Project Summary
Access to various contraceptive methods and associated laws on parental consent have changed over time
and across states in the U.S. In particular, progestin-only emergency contraception (EC)—also known by the
brand name Plan B—has been subject to changing access laws at both the state and federal levels. The most
significant change in access to EC since its release was its FDA approval as an over-the-counter (OTC)
medication in 2006, where previously it had been available by prescription only. Improving ease of access to
Plan B may have a substantial impact on both EC uptake and efficacy. Previous research has had limited
follow-up, used data that lacked the appropriate denominators, and was largely unable to measure the uptake
of EC; such research also did not examine differences by race and ethnicity, in particular among Hispanic
women and non-Hispanic Black women. For multiple socioeconomic reasons, visiting a physician to obtain a
prescription for EC may present differential barriers to access for these populations. Thus, there is a critical
need to understand the impact of OTC access to EC on uptake and pregnancy and birth rates. Our objective is
to meet this critical need by studying the impact of the 2006 approval of Plan B. Based on our preliminary data
analyses, the central hypothesis is that increased access to EC because of OTC availability will result in
increased uptake and lower pregnancy and birth rates. This project will use data from three data sources—the
Nielsen Consumer Panel, American Community Survey, and Behavioral Risk Factor Surveillance System—to
address the following specific aims: (1) measure the effect of OTC availability of EC on uptake and overall
pregnancy and birth rates, and (2) measure the differential impact of OTC availability of EC on pregnancy and
birth rates among racial/ethnic groups that are most likely to have unintended pregnancies—Hispanic women,
non-Hispanic Black women, and teenagers. Using these three data sources, we will conduct difference-in-
differences analyses to study the outcomes of interest. This research is innovative because it uses data
sources that allow us to examine the long-term impact of increased access to EC using detailed, individual-
level data. It is also the first study to examine differences by race and ethnicity. The proposed research is
significant because it will shed light on the effect of increased access to EC on the rate of unintended
pregnancy; unintended pregnancies resulting in births are associated with poorer maternal and infant health
outcomes, impacts on physical and mental health, and negative economic outcomes. This research will benefit
vulnerable minority populations and promote public health by providing evidence on a simple policy tool
(improved access to EC) that may have a substantial impact on reducing unintended pregnancy.