Improving access to emergency contraception

Is emergency contraception readily available at your facility? If it is, are you taking the next step by providing emergency contraceptive pill (ECP) prescriptions or pills in advance so women have a backup in case their birth control method fails or they have unprotected sex?

If ECP provision isn’t on your service menu, you may want to consider adding it. A new reference, A Clinician’s Guide to Providing Emergency Contraceptive Pills, offers tips on policies, organizational and management issues, staff training, and billing and insurance procedures. It is published by the Pacific Institute for Women’s Health in Los Angeles, the Family Planning Council of Southeastern Pennsylvania in Philadelphia, and the California Family Health Council in Los Angeles. (See resource box, p. 94.)

The reference guide grew out of research by the institute in partnership with the Family Planning Council at eight family planning clinics in and around Philadelphia, says Rochelle Fabb, the institute’s director of communications. The study examined the responses of directors, staff, and clinicians to the council’s policy to distribute ECPs prophylactically to all family planning patients and responses to its attendant ECP media campaign.1

Research findings pointed to a specific need for a clear, concise "how-to" manual aimed at family planning clinicians that would promote awareness of the method and ease the introduction of ECPs into clinical practice, says Fabb. "It is our hope that this guide [which includes a sample telephone screening protocol and instructions for use] will help many more clinicians to implement a quick response system so that they and their staff can provide ECPs when women need it." (See screening protocol, inserted in this issue.)

To reach that goal, the guide is being widely disseminated to physicians, nurse practitioners, family planning clinics, and state-funded family planning providers, thanks to the efforts of many organizations, including AVSC International in New York City; Medical Students for Choice in Berkeley, CA; the National Family Planning and Reproductive Health Association and the Reproductive Health Technologies Project, both in Washington, DC; the American Medical Women’s Association in Alexandria, VA; and the Program for Appropriate Technology in Health in Seattle.

If your facility is providing ECPs, how can you boost awareness of the method? Take a tip from Planned Parenthood of Los Angeles, which has seen its numbers rise since instituting a campaign this spring. In the first month of operation, the number of patients who took home ECPs, including those who came to the affiliate clinics specifically because they had unprotected sex, jumped from 448 to 976.

The Los Angeles affiliate began looking at ways to promote awareness and access to EC following the Food and Drug Administration’s 1997 declaration of ECPs’ safety and effectiveness. However, 1999 market research showed that EC awareness was still low, with the method used by only a small percentage of patients, says Nancy Sasaki, president and chief executive officer of Planned Parenthood Los Angeles.

The affiliate decided the best way to market EC was through its clinics to existing patients. The campaign’s goals? The first was to promote the use of EC for women whose regular birth control method failed. The second goal was to increase awareness by educating women who already are inclined to get birth control information from Planned Parenthood, who then would spread the information by word of mouth.

These audiences were chosen to receive emergency contraception to take home at the time of their clinic visit: women with negative pregnancy tests who decline a regular method of birth control, women who use condoms as their only method of birth control, women who use the Pill as their main method of birth control (because many women abandon use of the Pill when not in a relationship), and women who test positive for a sexually transmitted infection (because women who have had sex without a condom might also be at risk for an unplanned pregnancy).

The campaign was designed by the affiliate’s marketing department with input from the clinical services administration staff, clinicians, and clinic staff. It centered on posters reading, "If you have unprotected sex, you have 72 hours to prevent unintended pregnancy" and buttons with "EC — Ask me." Cost of the materials was less than $250, says Sasaki. Easy access to EC is important, she stresses. "Studies2-3 into the use of EC indicate that women are much more likely to use emergency contraception when they need it if they already have it at home."

References

1. Castle MA, Friedlander E, Bird ST, et al. Introducing Emergency Contraceptive Pill Services at Family Planning Clinics in Philadelphia: The Organizational and Social Context. Los Angeles; Pacific Institute for Women’s Health; 1999.

2. Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998; 339:1-4.

3. Raine T, Harper C, Leon K, et al. Emergency contraception: Advance provision in a young, high-risk clinic population. Obstet Gynecol 2000; 96:1-7.

For a copy of A Clinician’s Guide to Providing Emergency Contraceptive Pills, contact:

Melody Sokolow, Pacific Institute for Women’s Health, 2999 Overland Ave., Suite 111, Los Angeles, CA 90064. Telephone: (310) 842-6828. Fax: (310) 280-0600. Printed copies are $6 (including shipping and handling); the guide also may be downloaded as an Adobe Acrobat PDF format file from the Web: www.piwh.org/ publications.html.