OTC Emergency Contraception Sharply Reduced Related ED Visits

January 31st, 2024

By Jill Drachenberg, Editor, Relias Media

Nearly 18 years after emergency contraception (EC), such as the Plan B pill, was approved for over-the-counter (OTC) status, emergency department (ED) visits to obtain the medication have fallen drastically.

Researchers studied data from the Nationwide Emergency Department Sample related to EC visits from 2006 (when OTC EC was approved) to 2020. During this period, EC-related visits plummeted 96%, from 17,019 to 659. Hospital costs related to EC fell 95%, from $7.61 million to $385,946. Most of the decrease in ED visits occurred in hospitals in the Northeast. Patients presenting for EC tended to be younger women (ages 15 to 25 years), women of color, and those who are low-income and/or insured with Medicaid. The rates of women seeking EC after sexual assault shot up from 0.48% in 2006 to 7.68% in 2020.

Access to all forms of contraception, including OTC EC, is more crucial than ever. Since the Supreme Court overturned Roe v. Wade in June 2022, 14 states have banned abortion. Only five states allow an exception for rape — and only if the rape is reported to police. The authors of another recent research letter estimated 64,565 pregnancies have occurred from rapes in the months since Roe was overturned. Nine percent of these pregnancies are in states with rape exceptions to abortion bans and 91% in states without exceptions.

Because of this, states must ensure access to EC and other forms of contraceptives without barriers. However, barriers to EC and other contraceptive care remain, including income barriers. “Our finding that younger, low-income, Medicaid-insured, Black, and Hispanic females are overrepresented in EC-related ED visits … suggests ongoing barriers to OTC EC access and/or increased ED utilization for other reasons, including sexual assault,” the study authors noted. “The steep decrease in privately insured EC ED visits affirms possible income-related disparities. … Increasingly restrictive abortion access will likely drive EC demand to prevent unintended pregnancy. Moreover, disparities in EC-related ED utilization highlight complexities in OTC EC for certain populations. Future policies should reduce barriers to make EC safe and affordable to all.”

More information on this study and its implications will be available in the April issue of Contraceptive Technology Update.