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Imagine this scene where countless women find themselves every year. Maybe you had unprotected sex, or the condom was broken, or maybe you accidentally missed taking one or two birth control pills. You don’t want to get pregnant, so you go to the pharmacy for emergency contraception. The clock is ticking all the time.
“These drugs are incredibly time-sensitive,” said Dr. Sonia Borero, a professor of medicine at the University of Pittsburgh, who focuses on reproductive health equity. She says she needs to take emergency contraceptive pills within five days of unprotected sex – “but the sooner, the better.”
Studies show that about a quarter of American women, at some point in their lives, have used emergency contraceptive pills to prevent an unintended pregnancy. Such contraceptives are effective, safe and legal throughout the United States. And yet researchers are finding that it is not always available when people need it.
Take levonorgestrel, for example, a form of emergency contraception known as the Plan B brand, although it is also available in generic versions, including My Way, Tech Action and My Choice, to name a few. Borrero says the Plan B counter, on the shelf, is supposed to be stocked for all ages.
But when Borrero sent a team of medical students to pharmacies across West Pennsylvania to see what was actually in these stores, they found that one-third of Pharmacy Plan B did not stock. 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 a customer has to tell someone for their emergency contraception. Can be a real obstacle.
“As you can imagine, especially for a teenager, going and asking for one of these products and worrying about a possible verdict can be a significant barrier to purchase,” Borero says.
Pharmacists say there are good reasons to keep Plan B locked and under the key. Don Downing, a clinical professor at the University of Washington School of Pharmacy, has spent many years as a retail pharmacist and has helped develop Plan B. He says many pharmacists have told him over the years that Plan B is often the target of theft. , And many pharmacies are struggling financially and unable to make up for losses. He said he would not see it locked in the store.
“If they can make it available by putting it behind the counter, it can be more helpful to a woman in the end than to save it at all,” Downing said.
Noah Rosenthal is a merchandising analyst at Hamachar Resource Group, which provides analysis and advice for retail pharmacies. He notes that Plan B and its generics retail for about 40 to $ 50, and this cost is a major reason why some retailers may stock emergency contraceptives in a locked box or behind a counter. In an email to NPR, he mentioned that before 2006, Plan B could only be delivered by one pharmacist, so some pharmacies could not transfer it even after the FDA cleared it for over-the-counter sales. He added, “Some pharmacists may choose to place these items behind the counter for religious or other personal opinions.”
For other forms of the emergency contraceptive pill sold at the pharmacy, Bororo’s results were even weaker – Ella, which requires a prescription. The survey found that only 5% of pharmacies had it available for immediate purchase.
“So 5% was unusual. I was really very surprised,” Borero said. “I really thought it would be something like 50% – 5% was crazy.”
This is a nationwide problem
And the problem is not limited to Pennsylvania. Studies conducted in pharmacies across the United States have found similar problems with access and availability of emergency contraception. Rebecca Stone, a clinical associate professor at the University of Georgia’s College of Pharmacy, said a clinical associate professor at the Georgia College of Pharmacy who conducted similar research said that in Elara’s case, the prescription form of the emergency contraceptive pill was a major obstacle.
Ella “is not very well known by prescribers – meaning physicians, nurse practitioners, any kind of traditional prescribers, not by pharmacists,” Stone said.
And if providers don’t determine it, pharmacies are less likely to keep it in stock. “It’s kind of chicken and egg,” Stone says.
“It’s really worrying, because Ella is more effective,” said Kelly Cleland, executive director of the American Society for Emergency Contraception. Evidence shows that Plan B works best within the first 72 hours of unprotected intercourse, then decreases its effectiveness within five days. In contrast, Ella is effective across the five-day window. It is more effective for overweight or obese women.
“There’s a problem with Plan B and its generics are probably not working for people over 165 pounds,” Cleland notes. “And for those people, Ella seems more effective” – up to 195 pounds. “So it’s important that Ella is available in stock and people know about it.” (For women who are heavier than the recommended weight for Elara, a copper IUD is the preferred choice for emergency contraception, but it must be inserted by a trained physician.)
Cleland says pharmacies often offer orders to the area overnight. “But it’s not good enough for such a time-sensitive product. It may be right for your antibiotic, but it’s not right for something you need to take as soon as possible.”
Those who work in reproductive health want to see more education about emergency contraception – for pharmacists, for women, and for healthcare professionals whose studies show that not all emergency contraceptive options available are always well-versed. Advocates say access and education expansion will become more important in a post Rowe vs. Wade America.
Training for providers
There are already lawsuits against Laura Bayliss. She is the Executive Director of the Tech Control Initiative, Tulsa County, Oklar a contraceptive access program. This month, the program began training for doctors and other providers when many of them said they had many questions about emergency contraception.
“Sometimes doctors say, ‘Can I give this to someone?’ And the answer is yes, “said Bayliss. They don’t. “If someone is of reproductive age, you know, there’s nothing to stop them from giving it. It’s safe to have on hand. They can keep it in their medicine cabinet at home.”
Bayliss says having an emergency contraceptive in hand is especially important in places like his own state. In May, Oklahoma passed the country’s most restrictive abortion law. It is now illegal in a few cases. “And with that, we know how critical it is that people get access to the last lines of defense, like emergency contraception,” she says.
He said the Tech Control Initiative offers free kits with levonorgestrel pills that people can pick up from various community sites around Tulsa County – they usually cost $ 40 to $ 50 at a pharmacy, or are available cheaply online. The group is using social media to raise awareness about the weight considerations involved in choosing an emergency contraceptive. She says its helpline has received more calls in recent months from people interested in installing IUDs as an emergency contraceptive.
Companies like Nurx, SimpleHealth and PRJKT RUBY also offer telemedicine appointments for women who need a prescription for Ella.
Dr. Leah Upton, a family physician and medical director of a federally qualified health clinic in Tulsa, Oklahoma, says she has seen what can happen if patients do not receive emergency contraception in a timely manner. She recalls a 15-year-old patient who told Upton that she had trouble accessing both her contraception and emergency contraception.
“As we know, there is a time that you have to get. In addition, there are costs.” The patient, Upton, said he had a turbulent time in his life – he was evicted from his home and living with a relative. “Among the transportation and costs and everything else that she was dealing with in her life at the time, she couldn’t take emergency contraception, or contraceptive care in general. And so I didn’t see her as a family plan. Patient. I saw her as a prenatal patient.”
Cynthia Harper is a professor of obstetrics, gynecology and fertility at the University of California, San Francisco, and a longtime contraceptive researcher. She has helped develop the training that the Tech Control Initiative is offering, which suggests that providers regularly offer patients advanced prescriptions for emergency contraception. He plans to make it available to suppliers across the country.
“It simply came to our notice then [abortion] Restrictions are imminent or have happened, ”he says.