Effect of changes to cost and availability of emergency contraception on users’ profiles in an emergency department in Catalunya

Abstract

Objective Emergency contraception (EC) accessibility has evolved differently in Catalunya as compared with other autonomous communities in Spain. Free-of-charge access within the Public Health System was authorised in 2004, and over-the-counter (OTC) access was implemented in 2009. The aim of the study is to assess the impact of these measures on demand and users’ profiles at our institution.

Methods A retrospective study, in our Emergency Department, was conducted to evaluate EC requests in relationship to accessibility modifications. The age of women and which days of the week they attended were analysed.

Results The number of EC requests, the distribution by age and the demand over the week remained stable after access to EC became free of charge. However, requests sharply decreased following OTC access implementation. Distribution by age also changed, with a significant increase in requests from women under 25 years (72% vs 56%, p < 0.001). Demand was greatest on Sunday and Monday, and this distribution persisted over the study period.

Conclusion EC requests remained unchanged following free-of-charge access to EC, but decreased after OTC implementation. Women currently seeking EC at no cost at our institution are more likely to be younger and to request it on a Monday.

Chinese Abstract

摘 要 目的 与西班牙其他自治区相比，在加泰罗尼亚，紧急避孕药（emergency contraception，EC）获取途径的演变有所不同。2004年公共卫生系统批准其免费发放，2009年后将其列为非处方类药物（over-the-counter，OTC）。本研究目的在于评价不同措施对于公众需求的影响。

方法 运用回顾性研究评价紧急避孕药的需求与药物获取途径间的关系。并分析女性的年龄及一周中有需求的天数。

结果 EC免费发放，EC的需求量、使用者年龄分布及一周中有需求的天数均保持稳定。然而，将EC列为OTC后，其需求量显著减少，在小于25岁的女性中分布上升（72% VS 56%，p＜0.001）。整个研究期间还发现周日与周一的需求量始终保持最高。

结论 免费发放EC并不影响其需求量，但转变为非处方药时，其使用量明显减少。本研究中免费获取EC的女性年龄偏小且倾向于在周一使用。

KEYWORDS:

• Accessibility
• Availability
• Contraceptive use
• Emergency contraception
• Levonorgestrel
• Over-the-counter

ACKNOWLEDGEMENTS

We thank Dr Anne Webb for the comments she made when reviewing our manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and the writing of the paper.