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Population Effect of Increased Access to Emergency Contraceptive Pills: A Systematic Review

Raymond, Elizabeth G. MD, MPH1; Trussell, James PhD2; Polis, Chelsea B.3

doi: 10.1097/01.AOG.0000250904.06923.4a
Reviews

OBJECTIVE: We systematically reviewed data on effects of increased access to emergency contraceptive pills on pregnancy rates and use of the pills.

DATA SOURCES: We searched MEDLINE, POPLINE, EMBASE, and LILACS, and we consulted with experts.

METHODS OF STUDY SELECTION: We included studies that compared the effect of different levels of access to emergency contraceptive pills on pregnancy rates, use of the pills, and other outcomes.

TABULATION, INTEGRATION, AND RESULTS: Of the 717 articles identified, we selected 23 for review. The studies included randomized trials, cohort studies, and evaluations of community interventions. The quality of these studies varied. In all but one study, increased access to emergency contraceptive pills was associated with greater use. However, no study found an effect on pregnancy or abortion rates.

CONCLUSION: Increased access to emergency contraceptive pills enhances use but has not been shown to reduce unintended pregnancy rates. Further research is needed to explain this finding and to define the best ways to use emergency contraception to produce a public health benefit.

Increased access to emergency contraceptive pills enhances use but has not been shown to reduce unintended pregnancy rates.

From 1Family Health International, Research Triangle Park, North Carolina; 2Office of Population Research, Princeton University, Princeton, New Jersey; and Department of Population, Family and Reproductive Health, 3Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Support for this study was provided by Family Health International with funds from the William and Flora Hewlett Foundation. The views expressed in this article do not necessarily reflect those of Family Health International, Princeton University, Johns Hopkins Bloomberg School of Public Health, or the William and Flora Hewlett Foundation.

The authors thank Kavita Nanda and Carol Manion for assistance with systematic reviewing and literature searches, and David Grimes and Kate Schaffer for substantive input.

Corresponding author: Elizabeth Raymond, MD, MPH, Clinical Research Division, Family Health International, PO Box 13950, Research Triangle Park, NC 27709; e-mail: eraymond@fhi.org.

© 2007 The American College of Obstetricians and Gynecologists