'Don't Have Sex Without a Condom'? Taiwan's Proposed Regulation of Emergency Contraception Sparks Women's Anxiety

For Xie, a resident of Taipei, taking emergency contraception has always felt like a race against time.

The 34-year-old woman has used emergency contraception more than five times. She recalled to BBC Chinese that after unprotected sex, she would immediately panic about the possibility of an unintended pregnancy, calculating the hours late at night, wondering when the pharmacy would open, and worrying whether she could obtain the medication within the 24-hour 'golden window.'

'The pharmacist would ask a few basic questions, I’d answer quickly, and as soon as I got the pill, I’d rush to take it in a corner on the street,' she said.

The earlier emergency contraception is taken, the more effective it is. Generally, it works by delivering a high dose of hormones to suppress or delay ovulation and reduce the likelihood of a fertilized egg implanting, thus achieving emergency contraception.

Currently in Taiwan, certain emergency contraceptive drugs can be purchased directly at pharmacies. These medications technically fall under prescription-only status, but in practice, people can often obtain them directly from pharmacists, placing them in a gray area.

Taiwan’s Food and Drug Administration (FDA) recently proposed a legal amendment requiring a prescription to purchase emergency contraception and mandating that sellers and manufacturers register in a drug traceability and tracking system.

Officials emphasized that the move is in response to suspected illegal online sales of abortion drugs and aims to strengthen regulation to ensure medication safety. However, civil society groups worry this will make it harder for women to access the drugs, potentially increasing the risk of unintended pregnancies due to delays—especially affecting vulnerable groups such as young women, rural residents, foreign migrant workers, and survivors of sexual violence.

Meanwhile, a senior health official in Taiwan publicly stated, 'Don’t sleep with a man who hasn’t prepared a condom,' sparking social controversy. Women’s groups criticized the remark as deepening stigma and representing a setback for women’s autonomy.

A Race Against Time

'Afterward, I clearly knew I couldn’t get pregnant again—I already have two children,' said 39-year-old Lin, speaking to BBC Chinese.

Married with two children, she once urgently bought emergency contraception after unprotected sex, fearing an unplanned third pregnancy.

She admitted that married life has been largely consumed by parenting stress. 'We’re constantly in the hell of raising kids, taking turns caring for them. It’s nearly impossible to have sex.' Occasionally, when both children fall asleep and she isn’t too exhausted, the couple might spontaneously reconnect—but often in chaotic circumstances, sometimes encountering expired condoms or running out entirely, with no time to take regular birth control.

She said the anxiety and fear following sex are immediate and intense, worrying that another child would become a financial burden on the family. During the pandemic, when hospital visits were inconvenient, she chose to buy emergency contraception directly from a pharmacy.

Pharmacies are nearly ubiquitous across Taiwan, many operating 24 hours a day, making them a crucial access point for women in urgent need of emergency contraception.

However, Taiwan’s FDA recently announced that three drugs—Levonorgestrel (LNG), Ulipristal acetate (UPA), and Misoprostol (MISO)—used for emergency contraception or pregnancy termination will be placed under stricter management.

These three drugs serve different purposes. Misoprostol is a prostaglandin analog originally used to treat gastric and duodenal ulcers. When combined with Mifepristone, it can terminate early pregnancies within 49 days and is classified as an abortion drug.

The latter two drugs work by using high-dose hormones to suppress ovulation and reduce implantation success, achieving emergency contraception. Levonorgestrel is a synthetic progesterone that must be taken within 72 hours of unprotected sex, with effectiveness decreasing over time. Ulipristal acetate is more potent, extending the effective window to 120 hours.

Xie, who has used emergency contraception multiple times, said that if she now has to visit a hospital first to get a prescription, the process will become significantly more inconvenient—potentially delaying access and increasing the risk of unintended pregnancy.

She noted that although she lives in an urban area with relatively abundant medical resources, her work schedule doesn’t always align with clinic hours. Most women also prefer to see a doctor they’ve visited before and feel comfortable with.

Compared to pharmacies with long operating hours, gynecology clinics operate mainly on weekdays. In recent years, due to declining birth rates, gynecology clinics have been closing—23 shut down across Taiwan last year alone. In rural or suburban areas, gynecological resources are scarce, and residents often have to drive long distances to reach major hospitals.

Meanwhile, women’s groups worry that requiring sellers and manufacturers to register in a drug traceability system could increase pharmacies’ operational costs, reducing their willingness to stock these drugs and further limiting public access.

Shame and Stigma

Women have various contraceptive options, including regular birth control pills, condoms, and long-acting methods like IUDs. Emergency contraception is often seen as a last resort.

