Decreased emergency contraception-related ED visits in US from 2006 to 2020

Key takeaways:

• Over 14 years, emergency contraception-related ED visits and related hospital charges decreased by 96% and 95%, respectively.
• Emergency contraception-related ED visits for sexual assault increased.

Since FDA approval of over-the-counter emergency contraception in 2006, there has been a large decrease in emergency contraception-related ED visits and total annual hospital charges, researchers reported.

“Emergency departments are important sites for obtaining emergency contraceptives given their 24-hour access and high-acuity care,” Emily L. Vogt, BA, an MD candidate in the department of obstetrics and gynecology in the division of reproductive endocrinology and infertility at the University of Michigan Medical School at the University of Michigan Ann Arbor, and colleagues wrote. “No study has examined emergency contraception-related ED utilization trends despite their utility as a barometer of OTC emergency contraception access.”

Vogt and colleagues conducted a cross-sectional study using the Nationwide Emergency Department Sample, a database of 1,006,582,711 weighted ED visits in the U.S. to evaluate all emergency contraception-related ED encounters from 2006, when the FDA approved OTC emergency contraception, to 2020. All visits were from females aged 15 to 44 years.

The primary outcomes were annual emergency contraception-related ED visits and hospital charges with researchers evaluating age, income quartile by ZIP code, hospital geographic region, payment method and race and ethnicity.

Overall, there were 47,858 emergency contraception-related ED encounters from 2006 to 2020. Over this period, emergency contraception-related ED encounters decreased by 96% (P < .001) and total emergency contraception-related hospital charges decreased by 95% from $7.61 million to $385,946 (P < .001).

Researchers observed the most notable decrease from 2006 to 2007 for a primary emergency contraception diagnosis. In addition, younger, low-income, Black, Hispanic and Medicaid-insured women were overrepresented in emergency contraception-related compared with non-emergency contraception ED visits.

Northeast U.S. hospitals had 43.9% to 58.6% of emergency contraception-related ED visits despite comprising only 17.1% to 19.1% of non-emergency contraception ED visits. Southern U.S. hospitals had 4.5% to 17.4% of emergency contraception-related ED visits despite averaging more than 40% of non-emergency contraception ED visits.

Researchers also observed an increase in females who sought care for sexual assault from 0.48% of emergency contraception-related ED visits in 2006 to 7.68% in 2020.

“Increasingly restrictive abortion access will likely drive emergency contraception demand to prevent unintended pregnancy. Moreover, disparities in emergency contraception-related ED utilization highlight complexities in OTC emergency contraception for certain populations,” the researchers wrote. “Future policies should reduce barriers to make emergency contraception safe and affordable to all.”