Use of Emergency Contraception in the United States
Emergency contraception is a method for preventing pregnancy after unprotected sex or contraceptive failure.
- Emergency contraception has no effect on an established pregnancy and cannot cause miscarriage or abortion.1
- Dedicated emergency contraceptive pills work best when used as soon as possible after unprotected sex or contraceptive failure, and are effective for up to 3–5 days afterward.2
- Nonhormonal copper IUDs inserted up to five days after unprotected intercourse can also act as emergency contraception,2 and recent evidence suggests that levonorgestrel IUDs may be used similarly.3
Use of emergency contraceptive pills
Between 2008 and 2015, emergency contraceptive pill use increased substantially.4 (Please note that these usage data are for emergency contraceptive pills only and do not include use of the IUD as emergency contraception.)
23%
had ever used emergency contraceptive pills, up from 11% in 2008 4
- Use of emergency contraceptive pills increased substantially across almost every social and demographic characteristic examined, including age, race and ethnicity, income level, education, religion, marital status and women’s number of births, between 2008 and 2015.4
- In 2015, use was highest among sexually experienced women aged 20–29 and those who had never given birth. Among women in these groups, 35–36% reported having ever used emergency contraceptive pills.4
- Between 2008 and 2015, repeat use of emergency contraceptive pills among all sexually experienced women increased from 4% to 10%. Many women who had ever used emergency contraceptive pills had used them more than once (41% in 2008 and 45% in 2015).4
Changes in obtaining emergency contraception
- Reliance on a prescription to obtain emergency contraceptive pills fell from 31% in 2008 to 18% in 2015, despite the overall increase in use of this method.4
- Sixty-seven percent of women who used emergency contraceptive pills in 2008 obtained them at a health facility or clinic; in 2015, only 40% obtained them in this manner, likely reflecting some of the impact of the change to over-the-counter availability.4
Relevant policy developments
Access to and use of emergency contraception has likely shifted as a result of key policy changes.
- The Affordable Care Act’s contraceptive coverage guarantee took effect widely in January 2013. This new benefit eliminated cost sharing for emergency contraception (and other forms of contraception) for privately insured individuals, but only if they obtained a prescription.5
- Although the contraceptive coverage guarantee may have alleviated the cost burden for covered individuals obtaining emergency contraceptive pills by prescription, it may have inadvertently shifted the cost burden for others because the guarantee does not cover over-the-counter methods.4
- By 2014, the one-pill regimens of levonorgestrel emergency contraception (Plan B One-Step and generic formulas) had been approved for over-the-counter sales (i.e., by a pharmacist without a prescription or age restrictions).6
1. American College of Obstetricians and Gynecologists, Emergency contraception, 2019, https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2015/09/emergency-contraception.
2. Trussell J, Raymond EG and Cleland K, Emergency contraception: a last chance to prevent unintended pregnancy, Contemporary Readings in Law & Social Justice, 2014, 6(2):7–38, https://www.ceeol.com/content-files/document-124303.pdf.
3. Turok D et al., Levonorgestrel vs. copper intrauterine devices for emergency contraception, New England Journal of Medicine, 2021, 384(4):335–344, https://www.nejm.org/doi/full/10.1056/NEJMoa2022141.
4. Hussain R and Kavanaugh M, Changes in use of emergency contraceptive pills in the United States from 2008–2015, Contraception: X, 2021, 3:100065, https://www.sciencedirect.com/science/article/pii/S2590151621000125.
5. Guttmacher Institute, The federal contraceptive coverage guarantee: an effective policy that should be strengthened and expanded, Federal Policy Snapshots, 2021, https://www.guttmacher.org/fact-sheet/contraceptive-coverage-guarantee.
6. Cleland K et al., Access to emergency contraception in the over-the-counter era, Womens Health Issues, 2016, 26(6):622–627, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106326/.
*In this fact sheet, we refer to the contraceptive users for whom we have data as “women” to reflect the terminology used in the National Survey of Family Growth, a nationally representative survey of people aged 15–49 that gathers information on several topics, including contraceptive use. However, we recognize that data collection processes do not always accurately or comprehensively capture participants’ gender. We encourage readers to consider that contraceptive users’ gender identities are diverse, despite the limitations of this language and survey process.