Original research article
The determinants and circumstances of use of emergency contraceptive
pills in France in the context of direct pharmacy access
, James Trussell
, Nathalie Bajos
Office of Population Research, Princeton University, Princeton, NJ 08540, USA
Unite´ mixte Inserm–INED, U569, bEpide´miologie, de´mographie et Sciences Sociales,Q 94272 Le Kremlin–Biceˆtre, France
Faculte´deMe´decine, Biceˆtre Hospital, Universite´ Paris-Sud 11, 94276 Le Kremlin–Biceˆtre, France
Received 13 June 2006; revised 21 July 2006; accepted 28 July 2006
Background: In France, the 1999 introduction of a dedicated emergency contraceptive pill (ECP) available without a prescription has
resulted in a 72% increase in its use over the past 5 years, especially among younger women.
Methods: We used a population-based health survey conducted in 1999 and in 2004 to examine the changes in the determinants of lifetime
ECP use among women aged between 15 and 24 years. We also explored the determinants and circumstances of recent use of ECPs in 2004
among women aged between 15 and 44 years who are at risk for unplanned pregnancy.
Results: In 1999, 14.6% of women aged between 15 and 24 years had ever used ECPs; this proportion rose to 31.7% in 2004. Results show
consistent patterns of lifetime ECP use in 1999 and in 2004, with greater use among higher-educated women and women living in large cities.
In 2004, 22% of women were using no contraceptive at the time they used ECPs and 84% resumed use of a regular contraceptive after ECP
use. However, 5.5% had unprotected intercourse after taking ECPs in the same menstrual cycle and in the next.
Conclusion: Despite direct pharmacy access, differences in ECP use remain by social and residential status. Emergency contraceptive pills
were used as a backup method in case of contraceptive failure and did not impede the use of subsequent regular contraception.
D 2006 Elsevier Inc. All rights reserved.
Keywords: Emergency contraception; Pharmacy access; Contraceptive practices; Population-based survey
Despite the safety  and effectiveness [2–4] of
emergency contraceptive pills (ECPs), the elimination of
the prescription requirement remains to be controversial,
particularly in the United States. The debate essentially
centers on the potential unintended negative effects that a
wider availability of ECPs could have on women’s
contraceptive practices (switching from regular contra-
ceptives, especially condoms, thereby increasing the risk
for sexually transmitted infections, to ECPs or delaying the
start of use of modern methods of contraception, with the
consequence of more unprotected intercourse). The results
of clinical trials specifically addressing this issue are
reassuring [5–10]. However, little is known about the
population effects of making ECPs available without a
prescription. Two recent studies in the general population
conducted in England  and in France , where ECPs
are available without a prescription, confirm the findings of
the earlier clinical trials, showing no difference in sexual
behavior or contraceptive practices before and after the
policy change. These studies also show that women take
great advantage of the nonprescription availability of ECPs,
with a vast majority obtaining the method from pharmacies
with no prescription. However, whereas no increase in
ECP use was observed following direct pharmacy access in
England (16 years after the first dedicated product was
introduced), the introduction of a dedicated ECP product
directly available from pharmacies without a prescription
in May 1999 resulted in a 72% increase in its use by the
end of 2004 in France (from 9.8% of women aged between
15 and 44 years who had ever used ECPs in 1999 to 16.9%
in 2004) . This trend was greater among women
younger than 25 years, with an increase of 117% during the
0010-7824/$ – see front matter D 2006 Elsevier Inc. All rights reserved.
4 Corresponding author. Office of Population Research, Princeton
University, Princeton, NJ 08544, USA. Tel.: +1 609 258 6968; fax: +1 609
E-mail address: firstname.lastname@example.org (C. Moreau).
Contraception 74 (2006) 476 – 482