Emergency Contraception: A Primer for Pediatric Providers

Alana L. Clements; Alison Moriarty Daley

Disclosures

Pediatr Nurs. 2006;32(2):147-153. 

In This Article

Current Availability of Plan B

Since the FDA has yet to announce a decision on the status of Plan B, prescription access remains the norm in the United States for women of all ages. To circumvent the need for an urgent prescription, some states have established regulations allowing collaborative arrangements between pharmacists and health care providers that allow women to obtain EC directly from pharmacists. A collaborative practice agreement is defined as "a voluntary agreement between one or more prescribers and pharmacists establishing cooperative practice procedures under defined conditions and/or limitations" (Pharmacy Access Partnership, 2005, p.1). This type of arrangement had previously been approved for various health care needs, including immunizations, asthma therapy, smoking cessation, diabetes management, and influenza/antiviral therapy (Pharmacy Access Partnership, 2005). Washington was the first state to initiate use of this type of program for EC. Currently, six states have collaborative agreements that allow women to purchase EC directly from a pharmacist under designated conditions: Hawaii, Maine, New Mexico, California, Alaska, and Washington (Reproductive Health Technologies Project, 2005). In each of these states, pharmacists who wish to participate receive training and then enter into an agreement with a licensed practitioner. They can then register with various organizations that direct women to EC providers.

Some women's health and family planning organizations have sought to increase access by promoting awareness and creating a centralized source for EC prescriptions. One innovative program was a comprehensive advertising campaign initiated by Planned Parenthood affiliates and Family Health International in conjunction with a research project (Raymond et al., 2004). Through this program, women of all ages were able to call a toll-free number and, if medically indicated and appropriate, have a prescription faxed to the pharmacy of their choice. Callers also had the option to pick up their prescription at one of the Planned Parenthood facilities in the state, where EC is less expensive. Initially, this call-in service was free, and the number of calls increased steadily each month. At the end of the research grant, the service began to charge $40 per call, which decreased the number of calls significantly (Raymond et al., 2004). This may indicate that online and phone-in services that charge a fee for providing an immediate prescription for EC may not function as effectively if clients have to pay for the service in addition to paying for the prescription itself.

There are similar services available on the Internet, though a quick online search does not yield immediate and obvious results. There are also a number of services available that allow women to order Plan B in a similar way and have it mailed to them, though this would be much more appropriate for advanced provision than for immediate need, since it would take several days for the process to be completed.

Princeton University and the associated Reproductive Health Technologies Project have continued to develop innovative strategies to increase awareness and access to EC (Office of Population Research, 2005; Reproductive Health Technologies Project, 2005). In addition to their original "Not-2-Late" campaign, they have recently started the "Back up Your Birth Control" campaign; this effort, whose emblem is Rosie the Riveter (see Figure 1), includes advertisements in print and on the Internet, as well as an annual "Back Up Your Birth Control Day." All of these direct women to www.backupyourbirthcontrol.org for more information, and to the original "Not-2-Late" sites for a list of local providers (Office of Population Research, 2005).

Rosie the Riveter - "Back Up Your Birth Control" Campaign. Note: Reprinted with permission from http://www.backupyourbirthcontrol.org

The American College of Obstetricians and Gynecologists (ACOG) has also made an attempt to increase awareness of and access to EC through a program called "Every Woman, Every Visit." ACOG is committed to increasing EC knowledge among providers and their clients and encourages clinicians to write a prescription for EC for every woman of reproductive age at every office visit (ACOG, 2004). This practice would reduce the time it takes for women to obtain EC following an act of unprotected intercourse by eliminating the initial step of contacting and soliciting an appointment or a prescription from a provider. It is significantly more likely for a woman to find an open pharmacy in the evening or on the weekend than it would be to find an available provider.

Women in more than 30 countries are able to obtain EC without a prescription; this includes Jamaica, Argentina, Israel, Australia, New Zealand, China, parts of Africa and Europe, and three of the provinces of Canada (Center for Reproductive Rights, 2004). In some of these countries, EC is available over the counter, and in others, it is behind the counter and must be requested, which is the norm for all pharmaceutical products in some parts of the world and remains true for other family planning products in some parts of the United States. In 2002, France established regulations that allowed all women under 18 to obtain EC for free. If they are unable to access EC at a family planning center or from a doctor, they may get it from a school nurse at their junior or senior high school (Boonstra, 2002). Part of the requirements of this program is that all school nurses must set up an appointment for follow-up for students to whom they provide EC. Women who qualify for the free provision of EC are not, under any circumstances, required to obtain parental permission (Boonstra, 2002).

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