Sexual & Reproductive Health| Volume 26, ISSUE 6, P622-627, November 2016

Access to Emergency Contraception in the Over-the-Counter Era

Published:September 24, 2016DOI:



      After years of complex regulatory changes, levonorgestrel (LNG) emergency contraception (EC) is now approved for unrestricted sale in the United States. Timely access to EC pills is critical because they are more likely to work the sooner they are taken. This study assesses whether LNG EC is sold in accordance with current Food and Drug Administration regulations.


      We distributed an online questionnaire through an EC-focused listserv for reproductive health professionals, asking data collectors to visit local stores and document product names, price, over-the-counter shelf availability, and misinformation about age restrictions. We used χ2 analysis to assess bivariate associations and t tests and Wilcoxon rank-sum tests to determine differences in means.


      We collected information about 220 stores. The majority (65%) stocked EC on over-the-counter shelves, although only 22% of these displayed it without a locked security enclosure. Chain pharmacies were more likely to shelf-stock EC than independent pharmacies (77% vs. 5%; p = .000), but variation existed among stores within the same chain. Among stores that were asked, 40% incorrectly reported an age restriction for non-prescription purchase of LNG EC, whereas 95% correctly reported that men can buy LNG EC. The average price of branded and generic LNG EC was $49.64 and $40.05, respectively.


      Changes in the regulatory status of LNG EC have resulted in widespread confusion about how EC can be sold, and its high price contributes to access barriers. Retailers should ensure that consumers can access LNG EC quickly and easily by stocking the product on over-the-counter shelves and educating staff about current regulations.
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      Kelly Cleland, MPA, MPH, is a reproductive health researcher at Princeton University and the Executive Director of the American Society for Emergency Contraception. Her work focuses primarily on emergency contraception and medical abortion.


      Jamie Bass, MPH, consults with the American Society for Emergency Contraception, the International Consortium for Emergency Contraception, and the European Consortium for Emergency Contraception. Her work focuses on increasing access to emergency contraceptives.


      Florida Doci, BSc, BA, is currently an MSc candidate in Interdisciplinary Health Sciences at the University of Ottawa. Her research work is focused on women's reproductive health choices and needs primarily in low-income and developing countries.


      Angel M. Foster, DPhil, MD, AM, holds an Endowed Chair in Women's Health Research at the University of Ottawa. Her research focuses on emergency contraception, abortion, and health professions education. She leads projects in North America, the Middle East, and Asia.