“Morning after” Contraception: Too Difficult to Get

Emergency contraception, also known as Plan B and popularly referred to as the “morning after pill,” is more effective the sooner it is taken following unprotected intercourse. Accessibility to this product is therefore important in its efficacy.

In 2006 the Food and Drug Administration (FDA) granted Plan B “dual status,” which means that the drug can be available by prescription to women of all ages, and can also be available without prescription to people 18 and over with government-issued identification. This dual status was contingent on the manufacturer of Plan B providing pharmacists extensive education to ensure that the regulations would be followed.

A recent survey of pharmacies in Los Angeles shows that that this education has been uneven, or produced uneven results. In the study, published in the medical journal Contraception, all retail pharmacies in Los Angeles County were contacted by telephone by a sham 23-year-old caller. The purpose of the call was to assess the accuracy of the information a vulnerable young woman would be given about Plan B.

Out of a total 1206 pharmacies, 69.2 percent responded that they carried the product and had it available without prescription. An additional 19.2 percent who did not carry Plan B referred the caller to another pharmacy. Other findings include the following:

• 74 pharmacies (6.1 percent of those contacted) referred the woman to her clinician to get a prescription, although none is required;
• Another 12 pharmacies (1.0 percent) said they know the contraceptive was available without a prescription, but they required one before dispensing it to a woman of any age;  
• In 27.1 of the cases, the caller had to tell her story to two people; in 1.8 percent, she had to repeat it three or more times before she got information.
• At 39 of the pharmacies (3.2 percent), the person taking the call said that he or she did not know anything about what the woman was asking. Of those who did understand, 16 told the woman there was nothing she could do to keep from getting pregnant, while another 7 gave recommendations that are not FDA-approved for emergency contraception.

Another major finding of the study was the variability in the nomenclature used to describe emergency contraception. Some of the names given to Plan B are inaccurate, and may therefore be confusing. In addition, misinformation concerned not only what the drug is called, but also how it is used and the mechanisms of action. Moreover, some respondents were uncomfortable, intrusive, or judgmental.

Because the study was conducted in Los Angeles and California is one of the states most committed to expanding access to emergency contraception, the study data underestimates the barriers most U.S. women face in gaining access to this method. Yet, even in LA, almost 30 percent of the time a woman would have to call at least two pharmacies and repeat her story before getting access to emergency contraception.  As the study suggests, getting accurate information requires women who are knowledgeable, assertive and persistent. It is therefore not surprising that the availability of emergency contraception has not reduced the incidence of unintended pregnancies on a population basis.