Why is Emergency Contraception Still so Hard to Find?

The physical & invisible barriers to emergency contraception

It’s been nearly nine years since the FDA approved the use of Plan B One Step (levonorgestrel), an emergency contraceptive pill, for all women of child-bearing potential to purchase over the counter. The FDA made this decision based on the evidence that Plan B is safe to use without the supervision of a licensed practitioner. However, Plan B’s path to over-the-counter approval came with controversy and confusion over how emergency contraception works. The misconceptions about emergency contraception and stigma around reproductive health have led to barriers to access that stubbornly persist today, in both physical and invisible ways.

Before we get into the barriers women face in accessing emergency contraception, we want to be clear: emergency contraceptives are not abortifacients. Plan B, My Way and ella (and other emergency contraceptive pills or procedures) only work before pregnancy occurs. These medications do not affect a developing embryo and do not terminate a pregnancy, even if taken while pregnant.

Barriers in Pharmacies

Pharmacies usually stock over-the-counter emergency contraception in family planning aisles. Unfortunately, some pharmacies place emergency contraception behind a locked, plastic (literal) barrier that requires a patient to ask for assistance. These barriers are meant to prevent shoplifting but often deter women who want privacy. Other pharmacies may keep emergency contraception behind the counter, asking for payment from a patient before dispensing the medication. These extra steps in obtaining an over-the-counter medication make a stressful time unnecessarily awkward, too.

For women who only have independently-owned pharmacies near them, barriers are even higher. These pharmacies tend to have limited hours, making access difficult for those who don’t have flexible work schedules. Smaller pharmacies also tend to have fewer self-checkout options or none at all. Inadequate privacy in a pharmacy impacts the accessibility of emergency contraceptives and other forms of family planning.

The Invisible Social Barriers

The misconception that emergency contraceptives terminate a pregnancy is still pervasive, adding to the discomfort and need for a discreet way to access them. When it comes to picking up a prescription emergency contraceptive (ella®, which is ulipristal acetate, is prescription only), some women may feel uncomfortable with the pharmacist dispensing their medication. Even facing a cashier when purchasing Plan B over the counter can be an anxious experience for some women.

State & Policy Barriers

Six states explicitly allow a pharmacist to refuse to dispense emergency contraceptives, and three states allow entire pharmacies to refuse to dispense them. It’s not immediately obvious if a pharmacy or pharmacist refuses to dispense emergency contraceptives until a patient tries. The experience can be unexpected or shocking for a patient, and leave her with few options, especially if she is in a rural area. The patchwork of laws around access to emergency contraception makes a confusing process even more difficult to navigate.

Barriers from Education and Awareness

A study from 2015 showed that young women and adolescents had heard of emergency contraception, but many had incorrectly identified it as being “an abortion pill” and weren’t aware that Plan B is available over the counter. With the different types of emergency contraceptives on the market and their variations in timing, it’s a lot more information for a patient to track. Myths and misconceptions around emergency contraception only complicate this matter.

Confusion Between Pills

While Plan B is available over-the-counter, ella® is prescription only. By its nature, a prescription-only drug is more difficult to access: a patient must find a licensed provider, take the time for an appointment, and arrange to pick up the prescription. For patients who can’t afford the cost of a visit or the time, prescription emergency contraception is out of reach. Younger women, who may rely on their parents’ health insurance, may also feel their privacy is compromised if they use their health plan for an emergency contraceptive prescription.

The barriers to emergency contraceptives link back to misinformation about how they work, and how to get them. At Alpha, we hope to clear up any confusion and provide access to anyone in need. Emergency contraception is now available as a stand-alone consult, so our providers can support patients who need it urgently, or want to be prepared. All of our providers are trained in women’s health, so patients seeking emergency contraception will still be treated with a whole-person, personalized approach. Our telemedicine platform guarantees privacy with a discreet process that can be done on a patient’s schedule. Patients deserve healthcare that includes their reproductive health and wellbeing.