Population effect of increased access to emergency contraceptive pills: a systematic review.

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.