Over-the-counter access to levonorgestrel emergency contraception in South Texas: Does Over-the-counter mean ready to buy?

Vega, Alejandra Villagómez; Choi, Ye Ji; Tschann, Mary; Salcedo, Jennifer

doi:10.1016/j.contraception.2021.05.005

Cited by 7 publications

(12 citation statements)

References 12 publications

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“…Barriers to EC pharmacy availability are varied, including suboptimal stocking due to perception of low demand, pharmacy staff personal objection, or placing OTC EC behind the counter or in a locked box due to concerns about theft [14] . Our findings are consistent with other studies showing that a high proportion of pharmacies choose to keep LNG in a locked box or cabinet, complicating the OTC nature of this medication [7] . Moreover, almost half of pharmacists in our study spontaneously reported that they had never heard of UPA when asked about obtaining this medication.…”

Section: Discussionsupporting

confidence: 92%

“…A study conducted in Hawaii in 2018 found that only 84% of pharmacies had LNG readily available for purchase OTC [4] . A study conducted in 2018 to 2019 in South Texas found that only 2.6% of pharmacies had unrestricted LNG OTC access, meaning in-stock, directly available for purchase on the store shelf, and with no security barriers such as a locked cabinet or an individual locked container [7] . As for UPA, 2 studies conducted in 2018 and 2019 found that less than 10% of pharmacies routinely stock it for immediate access, with commercial pharmacies more likely to carry UPA than independent pharmacies [ 5 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Pharmacy availability of emergency contraception in southwestern Pennsylvania: A simulated patient study

et al. 2021

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Objective To assess the availability of oral emergency contraception in southwestern Pennsylvania pharmacies. Study design We conducted a simulated patient study to assess on-the-shelf availability of levonorgestrel emergency contraception and immediate availability of ulipristal acetate emergency contraception. Results Only 44% of pharmacies stocked levonorgestrel on-the-shelf and only 5% of pharmacies had ulipristal acetate immediately available. Conclusions We found significant barriers to obtaining timely oral emergency contraception in southwestern Pennsylvania. Implications statement Timely access to emergency contraception is important for people's ability to determine if, when, how, and under what circumstances to have children. Pharmacies in southwestern Pennsylvania need to expand access to oral emergency contraception.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Pharmacy availability of emergency contraception in southwestern Pennsylvania: A simulated patient study

et al. 2021

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“…This finding is consistent with those from a 2017 secret shopper study conducted in Los Angeles County that found that over-the-counter emergency contraception was not available at approximately 23% of pharmacies. Recent studies suggest that the availability of over-the-counter emergency contraception may be even more limited elsewhere in the US …”

Section: Discussionmentioning

confidence: 99%

Willingness of Pharmacists to Prescribe Medication Abortion in California

Cohen,

Hunter,

Beltran

et al. 2024

JAMA Netw Open

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ImportanceNearly half of US states have restricted abortion access. Policy makers are exploring pathways to increase access to abortion and reproductive health care more broadly. Since 2016, California pharmacists could prescribe hormonal birth control, providing an opportunity to learn about the implementation of pharmacist-provided reproductive health care.ObjectiveTo explore the feasibility of broadening pharmacist scope of practice to include prescribing medication abortion.Design, Setting, and ParticipantsA cross-sectional online survey was conducted from October 11 to December 20, 2022, among a convenience sample of California licensed community pharmacists to examine their attitudes toward, knowledge of, and confidence in prescribing hormonal birth control and reports of pharmacy-level practices.Main Outcomes and MeasuresDescriptive analyses and log-binomial regression models were used to compare medication abortion and contraceptive provision attitudes by pharmacist and pharmacy characteristics.ResultsAmong the 316 pharmacists included in the analysis who worked at community pharmacies across California (mean [SD] age, 40.9 [12.0] years; 169 of 285 [59.3%] cisgender women; and 159 of 272 [58.5%] non-Hispanic Asian individuals), most (193 of 280 [68.9%]) indicated willingness to prescribe medication abortion to pharmacy clients if allowed by law. However, less than half were confident in their knowledge of medication abortion (139 of 288 [48.3%]) or their ability to prescribe it (115 of 285 [40.4%]). Pharmacists who indicated that providing access to hormonal birth control as a prescribing provider was important (263 of 289 [91.0%]) and were confident in their ability to prescribe it (207 of 290 [71.4%]) were 3.96 (95% CI, 1.80-8.73) times and 2.44 (95% CI, 1.56-3.82) times more likely to be willing to prescribe medication abortion and to express confidence in doing so, respectively. Although most pharmacists held favorable attitudes toward hormonal birth control, less than half (144 of 308 [46.8%]) worked in a pharmacy that provided prescriptions for hormonal birth control, and 149 who did not reported barriers such as lack of knowledge or training (65 [43.6%]), insufficient staff or time to add new services (58 [38.9%]), and lack of coverage for services (50 [33.6%]).Conclusions and RelevanceThe findings of this cross-sectional survey study of California pharmacists suggest that most pharmacists were willing to prescribe medication abortion. However, future efforts to expand pharmacists’ scope of practice should include training to increase knowledge and confidence in prescribing medication abortion. Pharmacy-level barriers to hormonal birth control prescription, such as insurance coverage for pharmacist effort, should also be addressed, as they may serve as barriers to medication abortion access.

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“…31 A study conducted in late 2018-early 2019 at pharmacies in Hidalgo County, Texas, found that even though LNG EC was approved as an over-the-counter medication without age restrictions, it was behind security barriers more often than other reproductive health products, including some that had higher mean prices, a practice that has the potential to increase discomfort and delay care. 132 In Italy, where over-the-counter EC was approved in 2015 and uptake rates are among the lowest in Europe, interviews revealed that keeping the medication behind the counter created an impediment because of the embarrassment and fear of being labeled irresponsible that some consumers perceived when they had to request it. 133 The prescription requirement for UPA, which is more effective than LNG, and the need for a trained clinician to place the copper IUD 134 additionally limit access.…”

Section: Multiple Types Of Barriers To Ecmentioning

confidence: 99%

Emergency Contraception: Access and Challenges at Times of Uncertainty

Stein¹,

Deverakonda²,

Katz

et al. 2022

American Journal of Therapeutics

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Background:The UN Commission on Life-Saving Commodities for Women and Children identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation.Areas of uncertainty:Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access.Data Sources:PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetricians and Gynecologists, the World Health Organization, The United Nations.Therapeutic Advances:A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device.Conclusions:EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts, threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.

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Over-the-counter access to levonorgestrel emergency contraception in South Texas: Does Over-the-counter mean ready to buy?

Cited by 7 publications

References 12 publications

Pharmacy availability of emergency contraception in southwestern Pennsylvania: A simulated patient study

Pharmacy availability of emergency contraception in southwestern Pennsylvania: A simulated patient study

Willingness of Pharmacists to Prescribe Medication Abortion in California

Emergency Contraception: Access and Challenges at Times of Uncertainty

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