Morning after pills difficult for teenagers to procure

By Dr. Ananya Mandal, MDMar 27 2012

Quite a few U.S. pharmacies may give teen girls incorrect information over the phone about whether they can get the morning-after pill. The pill is a form of emergency contraception taken within 72 hours after unprotected sex to prevent pregnancy without a prescription, a new study suggests.

Two emergency contraceptives, both of which contain the hormone levonorgestrel, are approved for over-the-counter use and are stocked behind pharmacy counters: Plan B (including the single-pill version known as Plan B One-Step), and a so-called branded generic known as Next Choice.

In most states, anyone age 17 and over can get the pill without a prescription, as a result of a 2009 decision by the U.S. Food and Drug Administration. But the new research suggests some pharmacies may not always stock the medication, or workers may think only older patients can get it over the counter - and teens may have trouble accessing emergency contraception as a result.

“This is a delicate topic, and it could be something that's very sensitive for the teenager calling,” said Dr. Tracey Wilkinson, a pediatrician at Boston Medical Center and the lead author of the study published in the journal Pediatrics. “If you don't give the right information or you're not willing to have a discussion about how to help get the medication, the adolescent might just give up,” she told Reuters Health.

For the study Wilkinson and her team called every pharmacy in five different cities, pretending to be either a 17-year-old girl or the doctor of one, looking to get the morning-after pill. Two female research assistants at Boston University called the pharmacies and asked whether emergency contraception was available to them that day. If the answer was yes, they followed up with the question “If I'm 17, is that okay?” Altogether, the researchers made calls to 943 chain and independent pharmacies in Nashville, Philadelphia, Cleveland, Austin and Portland, Oregon.

They found that about 80 percent pharmacies told both girls and doctors that they had emergency contraception in stock. But even in those cases, one in five of the teen callers was told there was no way she could get the medication when she gave her age. When the morning-after pill was not available, more than one-third of pharmacies did not suggest any other options for how girls could get it. Pharmacies, moreover, incorrectly reported the age guidelines for over-the-counter access to 43% of the “girls” and 39% of the “doctors,” according to the study.

“I had heard anecdotal stories from my patients and also from other practitioners about adolescents really having difficulty obtaining emergency contraception,” Wilkinson said. But when one in five girls couldn't get the medication that was in stock, “I was shocked,” she said. “They were basically being told, ‘You can't get it at all,' which is not true but also scary, because you would think maybe a teenager wouldn't call another pharmacy.”

Misinformation of this sort could lead to unintended pregnancies, the researchers say. “It's important that adolescents get the correct information the first time,” said Wilkinson. “This highlights some of the barriers that adolescents face when accessing emergency contraception.”

Timely access to these drugs is important, Wilkinson and her colleagues say, since they're most effective in the 24 hours following unprotected sex or a contraception failure. The odds of getting pregnant rise by about 50% every 12 hours after the event, according to the study.

The results suggest little has changed over the years when it comes to education about and access to emergency contraception, said one reproductive health researcher not involved in the new study. James Trussell from Princeton University in New Jersey said he and his colleagues did a similar study over a decade ago, and found that even providers who said they stocked emergency contraception were not always able to help women get the pills. Now, he told Reuters Health, “You're getting results that are not at all dissimilar, although this time it appears to be over not having it in stock or being completely uninformed about what the rules are regarding age.”

“There were probably some people who had some personal objections about [emergency contraception] and didn't want to deal with it, and some were not educated about the laws and facts,” says Christopher Estes, an assistant professor of ob-gyn at the University of Miami Miller School of Medicine.

Jean Amoura, an associate professor of ob-gyn at the University of Nebraska Medical Center, in Omaha, has studied access to emergency contraception in Nebraska pharmacies and says barriers to access are often logistical. Rural pharmacies, for instance, may not stock the pill simply because too few people ask for it. Amoura has encountered ideological objections as well, however. Although Plan B and Next Choice are believed to work by preventing ovulation, like daily birth control pills, and “will not interrupt an established pregnancy,” Amoura says, some people view taking the drugs as tantamount to abortion. The “misunderstanding among the public, pharmacists, and doctors about this being an abortion pill” is an “ongoing dilemma,” Amoura says.

In 2011, the FDA recommended the removal of all age restrictions on Plan B One-Step, but in a controversial move, the U.S. Secretary of Health and Human Services, Kathleen Sebelius, overruled the agency.

Deborah Nucatola, senior director of medical services at Planned Parenthood, which provides reproductive health services - including emergency contraception - at more than 800 health centers around the country, says easing restrictions on emergency contraception may help address the uneven access seen in Wilkinson's study. “It's unclear if the pharmacy workers who provided incorrect information to the study callers were simply unfamiliar with the law, but one of the unfortunate results of the age restriction is that it requires drugstores to keep emergency contraception behind pharmacy counters,” Nucatola said in a prepared statement. “As the research shows, that restriction creates access barriers for women of all ages and these barriers can in turn result in preventable unintended pregnancies.”