Emergency contraception (EC) refers to a family of medications or devices used post-coitally to reduce, but not eliminate, the risk of pregnancy. Pills containing higher doses of the hormones found in oral contraceptive pills (OCPs) and the post-coital insertion of the copper-T IUD constitute the two primary methods of EC used worldwide. In the last fifteen years, dedicated emergency contraceptive pills (ECPs), progestin-only pills that are dosed, packaged, and marketed specifically for post-coital use, have been registered in more than 100 counties and are available without a prescription in nearly half of these settings. In 2001, Tunisia became the first country in the Arab world to register a dedicated levonorgestrel ECP (Norlevo®, HRA Pharma). Over the last decade ECPs have been subsequently registered in Algeria, Egypt, Lebanon, Libya, Morocco, and Yemen and registration efforts are now underway in Kuwait and Jordan. However, product registration does not guarantee availability, accessibility, or affordability and outside of Tunisia and parts of Lebanon, access to a dedicated post-coital method of pregnancy prevention is limited. Yet even in the absence of a dedicated ECP, the ubiquitous availability of OCPs through clinics and pharmacies means that throughout the region there is considerable access to medications that could be used post-coitally to reduce the risk of pregnancy. Drawing from original research conducted in Tunisia, Palestine, and Jordan, this paper explores the journey of EC in the region. Through an examination of the successes and challenges associated with the introduction of this relatively new reproductive health technology and the integration of ECPs into national family planning programs, standards of care protocols, and service delivery guidelines, this research offers insights into the ways in which EC has been locally appropriated. This paper showcases efforts that have been undertaken to expand information about EC to both clinicians and individual women and to engage with a variety of stakeholders to increase acceptability and awareness of the method. With the 10 year anniversary of dedicated product registration upon us, this paper critically examines the debates that have been generated by ECPs and argues that these debates center on broader issues of sexual and reproductive autonomy. In a region in which nearly one fourth of all pregnancies are unintended, EC continues to hold considerable promise for addressing women’s pregnancy prevention and reproductive health needs. This paper concludes by offering some reflections on the lessons learned and priorities for expanding EC access.