Background: Emergency contraception has been known for several decades, and dedicated products have been on the market for close to 20 years. Yet it is unclear whether women, particularly in low-resource countries, have access to this important second-chance method of contraception. Objectives: To review relevant policies, regulations, and other factors related to access to emergency contraception worldwide. Search strategy: A wide range of gray literature was reviewed, several specific studies were commissioned, and a number of online databases were searched. Main results: Several positive policies and regulations are in place: emergency contraception products are registered in the majority of countries around the world, listed in many countries' essential medicines lists, included in widely used guidance, and supported by most donors. Yet analysis of demographic data shows that the majority of women in low-income countries have never heard of emergency contraception, and surveys find that many providers have negative attitudes toward providing emergency contraception. Conclusions: Despite more than a decade of concerted international and country-level efforts to ensure that women have access to emergency contraception, accessibility remains limited. (c) 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.