Academic journal article Economic Inquiry

The Effects of Increased Access to Emergency Contraception on Sexually Transmitted Disease and Abortion Rates

Academic journal article Economic Inquiry

The Effects of Increased Access to Emergency Contraception on Sexually Transmitted Disease and Abortion Rates

Article excerpt


Emergency contraception is a type of birth control that if taken shortly after sexual activity can prevent a pregnancy from occurring. Historically, access to emergency contraception was controlled through prescriptions by physicians. Because of the time-sensitive nature of emergency contraception, nonprescription access may prevent unintended pregnancies. But changes in public policy can affect the costs and benefits of engaging in particular behaviors, and can thereby influence incentives that have both intended and unintended consequences. Increased accessibility to emergency contraception reduces the expected costs of engaging in sexual activity. If a pregnancy is possible, whether due to contraceptive failure or unsafe sexual activity, use of emergency contraception can prevent an unintended pregnancy. If individuals recognize that the costs associated with engaging in risky sexual behavior are lower, however, then these individuals may enjoy greater risk taking.

Sexually transmitted disease (STD) rates should increase as a result of increases in risky sexual activity or from changes in contraceptive use. The effect on abortions, (1) however, depends on the net effect. If an increase in risky sexual behavior leads to additional pregnancies, then the net effect on abortions could be positive. If emergency contraception is used as a substitute for a subsequent abortion, then abortion rates could decline.

Increases in access to emergency contraception in the United States first began in Washington State. In 1998, Washington was the first state to expand access to emergency contraception through pharmacies without a prescription. (2) This expansion was accomplished through the use of collaborative agreements between pharmacists and physicians, not a state-wide policy change. More recently, access to emergency contraception changed at the national level. On August 24, 2006, the Food and Drug Administration (FDA) approved sales of emergency contraception through pharmacists without a prescription to individuals over the age of 18, and later on April 22, 2009, this accessibility was widened to include 17-year-olds (FDA News 2006, 2009). While the FDA change is relatively recent, we focus on the experience of Washington State to understand the impact of expansions in pharmacy access to emergency contraception.

This paper utilizes county-level data from Washington State to consider the intended and unintended consequences of increased access to emergency contraception by exploiting a quasi-experimental design. To understand the consequences of nonprescription access, we use county-level variation in pharmacy access. We estimate the treatment effect of increased access to emergency contraception on sexually transmitted disease and abortion rates. Assuming pharmacy access increases both access to and use of emergency contraception, the effect of such changes may be realized in both intended and unintended areas.

The results indicate that while county-level access to emergency contraception was unrelated to trends in STDs and abortions before access changed, pharmacy access caused a statistically significant increase in STD (gonorrhea) rates, both overall, for females, and for females aged 15-24. However, we find no effect of pharmacy access on abortion rates for the same group of women. These results are supported by confirming the similarity of pretreatment trends as well as several specification and falsification tests. In light of the national changes with respect to emergency contraception access, these results provide some insight into how nonprescription access may affect STD and abortion outcomes outside of Washington State in the future. From a policy perspective, it is important to be aware of both the intended and unintended consequences that resulted from expansions in access to emergency contraception.


A number of papers focus on the behavioral effects of policy resulting in moral hazards, presenting similar arguments for the effects of moral hazards on outcomes, with offsetting effects. …

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