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Imagine this scenario in which countless numbers of women find themselves every year. Maybe you had unprotected sex, or the condom broke, or maybe you accidentally forgot to take a birth control pill or two. You don’t want to get pregnant, so you rush to the pharmacy for emergency contraception. All the while, the clock is ticking.
“These drugs are extremely time-sensitive,” says Dr. Sonya Borrero, a professor of medicine at the University of Pittsburgh who focuses on reproductive health equity. She says emergency contraceptive pills should be taken within five days of unprotected sex – “but the sooner the better”.
Surveys show that about a quarter of American women have, at some point in their lives, used emergency contraceptive pills to prevent unwanted pregnancy. This type of birth control is effective, safe, and legal throughout the United States. And yet, researchers find that it’s not always available when people need it.
Take, for example, levonorgestrel, a form of emergency contraception better known under the brand name Plan B, although it is also available in generic versions with names such as My Way, Take Action and My Choice, to to name a few. Borrero says Plan B is meant to be available over the counter, on the shelf, stocked for all ages.
But when Borrero sent a team of medical students to pharmacies in western Pennsylvania to see what those stores actually had on hand, they found that a third of pharmacies didn’t stock the plan at all. B. And when they had it, “most of the time it wasn’t really on the shelf. It was either behind the counter or in one of those locked boxes” which means that a customer should ask someone to hand over the emergency. contraception. She says it could be a real deterrent for some people.
“You can imagine, especially for a teenager, going to ask for one of these products and being concerned about potential judgment can be a significant barrier to purchase,” Borrero says.
Pharmacists say there are good reasons to put plan B on hold. Don Downing, a clinical professor at the University of Washington School of Pharmacy, spent many years as a retail pharmacist and also helped develop Plan B. He says many pharmacists have told him over the years that plan B was often the target of theft. , and many pharmacies are struggling financially and cannot afford to cover losses. He says he’d rather see it locked in the store than not available at all.
“If they could make it available by keeping it behind the counter, that might end up being more useful for a woman than not having it stored at all,” Downing said.
Noah Rosenthal is a merchandising analyst at Hamacher Resource Group, which provides analysis and advice to retail pharmacies. He notes that Plan B and its generics cost around $40 to $50, and that cost is a major reason some retailers may stock emergency contraception in a locked box or behind the counter. In an email to NPR, he noted that before 2006, Plan B could only be dispensed by a pharmacist, so some pharmacies may not have moved it even after the FDA moved it. authorized for over-the-counter sale. He added: “Some pharmacists may choose to place these items behind the counter for religious or personal views.”
Borrero’s findings were even grimmer for the other form of emergency contraceptive pill sold at pharmacies – Ella, which requires a prescription. The study found that only 5% of pharmacies had it available for immediate purchase.
“So 5% was abysmal. I was really very surprised,” Borrero said. “I really thought it would be something like 50% – 5%, that was crazy.”
It’s a national problem
And the problem is not limited to Pennsylvania. Studies in pharmacies across the United States have revealed similar issues with access and availability of emergency contraception. When it comes to Ella, the prescription form of the emergency contraceptive pill, lack of knowledge is a big hurdle, says Rebecca Stone, an associate clinical professor at the University of Georgia College of Pharmacy who has conducted similar studies. .
Ella is “not widely known to prescribers — that is, doctors, nurse practitioners, any type of traditional prescriber, or pharmacists,” Stone said.
And if providers don’t prescribe it, pharmacies are less likely to keep it in stock. “It’s sort of a chicken and egg,” Stone says.
That’s really concerning because Ella is more effective, says Kelly Cleland, executive director of the American Society for Emergency Contraception. Evidence shows that Plan B works best in the first 72 hours after unprotected sex, then its effectiveness declines over five days. In contrast, Ella is effective throughout the five-day window. It is also more effective for overweight or obese women.
“There is a problem with Plan B and its generics potentially not working for people over 165 pounds,” Cleland notes. “And for those people, it seems like Ella is more efficient” – up to 195 pounds. “So it’s important that Ella is in stock and people know about it.” (For women heavier than Ella’s recommended weight, a copper IUD is the recommended choice for emergency contraception, but must be inserted by a trained clinician.)
Cleland says pharmacies often offer to order Ella overnight. “But that’s not good enough for such a time-sensitive product. It might be OK for your antibiotic, but it’s not OK for something you need to take as soon as possible.”
People who work in reproductive health want to see more education about emergency contraception – for pharmacists, for women, and for healthcare professionals, who surveys show are not always aware of well all available emergency contraception options. Supporters say expanding access and education will become more critical in a post Roe vs. Wade America.
Training for providers
Laura Bellis is already on the case. She is the executive director of Take Control Initiative, a contraceptive access program in Tulsa County, Okla. This month, the program rolled out training for doctors and other providers it works with after many said they had lots of questions about emergency contraception.
“Sometimes clinicians think, ‘Can I just give this to anybody?’ And the answer is yes,” Bellis says, noting that confusion persists about whether emergency contraceptive pills are age-restricted. They’re not. “If someone is, you know, of childbearing age, nothing prevents you from giving it to him. It’s safe to have on hand. They could put it in their medicine cabinet at home.”
Bellis says having emergency contraception on hand is especially critical in places like her home country. In May, Oklahoma passed the nation’s most restrictive abortion law. It is now illegal in all but a few cases. “With this, we know how critical it is for people to have access to the last lines of defense, like emergency contraception,” she says.
She says the Take Control Initiative offers free kits with levonorgestrel pills that people can get at various community sites in Tulsa County — they’re usually $40 to $50 at a pharmacy or can be found cheaper online. . The group also used social media to raise awareness of the weight considerations involved in choosing emergency contraception. She says her helpline has received more calls than ever in recent months from people interested in having an IUD inserted as a form of emergency contraception.
Companies such as Nurx, SimpleHealth and PRJKT RUBY also offer telemedicine appointments for women who need a prescription for Ella.
Dr. Leah Upton, family physician and medical director of a federally licensed health clinic in Tulsa, Okla., says she’s seen what can happen when patients don’t receive emergency contraception at time. She recalls a 15-year-old patient who told Upton she had difficulty accessing both birth control and emergency contraception.
“As we know, there’s a window of time in which you have to get this. Also, there’s the cost.” The patient, Upton says, was going through a turbulent time in her life – she had been kicked out of her home and was living with a relative. “Somewhere between transportation and costs and all the other things she was dealing with in her life at the time, she couldn’t get this emergency contraception, or contraceptive care in general. And so I didn’t didn’t see her as a family planning patient. I saw her as a prenatal patient.
Cynthia Harper is a professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco and a longtime researcher on contraception. She helped develop the training offered by the Take Control Initiative, which recommends that providers routinely offer patients advanced prescriptions for emergency contraception. She plans to make it available to vendors across the country.
“It’s going to become much more important in states where [abortion] restrictions are imminent or have taken place,” she said.