Since the US Food and Drug Administration (FDA) deemed that women 18 years and older could purchase levonorgestrel EC — known as the morning-after pill — without a prescription in 2006, visits to the emergency department for contraception have declined significantly, new research shows

"This study shows that thoughtful healthcare policy matters and can have a really positive impact on women's access to care," said senior investigator Erica Marsh, MD, from the University of Michigan in Ann Arbor.

"We need to keep fighting the good fight to support health care policies that are going to allow women to access the care that they need," she said at the American Society for Reproductive Medicine 2018 Scientific Congress in Denver.

Marsh and her team searched the Nationwide Emergency Department Sample database and identified women 15 to 44 years of age with "encounter for emergency contraception counseling and prescription" listed as the primary ICD-9 diagnosis from 2006 to 2014. The primary outcome was the number of annual emergency department visits.

The steepest decline occurred immediately after the policy change. In 2006, there were 15,039 visits, and in 2007, there were 4370 visits. From 2007 on, the number of visits decreased steadily, reaching just 685 visits in 2014.

"Previous research indicates that the use of emergency contraception overall, regardless of where it is obtained, is increasing," said lead investigator Shani Chibber, MS, a fourth-year medical student at the University of Illinois College of Medicine in Chicago, who completed this work during a research fellowship at the University of Michigan.

"Our analysis shows that emergency department utilization decreased, in the context of these FDA policy changes, quite dramatically," Chibber told Medscape Medical News. "In fact, we found an incredibly steep fall in emergency department visits in 2006 and 2007. They dropped by 95%."

Decrease in Costs

Costs for visits to the emergency department for the morning-after pill decreased over the same period — from $6.2 million in 2006 to $0.65 million in 2014. For all age groups, the decrease in visits to the emergency department exceeded 90% during the study period. The largest decrease, of 97.2%, was seen in women 20 to 24 years of age.

Decreases in visits in all income quartiles and in all geographic regions of the United States also exceeded 90%. When the cohort was divided by payment method, the decrease in emergency visits by patients with private insurance and by those who paid themselves was 98% in both cases. For patients covered by Medicaid, the decrease was 84%.

In fact, lower-income patients accounted for 30% to 36% of all visits to the emergency department for contraception in 2014, Chibber reported. "We think this is because lower-income women may incur out-of-pocket costs at their local pharmacy" but not at the emergency department, she said. Emergency contraception can range from $35 to $70, "which could be prohibitive for some low-income women."

The Power of Policy

"This is an important study showing that better access to contraception has implications even beyond the tremendous benefits of preventing unwanted pregnancies," said Abigail Mancuso MD, from the University of Iowa in Iowa City.

"Making contraception easier to access can save millions of healthcare dollars and also decrease visits to overburdened emergency departments," she told Medscape Medical News. "We should continue to work on improving access.

This does not seem to be a controversial issue. "Allowing women access to affordable and effective birth control benefits both women and society," said Elizabeth Ginsburg, MD, from Brigham and Women's Hospital and Harvard Medical School in Boston.