Is sex safer?

Emergency contraception (EC) is a safe, moderately effective option to prevent an unintended pregnancy. It is one of the FDA-approved, family planning options that health insurance plans are required to cover without any copayment through the Affordable Care Act (ACA).

Through the ACA, women should have access to all FDA-approved contraception such as birth control pills, injections, and long-acting reversible methods like arm implants and intrauterine devices. When used properly, these methods are more effective at preventing pregnancy.

However, if birth control fails or was not used, EC can be used as a backup. Taking EC pills within the first few days after unprotected sex can reduce the risk of pregnancy between 42-88%.  Yet, some people are concerned about the consequences of making EC widely available.

Researchers Atkins and Bradford studied whether accessibility of EC was associated with a higher potential for risky sexual behavior in women at least 18 years old from 1999 to 2009. They took into account state level changes that preceded the national policy change in 2006.

Increased EC access through a national policy change was associated with a decreased probability of sexual activity and sexual activity with more than one partner. State–level policy changes were not associated with an effect on sexual activity or multiple partnerships. However, it was associated with an increased probability of sex without a condom for women with multiple sexual partners.

As the study progressed, the sample population aged, and national policy made EC more accessible. Researchers posit that as EC became more accessible, women were less able to negotiate protected sex. Younger women may have participated in riskier behaviors when faced with lower bargaining power. Older women were more risk-averse and chose to abstain or enter monogamous relationships.

Since this study was completed, progestin-only EC is now available over-the-counter without age restrictions.

Helping women control their fertility can reduce the risk of unintended pregnancies, which can lead to greater social and economic opportunities. Women should have full access to contraception, including emergency contraception.

commentary by May Nguyen, MD, MPH

Abstract

OBJECTIVE: We studied whether increased emergency contraception availability for women over age 18 was associated with a higher probability of risky sexual practices.

DATA: A total of 34,030 individual/year observations on 3,786 women aged 18 and older were extracted from the National Longitudinal Survey of Youth, 1997 from October 1999 through November 2009.

STUDY DESIGN: We modeled three binary outcome variables: any sexual activity; sexual activity with more than one partner; and any sex without a condom for women with multiple partners for women in states with state-level policy changes (prior to the 2006 FDA ruling) and for women in states subject to only the national policy change both jointly and separately.

FINDINGS: We found different results when estimating the state and federal changes separately. The national change was associated with a reduction in the probability of sexual activity, a reduction in the likelihood of reporting multiple partnerships, and there was no relationship between the national policy change and unprotected sexual activity. There was no relationship between the probability of sexual activity or multiple partnerships for women in states with their own policy changes, but we did find that women in these states were more likely to report unprotected sex.

PMID: 25367046

Atkins, DN and Bradford WD. HSR. 2014 Nov 3; [E-pub].