Pharmacy Access vs. Having the Pill On Hand

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 the morning-after pill through pharmacies versus receiving the medication in advance.

The trial included 2,117 women, ages 15 to 24 years, attending four California clinics providing family planning services, who were not desiring pregnancy, using long-term hormonal contraception, or requesting emergency contraception (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 the morning-after pill (24.2 percent) than those who had clinic access (21.0 percent).

However, women who were given the pill in advance (37.4 percent) were almost twice as likely to use it than the clinic-access group (21.0 percent), even though their reported frequency of unprotected intercourse was similar (39.8 percent vs. 41.0 percent, respectively).

No Change in Sexual Behavior

Only half (46.7 percent) of study participants who had unprotected intercourse used the morning-after pill over the study period.

Eight percent of participants became pregnant and 12 percent acquired an STI; compared with controls, women in the pharmacy-access and advance provision groups did not experience a significant reduction in pregnancy rate or increase in STIs.

There were no differences in patterns of contraceptive or condom use or sexual behaviors by study group.

"[I]n our study population, direct pharmacy access did not appear to be any more useful than access through clinics," the authors write. "While study participants had a choice of 13 pharmacies, they could have been reluctant to go to a pharmacy or experienced difficulty getting to a pharmacy or finding a pharmacist on duty who was trained to dispense EC," they note.

Public Health Implications

"The requirement to go through pharmacists or clinics to obtain EC appears to be a barrier that limits use," the authors maintain. "Even though rates of unprotected intercourse were similar across study groups, women in the advance provision group were still almost twice as likely to use EC than women in the clinic access group.

"Furthermore, contrary to concerns that increased access to EC will entice women to use EC repeatedly, only a small fraction of women in the pharmacy access and advance provision groups used EC more than once over the 6-month period, even though EC was supplied at no cost," say the authors.

"These data support the previous scientific literature that indicates that among young sexually active women, unprotected intercourse leads to EC use, not the converse," they add.

"[O]ur study has important public health implications," the authors point out. "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 through clinics," the researchers conclude.