摘要
Context: It is estimated that half of unintended pregnancies could be averted if emergency contraception (EC) were easily accessible and used. Objective: To e valuate the effect of direct access to EC through pharmacies and advance provisi on on reproductive health outcomes. Design, Setting, and Participants: A randomi zed, sin-gle-blind, controlled trial (July 2001-June 2003) of 2117 women, age s 15 to 24 years, attending 4 California clinics providing family planning servi ces, who were not desiring pregnancy, using long-term hormonal contraception or requesting EC. Intervention: Participants were assigned to 1 of the following g roups: (1) pharmacy access to EC; (2) advance provision of 3 packs of levonorges trel EC; or (3) clinic access (control). Main Outcome Measures: Primary outcomes were use of EC, pregnancies, and sexually transmitted infections (STIs) assesse d at 6 months; secondary outcomes were changes in contraceptive and condom use a nd sexual behavior. Results: Women in the pharmacy access group were no more lik ely to use EC (24.2%) than controls (21.0%) (P=.25). Women in the advance prov ision group (37.4%) were almost twice as likely to use EC than controls (21.0% ) (P<.001) even though the frequency of unprotected intercourse was similar (39. 8%vs 41.0%, respectively, P= .46). Only half (46.7%) of study participants wh o had unprotected intercourse used EC over the study period. Eight percent of pa rticipants became pregnant and 12%acquired an STI; compared with controls, wome n in the pharmacy access and advance provision groups did not experience a signi ficant reduction in pregnancy rate (pharmacy access group: adjusted odds ratio [ OR], 0.98; 95%confidence interval [CI], 0.58-1.64; P=.93; advance provision gr oup: OR, 1.10; 95%CI, 0.66-1.84, P=.71) or increase in STIs (pharmacy access g roup: adjusted OR, 1.08,95%CI, 0.71 -1.63, P=.73; advance provision group: OR, 0.94, 95%CI, 0.62-1.44, P=.79). There were no differences in patterns of cont raceptive or condom use or sexual behaviors by study group. Conclusions: While r emoving the requirement to go through pharmacists or clinics to obtain EC increa ses use, the public health impact may be negligible because of high rates of unp rotected intercourse and relative underutilization of the method. Given that the re is clear evidence that neither pharmacy access nor advance provision compromi ses contraceptive or sexual behavior, it seems unreasonable to restrict access t o EC to clinics.
Context: It is estimated that half of unintended pregnancies could be averted if emergency contraception (EC) were easily accessible and used. Objective: To e valuate the effect of direct access to EC through pharmacies and advance provisi on on reproductive health outcomes. Design, Setting, and Participants: A randomi zed, sin-gle-blind, controlled trial (July 2001-June 2003) of 2117 women, age s 15 to 24 years, attending 4 California clinics providing family planning servi ces, who were not desiring pregnancy, using long-term hormonal contraception or requesting EC. Intervention: Participants were assigned to 1 of the following g roups: (1) pharmacy access to EC; (2) advance provision of 3 packs of levonorges trel EC; or (3) clinic access (control). Main Outcome Measures: Primary outcomes were use of EC, pregnancies, and sexually transmitted infections (STIs) assesse d at 6 months; secondary outcomes were changes in contraceptive and condom use a nd sexual behavior. Results: Women in the pharmacy access group were no more lik ely to use EC (24.2%) than controls (21.0%) (P=.25). Women in the advance prov ision group (37.4%) were almost twice as likely to use EC than controls (21.0% ) (P<.001) even though the frequency of unprotected intercourse was similar (39. 8%vs 41.0%, respectively, P= .46). Only half (46.7%) of study participants wh o had unprotected intercourse used EC over the study period. Eight percent of pa rticipants became pregnant and 12%acquired an STI; compared with controls, wome n in the pharmacy access and advance provision groups did not experience a signi ficant reduction in pregnancy rate (pharmacy access group: adjusted odds ratio [ OR], 0.98; 95%confidence interval [CI], 0.58-1.64; P=.93; advance provision gr oup: OR, 1.10; 95%CI, 0.66-1.84, P=.71) or increase in STIs (pharmacy access g roup: adjusted OR, 1.08,95%CI, 0.71 -1.63, P=.73; advance provision group: OR, 0.94, 95%CI, 0.62-1.44, P=.79). There were no differences in patterns of cont raceptive or condom use or sexual behaviors by study group. Conclusions: While r emoving the requirement to go through pharmacists or clinics to obtain EC increa ses use, the public health impact may be negligible because of high rates of unp rotected intercourse and relative underutilization of the method. Given that the re is clear evidence that neither pharmacy access nor advance provision compromi ses contraceptive or sexual behavior, it seems unreasonable to restrict access t o EC to clinics.
