legislation or regulatory action has made it possible for pharmacists in Alaska, California, Hawaii, Maine, New Hampshire, New Mexico, and Washington to dispense EC directly to a woman without a prescription from a physician. Elsewhere in the US, EC is available only by prescription, and women must rely on physicians or clinics to prescribe or give them EC.

What is sexual risk-taking?

Opponents of increased access to EC assert that making it available OTC will lead teens and women to take sexual risks.6 Health-care providers who care for adolescents and women and even some women at risk for unintended pregnancy have expressed concerns that ready access to EC may send mixed messages about sexual health.7,8

By definition, sexual risk-taking is any sexual behavior that places a person at risk for unintended pregnancy and/or sexually transmitted infections (STIs). Examples include unprotected sex (sex without condoms or any method of contraception), inconsistent use of contraception, use of contraception without appropriate protection against STIs, and sex with multiple partners. Concerns have been raised that easier access to EC would lead to repeat or excessive use of EC, which is intended only for occasional use. There is no scientific evidence, however, to substantiate any of these arguments. To the contrary, a vast body of research demonstrates that improving the availability of EC does not increase any form of sexual risk-taking.

Does increased access to EC influence contraceptive behavior?

Studies in both the US and abroad have found that most women who seek EC routinely use contraception but have experienced method failure, such as a condom break.9-11 Some physicians will give a patient EC during a routine visit or offer a prescription that she can keep on hand for future use. Women who receive such "advance provision" are no more likely to have unprotected sex than those who get EC from a doctor or clinic after having unprotected sex.12-15