Frequency and patterns of emergency contraceptive demand among users of a UK-based free online sexual and reproductive health service: an observational study using routinely collected health data.

Objective: To describe patterns of oral emergency contraception (EC) orders among users of a free service, commissioned by the UK National Health Service, ordered online and delivered by post.

Study design: Routinely collected anonymised data from an online sexual health service in the UK from 1 January to 31 December 2023 were analysed. The number of times EC was ordered and prescribed was calculated and the age and level of deprivation assigned to the postcode where the user resided were extracted. Individual time lines were developed for those prescribed more than 10 times in 12 months.

Results: During 2023 there were 32 659 oral EC requests from 19 501 users, resulting in 29 073 prescriptions from 17 576 users. Ulipristal acetate (UPA) was prescribed in 90% of the orders. The majority of users (n=12 238; 69.63%) received EC once a year, 5237 (29.80%) received it more than once and 101 (0.57%) received it more than 10 times. The mean (SD) number of prescribed orders per user was 1.65 (1.49) and the highest was 29. Oral EC had been used in the previous week by 794 of the 17 576 users (4.5%) and nine (0.05%) were prescribed more than 150 mg of UPA in 30 days.

Conclusions: A small group of people order EC repeatedly, sometimes within the same cycle, putting them at increased risk of pregnancy. A minority of people order doses of UPA of >150 mg in 30 days.