Following federal approval for over-the-counter emergency contraception in 2006, emergency room visits across the United States saw a significant decrease, along with associated physician costs, as a new study shows.
Emergency room visits related to emergency contraception decreased by 96%, from 17,019 to 659, while total associated hospital costs from 2006 to 2020 decreased by $7.2 million – from $7.6 million to $385,946. The most significant decrease was observed between 2006 and 2007, specifically among individuals seeking emergency contraception.
The findings from Michigan Medicine appear in JAMA Network Open.
“Emergency departments are important places for access to emergency contraception, as they are accessible 24/7 and provide high-quality care,” said lead author Erica Marsh, MD, professor of obstetrics and gynecology at the University of Michigan Medical School and director of the Division of Reproductive Endocrinology and Infertility at UM Health Von Voigtlander Women’s Hospital at Michigan Medicine.
“We believe this is the first study to specifically examine the link between relevant policy changes and disparities and trends in emergency room visits related to the use of emergency contraception.”
Researchers found that compared to other emergency department services, there was a disproportionately high rate of younger, low-income, Black, Hispanic, and Medicaid-insured patients observed in visits related to emergency contraception.
“We identified overrepresentation of certain demographic groups utilizing emergency rooms for emergency contraception. This is consistent with previous outpatient studies suggesting persistent barriers to access to over-the-counter emergency contraception and/or increased use of the emergency department for other reasons, including instances of sexual assault.”
– Erica Marsh, MD, Professor of Obstetrics and Gynecology at the University of Michigan Medical School
Prior research by Marsh and colleagues found that emergency room visits related to sexual assaults have increased by more than tenfold in the last decade.
Emergency contraception traditionally includes methods aimed at preventing pregnancy in the first few days after unprotected intercourse, sexual assault, or failure of contraceptive use.
Although the FDA approved the first dedicated product for emergency contraception in 1998, over-the-counter approval came in 2006 for adults and in 2013 for minors. The Patient Protection and Affordable Care Act also mandated insurance coverage for emergency contraception in 2012.
Despite the possibility that the number of emergency room visits related to contraception might have already declined before 2006, the sharp decrease between 2006 and 2007 indicates a correlation, say the authors.
Barriers Still Exist
The researchers analyzed national data from over 2 million emergency room visits involving female patients aged 15 to 44 over a period of 14 years.
Hospitals in the Northeast accounted for 44-59% of emergency room visits related to contraception, despite comprising only 17-19% of other emergency room visits.
Meanwhile, 4.5-17% of visits related to emergency contraception were attributed to hospitals in the South, although they consistently accounted for more than 40% of other types of emergency room visits in 2006.
“Our analysis indicates persistent barriers to over-the-counter emergency contraception and disparities in use among certain populations,” said Marsh.
“Future policies should remove barriers to make emergency contraception safe and affordable for everyone.”
Michigan Medicine – University of Michigan
Vogt, EL, et al. (2024). Trends in Encounters for Emergency Contraception in US Emergency Departments, 2006–2020. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2023.53672