More research needed into access to emergency contraception

Experts at The University of Nottingham have called for more research into whether systems for accessing emergency contraception are meeting the needs of younger women and those from poorer backgrounds.

The comment piece by Dr Paul Bissell and Professor Claire Anderson, published in today’s Lancet, examines studies that have looked at the effects of women using emergency contraception (EC) on sexual activity, pregnancy and sexually transmitted diseases.

They say that research has shown that there is little evidence that easier access to emergency contraception through pharmacists does not impact on regular contraceptive use or encourage risky behaviour.

However, as well as saying that recent studies should reassure people concerned about the links between EC and sexual morality, the authors call for greater thought to be given to making it easier for younger women and those from lower socio-economic groups to receive emergency contraceptives when needed.

In their comment piece, Dr Bissell and Professor Anderson say that, despite its ‘undisputed safety and efficacy’, widening access to EC to women has been ‘controversial’.

They add: “Some of this controversy is related to ECs ‘anomalous’ position in the family planning repertoire: anomalous because it is used after sex. At the same time, some EC service developments aimed at combating teenage and unwanted pregnancy have been reported on in particularly lurid terms in the media, conflating concerns about sexual morality, inappropriate use of contraception and the spread of sexually transmitted infections (STIs).”

They quote a study (Raine et al) that randomly assigned 2,117 women aged between 15 and 24 either pharmacy access to EC without a prescription, an advanced provision of ECs to keep at home or usual care requiring a visit to a clinic. It found that pregnancy rates and rates of new STIs were comparable in all the groups.

Another study conducted in Scotland quoted by the Nottingham academics (Ziebland et al) showed that advanced supply was viewed positively by women and that concerns about repeated EC use as well as links between easy access to EC and risky sex or changed contraceptive behaviours appear to be unfounded.

However, the Scottish study reported no decrease in abortion rates, possibly because access to EC did not meet the needs of those most at risk of unwanted pregnancy.

Dr Bissell and Professor Anderson say: “We believe that research is needed to explore whether new routes of supply (both pharmacy supplied EC and EC provided in advance) meet the needs of younger women and those from lower socio-economic groups.

“We are acutely aware from our research in Greater Manchester that free supplies of EC distributed through community pharmacies were mainly sought by women over 20 and the perception of participating pharmacists was that use was mainly confined to women from higher socio-economic groups.”

The pair conclude that understanding the issues surrounding the supply of EC to younger women and those from lower socio-economic backgrounds may shed important light on the appropriateness of services and their use by those most at risk of unwanted pregnancy.