Time for Plan B

Emergency contraception (EC) is a birth control method that can prevent a pregnancy when used up to five days after having unprotected sex. EC pills were first approved by the FDA in 1998 and became available over the counter without age restrictions in 2013 under the brand name “Plan B.” Several generic versions of EC are available over the counter and one type requires a prescription. Since the FDA’s approval, use of emergency contraception increased from 4% in 2002 to 20% in 2011-2015.

Racial disparities in rates of unintended pregnancies and contraceptive use are well-documented. Black and Hispanic women have higher rates of unintended pregnancy than White women and are more likely to use less effective birth control methods. But, little is known about patterns of EC use by race or ethnicity or the factors associated with EC use for women of different racial and ethnic groups.

Recent policy changes and debates have altered the reproductive health landscape. In early 2018, nearly 40 percent of women expressed concern that accessing birth control would become more difficult over the next year. It’s more important now than ever that we understand women’s experiences accessing and using birth control, including their use of EC. Women’s ability to prevent an unintended pregnancy is especially imperative today, as a growing number of states have passed laws restricting abortion.

We used data from the Urban Institute’s 2016 Survey of Family Planning and Women’s Lives to identify factors associated with ever using EC, particularly factors that could be changed through education and access to health care.  Our study examined the association between EC use and women’s sexual and pregnancy history, their attitudes towards pregnancy and contraception, and their awareness and beliefs about EC. We investigated factors associated with EC use for 1,624 women ages 18-44 women with a focus on differences by race and ethnicity.

More than one-quarter (28%) of women in our study reported ever using EC. A large majority (85%) had heard some or a lot about EC. Fifty one percent believed it to be somewhat or very safe, and 68% believed it to be somewhat or very effective at preventing pregnancy. After adjusting for demographic characteristics, we found no significant differences in use of EC, awareness, or beliefs between women of different racial and ethnic groups.

Our findings suggest that providing information to women about EC availability, safety, and effectiveness may empower them to make informed decisions about whether to use it.

The factors associated with EC use varied by race/ethnicity, however. White women were more likely to have used EC if they used barrier methods of contraception, had a previous unplanned pregnancy, reported having heard some or a lot about EC, or believed EC was somewhat or very effective. Among Black women, EC use was more likely for those who had a previous unplanned pregnancy or believed that EC was somewhat or very effective. Hispanic women were more likely to use EC if they had used long-acting reversible contraceptives, had recent male sexual partners, or believed that EC was somewhat or very safe and effective.

Awareness and beliefs about the safety and effectiveness of EC were the strongest and most consistent factors associated with EC use. Though we can’t be sure of the causal direction of the association, women of each race and ethnicity who believed EC was somewhat or very effective had higher odds of EC use. Beliefs about safety were also associated with EC use among Hispanic women. And Hispanic and White women who were aware of EC were more likely to have used it.

Our findings suggest that providing information to women about EC availability, safety, and effectiveness may empower them to make informed decisions about whether to use it. Previous research shows that rates of emergency contraception counseling remain low, but counseling can increase knowledge and use. Clinicians and the public health community should consistently counsel women of reproductive age about the safety and effectiveness of EC, incorporating best practices from contraceptive counseling to ensure that women are aware of and informed about all effective contraceptive methods.