Barriers to hormonal emergency contraceptive (EC) access in Canada and the United States led professional and lay groups to lobby for levonorgestrel (LNG) (PLAN B, Barr Pharmaceuticals, Pomona, New York) to be made available over-the-counter. In December 2000, British Columbia, Canada, granted EC prescriptive authority to pharmacists, followed by Quebec in December 2001 and Saskatchewan in September 2003. In April 2005, Health Canada placed LNG on non-prescription, behind-the-pharmacy-counter status with no age restriction. After much controversy, in August 2006, the Food and Drug Administration (FDA) approved over-the-counter access to LNG by adults in the United States. Results of our experience in Canada and recent information regarding mechanisms of action, effectiveness, adverse effects, and the effect of increased availability on reproductive health outcomes are presented here to help inform clinical practice.