Current Issues in Emergency Contraception: An Overview for Providers

Jennifer Brunton, CNM, MSN; Margaret W. Beal, CNM, PhD

Disclosures

J Midwifery Womens Health. 2006;51(6):457-463. 

In This Article

Strategies for Improving Access to Emergency cContraception

Improving awareness of and knowledge about EC would allow women and providers to make informed choices about its use. One educational intervention studied included in-service training of providers and other office staff as well as development of patient and provider informational materials. It proved effective at increasing provider knowledge and prescriptive practices in a follow up survey one year after the intervention.[47] Resources for clinicians and consumers can be found in Appendix.

EC should be discussed routinely during primary and gynecologic care, and should always be offered as an option for women who present after an act of unprotected intercourse. Written materials should be made available so that women can make informed decisions whether or not to use EC. It is understood that some providers may have personal objections to EC, in which case, a referral should be made to a provider who will do so, as withholding this safe, effective option from women could be considered below contemporary standards of practice.

There are recent successes in surmounting the major barrier that was created by the prescription-only status of EC. On August 24, 2006, the FDA announced that Plan B could be sold without prescription to women aged 18 and older. This is consistent with the policies of 39 other countries as diverse as Canada, India, and Sweden, where EC is available either over-the-counter or directly from pharmacists.[48] The FDA decision will still require that women under the age of 18 have a prescription in order to obtain Plan B.

The procedure for women aged 18 and older to obtain Plan B without a prescription will probably be similar to the procedure already in place in states that have taken the approach of providing "behind the counter" status, in which pharmacists can provide the medication without the woman presenting a prescription. This option has been available in 8 states (Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, and Washington). All have required patient consultation with the pharmacist before EC is dispensed; under the new rules, women may have to present proof of age and thus pharmacist consultation may still be required.

Data on the effects of pharmacy access are encouraging. A study from the United Kingdom, where EC has had "behind the counter" status since January 2001, revealed that this status allowed women to access EC more quickly than if a prescription were required. Women receiving EC directly from pharmacists were also just as well informed, just as likely to receive follow up care, and reported high satisfaction with this system.[37,49] A demonstration project on pharmacy-accessed EC in Washington State also found positive results. Concerns remain about the lack of access for adolescents. In one study adolescents were asked what they would have done to access EC had pharmacy access not been available. Almost half stated either they would have waited to see if they got pregnant or they did not know what they would have done.[50]

Strategies to ensure availability for adolescents can involve the advance provision of ECPs and signed standing orders for ECPs on all charts. Adolescents can be given instruction sheets and prescriptions at annual visits. All women can be given a list of local pharmacies that stock EC to avoid problems filling the prescription if it is needed. This ensures ease of access without having to make an office visit, thereby decreasing the delay from unprotected intercourse to administration of EC.

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