Demographic and health impacts of women's bodily autonomy: switching prescription requirements for emergency contraceptives.

Over the past decades, most European countries switched emergency contraceptive availability from prescription to over-the-counter (OTC) status. However, the effect of OTC switches on emergency and regular contraceptive use, on demographic indicators (birth rate, abortion rate) and health outcomes (sexually transmitted diseases) varies depending on the study setting. Only Poland switched emergency contraceptives back to prescription (Rx) status after previously loosening restrictions and causal analyses of an Rx switch are lacking entirely. We employ multiple (staggered/synthetic) difference-in-differences models to evaluate the effect of (a) an OTC switch, exploiting variation in the timing of the OTC switch among several European countries and (b) a Rx switch at the example of Poland. We find that the use of emergency contraceptives increased (decreased) after OTC (Rx) switches. The use of regular hormonal contraceptives, the rate of births and abortions and the incidence of various sexually transmitted diseases remained essentially unaffected or - if found - effects did not withstand robustness checks. Our results suggest that increased use of emergency contraceptives due to liberalized over-the-counter access may be reversed by a return to prescription bound access.