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The Effect of Increased Access to Emergency Contraception Among Young Adolescents

Harper, Cynthia C. PhD; Cheong, Monica MD; Rocca, Corinne H. MPH; Darney, Philip D. MD, MSc; Raine, Tina R. MD, MPH

doi: 10.1097/01.AOG.0000174000.37962.a1
Original Research

Objectives: The United States Food and Drug Administration cited an absence of data on young adolescents as the reason the emergency contraceptive, Plan B, could not be moved over-the-counter. This study analyzed data on young adolescents with increased access to emergency contraception.

Methods: We conducted an age-stratified analysis with previously published data from a randomized, controlled trial of Plan B with a sample size of 2,117, including 964 adolescents, 90 of whom were aged younger than 16 years. Participants were randomly assigned to nonprescription pharmacy access, advance provision of 3 packs, or clinic access (control). We measured contraceptive and sexual risk behaviors at baseline and 6-month follow-up and tested for pregnancy and sexually transmitted infections. We used contingency table and logistic regression analysis to measure the effect of the intervention on risk behaviors in young adolescents (< 16 years), compared with middle adolescents (16–17 years), older adolescents (18–19 years), and adults (20–24 years).

Results: Adolescents aged younger than 16 years behaved no differently in response to increased access to emergency contraception (EC) from the other age groups. As with adults, EC use was greater among adolescents in advance provision than in clinic access (44% compared with 29%; P ≤ .001), and other behaviors were unchanged by study arm, including unprotected intercourse, condom use, sexually transmitted infection acquisition, or pregnancy. Additionally, adolescents with increased access to EC did not become more vulnerable to unwanted sexual activity.

Conclusion: Young adolescents with improved access to EC used the method more frequently when needed, but did not compromise their use of routine contraception nor increase their sexual risk behavior.

Level of Evidence: I

Increased access to emergency contraception has the same effect on young adolescents as it does on women in older age groups.

From the Center for Reproductive Health Research and Policy, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California.

Supported by grants from the Compton Foundation, Inc., the Open Society Institute, the Walter Alexander Gerbode Foundation, and the William and Flora Hewlett Foundation. The Women’s Capital Corporation, distributor of Plan B, donated the emergency contraception for use in the trial. The San Francisco Department of Public Health and Diagnology Ltd. donated the tests for sexually transmitted infections.

Corresponding author: Cynthia C. Harper, PhD, Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Box 0744, UCSF, 3333 California Street, Suite. 335, San Francisco, CA; email:

© 2005 The American College of Obstetricians and Gynecologists