Seeking emergency contraception in the United States: A review of access and barriers

Abstract

Federal regulations governing access to levonorgestrel (LNG) emergency contraception (EC) have evolved since its introduction in the 1990s. LNG EC was initially available by prescription only, but is now available over-the-counter to consumers of all ages. Nonetheless, consumers seeking EC in their communities may face ongoing barriers to access, including low stock and inaccurate information provided by pharmacy staff. We conducted a review of LNG EC secret shopper studies to describe changes in EC access and barriers over time. EC access was compared across all applicable studies, which were published during 2003-2016. When possible, reasons for EC unavailability, helpfulness of pharmacy staff when EC was not in stock, and accuracy of EC information provided by pharmacy staff were described. Overall, access to EC appeared to be improving. However, EC was unavailable during 31 percent of encounters. Pharmacy staff attributed this to "low demand" (30 percent) or EC being "out of stock" (21 percent). Personal objections (9 percent) and store policy (10 percent) were also cited in studies from earlier years. Inaccurate information provided by pharmacy staff persists regarding federal EC regulations, mechanism of action, and drug administration. Pharmacy staff should remain informed about EC and its regulations in order to reduce remaining access barriers.

Over-The-Counter Availability of Levonorgestrel Emergency Contraception in Pharmacies on Oahu

“…Not having generic brands available likely relates to the limited shelf space of smaller pharmacies. Previous studies have shown that some pharmacies do not stock EC due to the perception of low demand, pharmacy staff personal objection to EC, or store policy [17]. Our study found that 58% of pharmacies on Oahu have LNG EC available OTC without a lock, which is higher than previous studies that show 22% of pharmacies nationwide have LNG EC available without a lock [18].…”

Emergency contraception from the pharmacy 20 years on: a mystery shopper study

“…8 Mystery shopper studies relating to EC access from pharmacies have also been published from other countries such as Australia and the USA. [9][10][11][12][13] While the research question posed by each investigator was somewhat different to that of our mystery shopper study, all concluded that pharmacists' practices are variable and not always in line with the recommendations in guidelines.…”

Pharmacy availability of emergency contraception in southwestern Pennsylvania: A simulated patient study

“…Although overall EC use has increased since FDA approval of OTC sale [6] , pharmacy access remains a common problem throughout the US [ 4 , 13 ]. Barriers to EC pharmacy availability are varied, including suboptimal stocking due to perception of low demand, pharmacy staff personal objection, or placing OTC EC behind the counter or in a locked box due to concerns about theft [14] . Our findings are consistent with other studies showing that a high proportion of pharmacies choose to keep LNG in a locked box or cabinet, complicating the OTC nature of this medication [7] .…”