More people are buying emergency contraception (EC), but they face barriers related to misinformation, pharmacy stocking issues, pharmacy staff’s lack of knowledge, and challenges in obtaining prescription EC.
Several researchers and advocates offer these suggestions to reproductive health clinicians and providers for improving access to EC in their communities:
• Keep EC on hand. Family planning clinics and OB/GYN offices could keep EC on hand to dispense to patients in need, suggests Chris ChoGlueck, PhD, an assistant professor of ethics, faculty advisor for the Responsible Conduct of Research, and adjunct professor of biology at the New Mexico Institute of Mining and Technology.
“Have it on hand for patients who are sexually active and don’t want to be pregnant. The whole idea of Plan B is a lot of people don’t expect to use it,” ChoGlueck explains. “You don’t expect a fire in your house, but you keep a fire extinguisher.”
Levonorgestrel EC, including Plan B, has a narrower window of efficacy, so it must be used quickly. If a person struggles to find a pharmacy that stocks it, they miss this window. Reproductive health providers can save them this frustration by keeping the contraceptive on hand for emergencies.
• Advocate and educate for easier access to ulipristal acetate (UPA), also known as ella. “For me, this means to provide education on emergency contraception, and I’ve given presentations at regional conferences,” says Nancy R. Downing, PhD, RN, FAAN, SANE-A, SANE-P, an associate professor in the Texas A&M University School of Nursing.
Nurse-to-nurse education helps, but providers also need to advocate for changes in hospital policies that block access to EC.
“Disseminate information on the policy they can implement in their program,” Downing suggests. “Coach them on how to speak to their medical directors and pharmacists on how to stock it.”
Forensic nursing often comes down to what is going on locally. “Some of the more global solutions are not the ones being implemented at the local level,” Downing says. “It’s mainly someone appealing to their medical director.”
• Provide outreach to youth and marginalized populations. “There are 50 colleges that have machines with emergency contraceptives, and we’re working with dozens more to get them online this school year,” says Kelly C. Cleland, MPA, MPH, executive director of the American Society for Emergency Contraception in Lawrenceville, NJ. “It’s a really terrific way to improve access, reduce stigma, and make sure students can get it when they need it.”
Family planning clinics can provide evidence-based information about EC to student health clinics on college campuses, Downing says.
Advocacy programs can educate people on how to obtain the more effective EC and who may need it, based on weight and body mass index.
Unfortunately, family planning centers are difficult to find in Texas and some other states, so this role could be picked up by public health departments and OB/GYN offices.
“My role is to educate forensic nurses and providers,” Downing explains. “A lot of times, we get a medical director who doesn’t have knowledge, so it’s a matter of educating them, and maybe providing toolkits for forensic nurses on how to approach your medical director to get a policy change at your facility or hospital.”
For rural communities, the solution could be a freestanding sexual assault clinic or mobile clinic that travels to an advocacy center or health center, Downing suggests.
• Determine which local pharmacies stock EC. One of the more frustrating experiences patients can have is if they cannot find Plan B on the shelves of local pharmacies. Or maybe Plan B is stocked, but it is incorrectly placed behind a counter or in a locked cabinet. “Plan B is supposed to be available over the counter and out of a lockbox, but a lot of pharmacies have it in a lockbox — even chain pharmacies,” ChoGlueck says. “They may justify this based on its cost, but it’s not supposed to be restricted in any way. It should not be in a lockbox, which is a barrier to access.”
Physicians and nurses can influence pharmacies more easily and could contact them to ensure EC is available over the counter without obstacles to its purchase. They also can correct any inaccurate information pharmacy staff might have. If they find that some pharmacies do not carry EC, they can advise patients about which ones do carry it.
For instance, some staff might tell youth that they cannot access EC because of their age, but there are no age restrictions on Plan B.
Pharmacy staff also need to allow anyone to purchase it, whether they appear to be male or female.
“One barrier for trans-masculine individuals is they sometimes get screened, with someone saying, ‘Why should you be buying this, you don’t have ovaries,’” ChoGlueck says. “None of those restrictions should be applied.”
More people are buying emergency contraception, but they face barriers related to misinformation, pharmacy stocking issues, pharmacy staff’s lack of knowledge, and challenges in obtaining prescription EC.
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