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Raine TR, Harper CC, Rocca CH, et al. Direct Access to Emergency Contraception Through Pharmacies and Effect on Unintended Pregnancy and STIs: A Randomized Controlled Trial. JAMA. 2005;293(1):54–62. doi:10.1001/jama.293.1.54
Author Affiliations: Center for Reproductive
Health Research and Policy, Department of Obstetrics, Gynecology, and Reproductive
Sciences, University of California, San Francisco (Drs Raine, Harper, Padian,
and Darney and Ms Rocca); Planned Parenthood Mar Monte, San Jose, Calif (Dr
Fischer); and San Francisco Department of Public Health, San Francisco, Calif
Context It is estimated that half of unintended pregnancies could be averted
if emergency contraception (EC) were easily accessible and used.
Objective To evaluate the effect of direct access to EC through pharmacies and
advance provision on reproductive health outcomes.
Design, Setting, and Participants A randomized, single-blind, controlled trial (July 2001-June 2003) of
2117 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.
Intervention Participants were assigned to 1 of the following groups: (1) pharmacy
access to EC; (2) advance provision of 3 packs of levonorgestrel EC; or (3)
clinic access (control).
Main Outcome Measures Primary outcomes were use of EC, pregnancies, and sexually transmitted
infections (STIs) assessed at 6 months; secondary outcomes were changes in
contraceptive and condom use and sexual behavior.
Results Women in the pharmacy access group were no more likely to use EC (24.2%)
than controls (21.0%) (P = .25). Women
in the advance provision group (37.4%) were almost twice as likely to use
EC than controls (21.0%) (P<.001) even though
the frequency of unprotected intercourse was similar (39.8% vs 41.0%, respectively, P = .46). Only half (46.7%) of study participants
who had unprotected intercourse used EC over the study period. Eight percent
of participants became pregnant and 12% acquired an STI; compared with controls,
women in the pharmacy access and advance provision groups did not experience
a significant reduction in pregnancy rate (pharmacy access group: adjusted
odds ratio [OR], 0.98; 95% confidence interval [CI], 0.58-1.64; P = .93; advance provision group: OR, 1.10; 95% CI, 0.66-1.84, P = .71) or increase in STIs (pharmacy access
group: adjusted OR, 1.08, 95% CI, 0.71-1.63, P = .73;
advance provision group: OR, 0.94, 95% CI, 0.62-1.44, P = .79). There were no differences in patterns of contraceptive
or condom use or sexual behaviors by study group.
Conclusions While removing the requirement to go through pharmacists or clinics
to obtain EC increases use, the public health impact may be negligible because
of high rates of unprotected intercourse and relative underutilization of
the method. Given that there is clear evidence that neither pharmacy access
nor advance provision compromises contraceptive or sexual behavior, it seems
unreasonable to restrict access to EC to clinics.
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