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.

KEYWORDS:

• Emergency contraception
• levonorgestrel
• pharmacy staff
• postcoital contraception
• secret shopper

Acknowledgments

Thank you to Ingrid Binswanger MD MPH, Miriam Dickinson PhD, and Miranda Kroehl PhD. Alia Moore had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interests

The authors have no conflicts of interest to disclose.

Additional information

Funding

This research was funded by the NIH/HRSA grant 5 T32HP100062300 and NIH/NCATS Colorado CTSI Grant UL1 TR001082. Contents are the authors’ sole responsibility and do not necessarily represent official NIH views. The funding source had no involvement in research development, data analysis, manuscript writing, or submission.