Providers make EC readily available
When it comes to emergency contraception (EC), three-quarters of respondents to the Contraceptive Technology Update 2000 Contraception Survey say they prescribe on-site and provide emergency contraceptive pills (ECPs) at any time. Another 17.1% of participants in the survey provide EC on-site in emergencies only, and 5.5% counsel and refer to another provider for prescriptions.
Figures for those three scenarios rose slightly from 1999 statistics. The number of responses indicating policies of just counseling alone or no EC services dropped to about 1%.
More women are aware that EC is available, say survey participants. Planned Parenthood of Southern Arizona in Tucson has seen the number of ECP users increase in the last year, even though the method has been offered for at least seven years, says Barbara Kremer, CNM, MPH, a clinician at the Tucson facility.
National media coverage of ECPs has led people to call, and the Planned Parenthood affiliate has done some specific marketing of ECPs, including a feature interview with the organization’s chief executive published in the local newspaper, reports Kremer. Women can call in for EC over the telephone on nights and weekends, if so needed, and the affiliate is listed on the Emergency Contraception Web site and hotline [Web: not-2-late.com. Hotline: (888) NOT-2-LATE].
Diana Lithgow, RN, FNP, a family nurse practitioner at Laguna Beach (CA) Community Clinic, notes that while her facility does not advertise its services in the media, the number of patients seeking ECPs has grown significantly. All patients receive a handout about ECPs, and posters on the walls of the exam rooms raise awareness of the method. (See resources, p. 113, for details on ordering EC promotion material.)
What is used for EC?
What do providers use for emergency contraception? Almost 60% of survey respondents say they use products specifically marketed for emergency contraception, with the remaining percent using a variety of oral contraceptives dispensed in doses effective for EC. About 21% report use of the Preven Emergency Contraceptive Kit, marketed by Gynétics of Belle Mead, NJ. Introduced in the United States in 1998, the Preven kit consists of an easy-to-use pregnancy test, a patient information guide, and four pills. Each pill contains 0.05 mg ethinyl estradiol and 0.25 mg levonorgestrel.
About 36% say they use Plan B, the progestin-only product debuted last year by the Women’s Capital Corp. of Bellevue, WA. The product consists of two 0.75 mg tablets of levonorgestrel.
Plan B has proven popular because it requires the client to take only one pill for each dose, and nausea is reduced over combined estrogen-progestin formulas, says Kremer.
The Food and Drug Administration (FDA) has just granted approval to extend the shelf life of Plan B to 18 months, says Sharon Camp, PhD, president of Women’s Capital Corp. in Washington, DC. Because the shelf life has been extended from the original eight-month limit, Plan B now can be merchandised through retail outlets, which gives more women access to the product. Plan B is available through Planned Parenthood clinics, campus health centers, and other providers listed on the Emergency Contraception Hotline.
Plan B was to be available through pharmaceutical wholesalers in August 2000 and to arrive on drugstore shelves soon thereafter, says Camp. The company is considering direct-to-consumer advertising to let women know the product is available in stores, she says.
Resource
• Wallet cards, laminated receptionist phone protocol cards, postcards, and posters, all of which promote the Emergency Contraception Hotline, may be ordered at no charge while supplies last. Contact: Reproductive Health Technologies Project, P.O. Box 33344, Washington, DC 20033. Telephone: (202) 530-2900. Fax: (202) \530-2901. Web: www.rhtp.org. Click on "Emergency Contraception," then "Order Form."
EC over the counter?
While access to emergency contraception has increased, advocates say the next step should include moving ECPs to over-the-counter (OTC) status. Representatives of several national women’s health research and advocacy organizations recently testified before the FDA in support of such a move.
While it is widely believed that moving ECPs to OTC status will increase access dramatically, some advocates are concerned that an OTC product will be too expensive for women with low or fixed incomes, says Kirsten Moore, project manager at Reproductive Health Technologies Project in Washington, DC. They are therefore encouraging the FDA to allow ECPs to be available both OTC and by prescription, preserving the product’s Medicaid reimbursement status.
The advocacy community is moving forward with a strategy to petition the FDA for the OTC switch, but it is still in development, she says.
By moving ECPs to OTC, no woman can be denied access due to conscience clauses, policies that enable health care providers to opt out of offering a service because of moral opposition. "Making ECPs available OTC is the best way to guarantee that a woman who is doing all she can to prevent an unwanted pregnancy is not denied service by a doctor or pharmacist who believes what she is doing is objectionable," she says.
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