Background: Unintended pregnancy continues to be a major public health concern, particularly among women 19-24 years of age. Emergency contraception became available for purchase without a prescription in the United States in 2006; however, its use among women at risk for unintended pregnancy has not been adequately explored. Therefore, the purpose of this project was to gain insight into the perceptions and experiences of college women regarding over-the-counter emergency contraception, since its change in status. Methods: This study used a descriptive, exploratory qualitative design. Small group interviews were conducted in early 2009 to obtain data from 24 women between the ages of 19 and 24 who were currently attending college and had purchased EC. Data were analyzed using content analysis. Findings: Participants were aware of emergency contraception and its availability over the counter, although certain gaps in knowledge exist. Decision-making related to use of EC was driven by the recognition of pregnancy risk and a strong desire to prevent unintended pregnancy. Confidentiality was a major concern, as was lack of access to EC for women under the age of 17. Participants noted limitations in the health services both in provision of and education about EC. Conclusions: Although women have an awareness of EC and its availability, more comprehensive knowledge is needed. Barriers to use exist, particularly confidentiality and age related restrictions. Increasing awareness of personal risk of unintended pregnancy, particularly among college women, is important. (C) 2014 Elsevier B.V. All rights reserved.