Is EC easily found? Evidence says no

The next time you offer counseling on emergency contraception (EC) for your adolescent patients, don't assume they can easily access it in their local pharmacies. Results of a new survey indicate that in pharmacies in low-income neighborhoods access to EC might be hampered because of misinformation about the age at which it can be accessed over the counter.1 Low-income neighborhoods often have the highest teen pregnancy rates.1

"Even though we found approximately 80% same-day availability of emergency contraception in [selected] metropolitan cities, misinformation regarding access was common, particularly in low-income neighborhoods," says Tracey Wilkinson, MD, MPH, a fellow in the Division of General Pediatrics at Boston Medical Center and Boston University School of Medicine.

Anyone (female or male) who is 17 or older can obtain the emergency contraceptives Plan B One-Step (Teva Pharmaceuticals, Woodcliff Lake, NJ) or Next Choice (Watson Pharmaceuticals, Parsippany, NJ) from a pharmacist without a prescription.

From September to December 2010, female research assistants posing as adolescents who recently had unprotected intercourse were assigned randomly to call all commercial pharmacies in Nashville, TN; Philadelphia; Cleveland; Austin, TX; and Portland, OR. Cities were chosen in geographically diverse states without pharmacy access laws that supersede uniform federal regulations. The callers were instructed to follow scripts to simulate real-world calls and elicit specific information on emergency contraception availability and access. Researchers then examined same-day availability of emergency contraception, whether emergency contraception could be accessed by the caller, and whether the pharmacy communicated the correct age at which emergency contraception was accessible over the counter.

In 19% of all locations, the caller was told EC was not available; the availability of the drug did not differ according to neighborhood income. If EC was available, then the caller stated she was 17 years old and asked whether she could get the drug. In 19% of calls, the caller was told she could not obtain EC under any circumstance. This misinformation occurred more often (23.7% versus 14.6%) among pharmacies in low-income neighborhoods. When callers inquired as to the age threshold for over-the-counter access, they were given the correct age less often by pharmacies in low-income neighborhoods (50.0% versus 62.8%). In all but 11 calls, the incorrect age was stated too high, which potentially restricted access.1

Advance provision is recommended so that EC can be taken as soon as possible after unprotected sex.2 A recent review of available literature suggests that among women 24 years of age or younger, advance provision of EC has a positive impact on use and time to use of EC.3

"I am a huge advocate for advance provision, because when we were doing this study, I realized that if you need it that day, you're not guaranteed to get somebody who can get it to you," says Wilkinson.

How about the IUD?

The Copper T-3801 A copper intrauterine device (ParaGard IUD, Teva Women's Health, North Wales, PA) is a highly effective method of emergency contraception, and it can be used as ongoing contraception for at least 10 to 12 years.4 Results of a new study indicate that most women are unaware of the copper IUD for EC; furthermore, there is little discussion between women and their healthcare providers around EC.5

To conduct the study, researchers undertook in-depth interviews with 14 emergency contraceptive IUD users and 14 emergency contraceptive pill users ages 18-30 years who were accessing public health clinics to study the factors influencing a woman's selection of EC method. The researchers report that EC users associated long-term methods of contraception with long-term sexual relationships. Cost was identified as a major barrier to accessing IUDs; also, perceived side effects and impact on future pregnancies further influenced the EC method a participant selected.5

What will it take to get more providers to offer information on the IUD as an EC method? Several items need to be set in motion, says Rachel Wright, a PhD candidate and graduate assistant in the College of Social Work at the University of Utah in Salt Lake City. Many healthcare offices are not equipped to offer immediate insertion of the IUD, which might limit their willingness or ability to offer it as a method of EC, notes Wright, who served as lead author of the current study.

"Many participants in the study I conducted further reported that they were told by their primary care providers that they were not eligible for an IUD for emergency contraception if they had not previously given birth," Wright comments. "To me, this is an indication that current guidelines and information on the copper IUD must be promoted, not only to potential EC users, but to healthcare providers as well."

Providers can be significant sources of support and information for women, and they often are their only exposure to accurate information, notes Wright.

"Few women in the U.S. use IUDs compared to other countries and additionally report low levels of knowledge about the IUD and its function as either a highly effective method of contraception or as emergency contraception," says Wright. "I think it would make a huge difference if discussions around all methods of emergency contraception were made a part of standard care, instead of limited to visits specifically for EC."

References

  1. Wilkinson TA, Fahey N, Suther E, et al. Access to emergency contraception for adolescents. JAMA 2011. Doi: 10.1001/jama.2011.1949.
  2. Association of Reproductive Health Officials. Update on Emergency Contraception. Washington, DC; 2010. Accessed at http://www.arhp.org/Publications-and-Resources/Clinical-Proceedings/EC.
  3. Meyer JL, Gold MA, Haggerty CL. Advance provision of emergency contraception among adolescent and young adult women: a systematic review of literature. J Pediatr Adolesc Gynecol 2011; 24:2-9.
  4. Dean G, Schwarz EB. Intrauterine contraceptives. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 20th revised edition. New York: Ardent Media; 2011.
  5. Wright RL, Frost CJ, Turok DK. A qualitative exploration of emergency contraception users' willingness to select the copper IUD. Contraception 2012; 85:32-35.