title: Effect of changes to cost and availability of emergency contraception on users' profiles in an emergency department in Catalunya.
abstract: OBJECTIVE
  Emergency contraception (EC) accessibility has evolved differently in Catalunya as compared with other autonomous communities in Spain. Free-of-charge access within the Public Health System was authorised in 2004, and over-the-counter (OTC) access was implemented in 2009. The aim of the study is to assess the impact of these measures on demand and users' profiles at our institution.
  
  
  METHODS
  A retrospective study, in our Emergency Department, was conducted to evaluate EC requests in relationship to accessibility modifications. The age of women and which days of the week they attended were analysed.
  
  
  RESULTS
  The number of EC requests, the distribution by age and the demand over the week remained stable after access to EC became free of charge. However, requests sharply decreased following OTC access implementation. Distribution by age also changed, with a significant increase in requests from women under 25 years (72% vs 56%, p < 0.001). Demand was greatest on Sunday and Monday, and this distribution persisted over the study period.
  
  
  CONCLUSIONS
  EC requests remained unchanged following free-of-charge access to EC, but decreased after OTC implementation. Women currently seeking EC at no cost at our institution are more likely to be younger and to request it on a Monday.
authors.affiliation: Department of Obstetrics and Gynaecology, Hospital de la Santa Creu i Sant Pau , Barcelona , Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Trilla
authors.forename: Raquel
authors.initials: R
authors.lastname: Senosiain
authors.forename: Joaquim
authors.initials: J
authors.lastname: Calaf
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Espinós
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D044363:Contraception, Postcoital / Q000191:economics* / Q000706:statistics & numerical data; D003270:Contraceptive Agents / Q000191:economics / Q000600:supply & distribution; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000191:economics / Q000600:supply & distribution; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D003270:Contraceptive Agents; D004366:Nonprescription Drugs
keywords: Accessibility; Availability; Contraceptive use; Emergency contraception; Levonorgestrel; Over-the-counter