One of the best parts of my job is that I get to mentor a large number of junior faculty in the school of medicine. So many of them are inspiring. One (Tracey Wilkinson) had a paper published this week* that deserves attention. “Access to Emergency Contraception After Removal of Age Restrictions“:
BACKGROUND: Levonorgestrel emergency contraception (EC) is safe and effective for postcoital pregnancy prevention. Starting in 2013, the US Food and Drug Administration removed age restrictions, enabling EC to be sold over the counter to all consumers. We sought to compare the availability and access for female adolescents with the 2012 study, using the same study design.
METHODS: Female mystery callers posing as 17-year-old adolescents in need of EC used standardized scripts to telephone 979 pharmacies in 5 US cities. Using 2015 estimated census data and the federal poverty level, we characterized income levels of pharmacy neighborhoods.
In 2013, you may remember, the FDA removed age restrictions from emergency contraception so that it could be sold over-the-counter to anyone having sex. I wrote about this issue a number of times. She set up “secret shoppers” to call pharmacies and ask them about EC access. Sometimes they shoppers pretended to be adolescents. Sometimes they were doctors.
Tracey had done a study on access to EC by adolescents (I highlighted her work in an Upshot column) in 2012. She repeated her study in 2015 to see if the new regulations made a difference.
Of the 979 pharmacies contacted, 83% indicated that EC was available for purchase. That hadn’t much changed over time. Neither had many of the barriers to getting EC in a timely way. Pharmacies in low-income neighborhoods were still the most likely to report that it was impossible to obtain EC access under any circumstances. Almost half still reported misinformation on who could get EC access over the phone.
In other words, they were still too-likely to tell adolescents it wasn’t over-the-counter or they weren’t old enough to get it.
Most pharmacies carry emergency contraception. But we still haven’t cleared the hurdles necessary to help adolescents get access to it. There’s much more work to be done.
*In the interests of full disclosure, I am also an author of this paper. Feel free to get angry at me for the imperfections. All credit goes to Tracey, though.
