When Prevention Becomes Emergency Care: Contraception in the ED
Kristen Downey | MD Candidate, Texas A&M COM 2026
Read the full paper: https://doi.org/10.1016/j.jemermed.2026.02.038
Emergency physicians treat the consequences of unintended pregnancy every day: ectopic pregnancy, miscarriage, hemorrhage, and preterm complications. But we rarely talk about prevention. Our paper makes a simple argument: contraception isn’t just outpatient care. In this moment, it’s emergency care.
The Gap We Keep Missing
More than 19 million women in the U.S. live in contraceptive deserts, where access to basic reproductive care is limited or nonexistent. At the same time, women of reproductive age make up nearly a quarter of ED visits. That means every shift, we are seeing patients who could benefit from contraception. Yet most of the time, it is never offered.
This Isn’t About Clinical Complexity
We already know how to do this. We prescribe medications with more contraindications, more monitoring, and more risk. Every. Single. Day. We already manage the outcomes of limited contraceptive access. The real barriers aren’t medical - they’re operational. Time. Workflow. Habit. The assumption that “someone else will handle it.” But for many patients, there is no someone else—wait times for OB/GYN care stretch for months, and access to insurance isn’t guaranteed.
What Patients Are Telling Us
Patients are not resistant to this. They are waiting for it. In one study, two-thirds of adolescents in the ED were open to talking about contraception, and nearly a quarter were ready to start that day. The interventions that matter most are simple: start contraception the same day, prescribe enough for a year, and use decision tools to support patient choice without adding time burden. Patient-facing platforms like Bedsider.org and Use.mybirthcontrol.org allow patients to compare methods and clarify preferences during ED wait time, while tools like the CDC Contraception App and Access Bridge pathways assess contraindications and streamline bedside decision-making. This isn’t about adding something new. It’s about using the encounter we already have.
The Usual Pushback
The ED isn’t the right place. There’s no time. What about follow-up? Is this even our role? But we already practice under time pressure. We already prescribe without guaranteed follow-up.
We already fill gaps left by a fragmented healthcare system. That’s the job. And right now, this gap is glaring.
Why This Moment Matters
Access to reproductive healthcare is shrinking. Clinics are closing. Providers are leaving. Barriers are growing—financial, geographic, political. The ED is increasingly the only place patients can go. So the question isn’t whether this is “our role.” It’s whether we’re willing to respond to the reality in front of us.
The Bottom Line
We are already treating the emergencies that result from a lack of access to contraception. We just haven’t fully accepted that prevention belongs to us, too. Because preventing an emergency is still emergency care.
A Personal Note
I wrote this as a fourth-year medical student going into emergency medicine, having initially planned to pursue OB/GYN as a women’s health advocate but realizing I could expand that work in the ED.
We see the downstream effects of gaps in care every day. Unintended pregnancy isn’t rare. The barriers to preventing it aren’t subtle. And the patients most affected are often the ones with the least access to care. This isn’t theoretical. It’s what we see over and over again.
The ED is the safety net. Sometimes that means catching people. Sometimes it means reaching them before they fall.