U. NOTTINGHAM (UK) — Offering emergency contraception free and over the counter in the U.K. has not reduced the number of teen pregnancies and may be associated with a rise in sexually transmitted diseases (STDs).
Those findings come from a study by researchers at the University of Nottingham who examined the impact of government-backed efforts in the U.K. to offer teens emergency birth control (EBC) at pharmacies without a prescription. Study details are reported in the Journal of Health Economics.
Their findings show that, on average, areas operating a pharmacy EBC program saw an overall increase of five percent in the rate of sexually transmitted diseases among teenagers—12 percent in the under-16 age group. The study also found that EBC programs may actually be associated with a small increase in the number of teens falling pregnant.
Increased access to emergency contraception has been a key part of the government’s Teenage Pregnancy Strategy, which was introduced in 1999 and aimed to reduce by half teenage pregnancy rates by 2010. However, as funding and implementation was devolved to local levels, local health authorities have been able to decide on whether to devote money to increasing access to EBC.
Specifically, since the start of 2000, local authorities in England have been encouraged to introduce programs that offer EBC free of charge, over the counter at pharmacies to teenagers under the age of 16. Although an increasing number of local authorities have introduced the program, they have come into force at different times and some have decided against it altogether.
Historically, a number of studies have been conducted looking at the impact of easier access to contraception and legalizing abortion and a review of 23 of these reports in 2007 revealed none that found any significant decreases in unwanted pregnancies or abortion rates.
The study looked at all teenage pregnancies, and two sub-groups of under 18 and under 16, between 1998 and 2004 using data obtained from the Office of National Statistics.
To measure sexually transmitted diseases, the researchers used data on the number of diagnoses of the main STDs at genitourinary medicine clinics, provided by the Health Protection Agency in the same age groups (apart from under-18 for which data are not available).
These were compared to a control group of women over age 24, who don’t have access to pharmacy EBC programs.
The study found that teenage conception rates showed a downward trend from a peak in 1998 (two years before the pharmacy EBC program started and a year before the Teenage Pregnancy Strategy) until 2003, followed by a small increase in 2004, just as the EBC scheme reached its peak.
In terms of STDs, rates for teenagers and older women both increased consistently over the period. However, rates among teenagers increased at a faster rate, and there is some evidence that the gap with rates among older women widened as the EBC programs progressed.
Researchers found that the EBC programs had no effect in reducing teenage conception rates and even some evidence that pointed to a small increase in the number of pregnancies.
The presence of an EBC program in a local health authority was linked to a 5 percent increase in sexually transmitted diseases in the under-18 age group and a 12 percent hike in those under 16.
“Our study illustrates how government interventions can sometimes lead to unfortunate unintended consequences,” says the study’s co-author David Paton, professor of economics. The findings, he says, “will raise questions over whether these schemes represent the best use of public money.”
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