In Taiwan, the most common clinical scenarios for using emergency contraception include condom slippage or breakage, forgetting to take regular birth control, or unprotected sex.

Recently, Lin Jingyi, Vice Minister of Taiwan’s Ministry of Health and Welfare, publicly stated during a discussion on tightening emergency contraception regulations: 'Don’t sleep with a man who hasn’t prepared a condom.' She was criticized for 'missing the point' and 'undermining women’s autonomy,' with many saying the comment deepens the long-standing stigma around emergency contraception.

Xie admitted that using emergency contraception often comes with shame and pressure. In the past, she even wore a mask to the pharmacy to buy the pill. Though she no longer does, she still wants the process to be as quick as possible.

She pointed out that needing to see a doctor because one didn’t use 'proper' contraception is already stressful. Doctors may ask more precise questions—while the health education information is correct, in the moment, it can feel like blame, as if questioning why one didn’t 'protect themselves properly,' 'risk their health,' or 'lack sexual knowledge.'

'Besides worrying about what others think of me, I also don’t want people to make extra assumptions or judgments about my partner.'

Xie has had multiple unprotected sexual encounters under different circumstances. She recalled that when she was younger and lacked sexual knowledge, she mistakenly believed condoms didn’t need to be used throughout. Even after fully understanding health education, she sometimes didn’t use them due to the situation.

'Sometimes I wanted to use a condom, but halfway through negotiation, I half-agreed without fully resisting. I don’t feel violated afterward, but often have a lingering sense that something was 'off' in retrospect.'

She further noted that this also involves power dynamics in relationships and dating, often intertwined with emotions and desire. 'Sometimes I feel like I’ve given everything—and that “everything” is my body.'

In Taiwan’s relatively conservative sexual culture, she spent a lot of time exploring sexuality. She once chose unprotected sex out of curiosity and desire, experiencing pleasure and enjoyment, but afterward, fear and anxiety followed.

'Things aren’t as simple as people discuss—like “don’t do it if there’s no condom.” In reality, it’s a complex interplay of negotiation and emotional tension,' she emphasized. Precisely because sexual behavior is so complex, more diverse contraceptive options are needed to help women avoid entering unwanted life stages.

Needs of Different Groups

Lin used emergency contraception for the first time after marriage. She believes this is an option that women at different life stages may face.

She recalled that just searching for information, thinking about how to approach the pharmacist, and figuring out where to get the drug took two to three hours. While discussing it with her husband and researching options, she also worried others might think she was 'ill-prepared,' blaming herself for ending up in a situation without safe contraception.

'Many people feel this anxiety when getting emergency contraception—as if they’ve done something wrong,' she said. The social atmosphere often makes people feel that sexual desire or unprotected sex is a wrong choice, leading to intense self-blame and guilt. Only when she finally walked into the pharmacy holding her daughter’s hand did she realize it wasn’t as difficult as she imagined—and felt a sense of relief.

Lin believes the current system, where pharmacists provide emergency contraception, is relatively convenient. Pharmacists fully inform users when dispensing the drug, reminding them that emergency contraception isn’t 100% effective and that they should continue monitoring for signs of pregnancy. She has even taken the pill directly in front of the pharmacist.

After public backlash over the proposed regulation, women’s groups and several legislators held a press conference to express opposition. They argued the policy was being pushed through without sufficient social discussion and could create additional barriers for vulnerable women.

Democratic Progressive Party legislator Lin Yueh-chin pointed out that young women, minors, foreign migrant workers, and those controlled by family or partners are often the very groups most in need of emergency contraception. She questioned whether these individuals, in sudden situations, would have the ability or willingness to immediately go to a hospital for a prescription—especially if they fear being discovered by family, partners, or schools.

Tu Ying-chiu, executive director of the Women’s Rescue Foundation, said at the press conference that based on practical experience, victims of intimate partner violence, women unprepared for pregnancy, and migrant workers may be unable to visit gynecologists within the golden 72-hour window due to fear or work constraints.

Including emergency contraception in a drug traceability system has also raised privacy concerns. One pharmacist wrote that emergency contraception involves sensitive personal information and bodily autonomy. If future rules require follow-up visits after purchase—ostensibly for safety—some people may avoid official channels due to fear of records or questioning, turning instead to informal or even unsafe alternatives.

A Decade-Long Debate, Still Unresolved

Emergency contraception contains high-dose hormones and still carries usage risks. Common side effects include nausea, vomiting, dizziness, and abnormal bleeding. Frequent use may