What about boys and emergency contraception?
By Anita Brakman, MS
Director of Education, Research & Training
Physicians for Reproductive Choice and Health
New York City
Melanie Gold, DO, FAAP, FACOP
Clinical Professor of Pediatrics
University of Pittsburgh School of Medicine
Staff Physician
University of Pittsburgh Student Health Service
When the Food and Drug Administration (FDA) approved Plan B Emergency Contraception (EC) for over-the-counter use in 2006, it opened up a new way for young men to be involved in preventing unintended pregnancy. For the first time, a dedicated EC product became available directly from pharmacies to any individual age 18 or older without a prescription.
In 2009, the age limit was lowered to include access for 17-year-olds. The same age-restricted structure is in place for generic levonorgestrel EC products as well. Individuals 16 and younger still require a prescription for EC, which can be written only for female patients. Ulipristal acetate, a newer type of EC product, is only available by prescription regardless of age, and again it is available only to females.
The American Academy of Pediatrics and Society for Adolescent Health and Medicine support over-the-counter access to EC without age restrictions, and they encourage physicians to counsel all adolescents, males and females, about this method of preventing pregnancy.1,2
Timeliness is crucial
Educating young men about this option and dispensing EC if possible is one more way to increase the likelihood of that EC will be used in a timely manner after unprotected sexual intercourse or contraceptive failure. Timeliness is essential with levonorgestrel EC, as efficacy drops over the 120-hour window for use.
While no studies have been published on advance provision of emergency contraception to men, similar studies of female adolescents show advance access to EC increases likelihood of use and decreases time between having unprotected intercourse and taking EC. Additionally, these studies have found no increase in the rates at which young people engage in unprotected intercourse based on increased availability of EC.3
A recent article in "Perspectives on Sexual and Reproductive Health" examined the literature on males and emergency contraception, and it found that many young men still are not even aware of this method.4 One of the first studies to report on male adolescents' knowledge of EC found that less than a quarter (24%) had ever heard of EC.5
More recent studies show increasing awareness of emergency contraception among males of various ages, but younger men still are much less aware than their older counterparts. In one study of high school students, 38% of males reported knowledge of EC.6 In comparison, studies of college-age men show that as many as 65% report being aware of emergency contraception.7,8
Check pharmacy access
Since clinicians cannot prescribe emergency contraception to young men, access for young men remains primarily at the pharmacy. Marcell's review above found few studies focused specifically on pharmacies' provision of EC to males. Examining pharmacist practices in Rhode Island, one study found 63% of pharmacists reported selling EC to males in the last year. Seventy-one percent of pharmacists in this study reported believing males should be allowed to purchase EC. However, fewer pharmacists approved of males purchasing emergency contraception in advance to have on hand (46%). Very few (4%) reported refusing to sell EC to males.9 Unfortunately this study did not report customer age.
A study in New York identified five out of 36 pharmacies visited asked male purchasers for detailed information about the intended user of the medication before allowing sale. Two pharmacists asked that the woman planning to use the medication must be present along with identification.10 Such restricted access is not in line with the FDA guidelines for over-the-counter emergency contraception provision and impedes timely access to effective EC use.
Over the past two years, the American Civil Liberties Union has documented several cases of men being refused EC at pharmacies based on their gender.11 An in-person mystery shopper effort by teens participating in the Teen Outreach Reproductive Challenge project of the National Institute for Reproductive Health earlier this year also found refusals based on gender in a small pilot study of New York City independent pharmacies in three neighborhoods. While this study was not solely focused on EC access for males, they did find that male mystery shoppers were more likely to be refused than female shoppers.12
While prescription to males might be possible in the future using a structure similar to expedited partner therapy for sexually transmitted infections (STIs), for now, clinicians can only provide adolescent males under 17 with counseling and information. Educating young men about emergency contraception as well as ongoing contraceptive methods allows them to be active participants in efforts to prevent unintended pregnancy.
Additionally, encouraging dual use of hormonal contraception and condoms provides both partners with the best protection against pregnancy and STIs.
References
- American Academy of Pediatrics, Committee on Adolescence. Emergency contraception. Pediatrics 2005; 116:1,026-1,035.
- Gold MA, Sucato GS, Conard LA, et al. Provision of emergency contraception to adolescents: position paper of the Society for Adolescent Medicine. J Adolesc Health 2004; 35:67-70.
- Harper CC, Cheong M, Rocc CH, et al. The effect of increased access to emergency contraception among young adolescents. Obstet Gynecol 2005; 106(3):483-491.
- Marcell AV, Waks AB, Rutkow L, et al. What do we know about males and emergency contraception? A synthesis of the literature. Perspect Sex Repro Health2012; 44(3):184-193.
- Delbanco SF, Parker ML, McIntosh M, et al. Missed opportunities: teenagers and emergency contraception. Arch Pediatr Adolesc Med 1998; 152(8):727-733.
- Urena E, Yen S. Emergency contraception knowledge and perceptions among teens. Ethn Dis 2009; 192(2):25-27.
- Miller LM. College student knowledge and attitudes toward emergency contraception. Contraception 2011; 83(1):68-73.
- Corbett PO, Mitchell CP, Taylor JS, et al. Emergency contraception: knowledge and perceptions in a university population. J Am Acad Nurse Pract 2006; 18(4):161-168.
- Nguyen BT, Zaller N. Pharmacy provision of emergency contraception to men: a survey of pharmacist attitudes in Rhode Island. J Am Pharm Assoc 2010; 50(1):17-23.
- Gordon L. Emergency contraception: Available at your pharmacy now. Accessed at http://bit.ly/RZLxAh.
- Jackson CF, Turner O, Amiri B. Not again: two more pharmacies refuse to sell emergency contraception to men. Accessed at http://bit.ly/TUu1QI.
- Kincler N, Won SH. Pharmacy access to emergency contraception for teens in NYC: An in-person mystery shopper study. Presented at the American Society for Emergency Contraception Meeting. New York, NY; October 2012.
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