Ten years of emergency contraception in Italy (2012–21) in the context of the second contraceptive revolution|Dieci anni di contraccezione d’emergenza in Italia (2012–21) nel contesto della seconda rivoluzione contraccettiva

Two emergency contraception pills (ECPs) can be purchased without prescription in Italy by adults: since May 2015 (ulipristal acetate UPA) and June 2016 (levonorgestrel LNG). The liberalization of the sale of ECPs has contributed to accelerating the second contraceptive revolution in Italy, mainly reducing unwanted pregnancies for single people. In October 2020, the sale of UPA was liberalized to minors. We measure the effects of LNG and UPA liberalization as well as of the COVID-19 lockdown on sales of ECPs, conceptions and abortions by monthly data on sales and individual data on conceptions by outcomes, studying discontinuity of abortion ratios by regression models. We also show the effects of the 2020 COVID-19 lockdown on ECPs sales. At most, one quarter of the decline in the conception rate between 2014 and 2016 was due to liberalization, reducing mainly abortions. Sales of UPA increased after liberalization for minors. The lockdown of March-May 2020 reduced ECP sales, conceptions and abortions, revealing that a large part of ECPs are used after sexual intercourse outside cohabiting couples.