This quasi-experimental study examined the impact of emergency contraceptive pill (ECP) availability on sexual and reproductive behavior among Chilean youth during the 2000s, exploiting variation in municipal-level adoption of the ECP policy using multilinear regression with time, municipality, and individual controls.
In municipalities where ECPs were available, youth were less likely to initiate sexual activity, showed no change in number of sexual partners per year, were more likely to use hormonal contraception, and had fewer unplanned pregnancies compared to youth in municipalities without ECP access.
The unstructured, municipality-level rollout creates potential selection bias if municipalities that adopted the policy differed systematically from those that did not. Individual-level causal inference is limited by the observational design. Long-term behavioral outcomes beyond the study window are unknown.
Making emergency contraception available to youth does not appear to increase sexual risk-taking and may actually delay sexual initiation and boost uptake of regular hormonal contraception. Clinicians and policymakers can reassure communities that ECP access is not associated with riskier sexual behavior in adolescents.
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