Update |

Why young people are still denied emergency contraception: Q&A with Tracey Wilkinson, MD, MPH

Dr. Tracey Wilkinson, alumna of our Leadership Training Academy’s Class of 2012 and faculty member for our Adolescent Reproductive and Sexual Health Education Program (ARSHEP), has recently received nationwide attention in outlets like Reuters and the Chicago Tribune as the lead author of a new study, published in the June issue of Pediatrics, on young people’s access to emergency contraception (EC). Although the U.S. Food and Drug Administration issued a ruling in 2013 allowing people of all ages to access EC, also known as the “morning-after pill,” without a prescription, Dr. Wilkinson’s research revealed that pharmacies regularly give incorrect information about EC to adolescents. In the study, women posing as 17-year-olds called 979 pharmacies to ask about obtaining EC, and in only 52% of these calls received accurate information about over-the-counter access. We talked to Dr. Wilkinson about the study and what can be done to improve EC access for young people.

Adolescent health experts devoted significant time and energy to encouraging the FDA to expand over-the-counter EC access, first for 17-year-olds and then for patients of all ages. Why is it especially important for young people to have access to EC?

Young people (and all people) need to have timely access to EC for a few reasons. First, it works better the sooner you take it. So, any delays on getting EC means that it won’t work as well by the time you take it. Second, we know that adolescents don’t always talk about birth control with a clinician before they need it, and we know that clinicians (pediatricians in particular) don’t routinely talk about or offer contraception. Therefore, young people need to have timely access to EC as a way to prevent unplanned pregnancy after they have had unprotected sex. Third, EC is really safe—much safer than a pregnancy would be—and many studies have proven that young people can take it correctly and know when to use it. Therefore, having access to it when it is needed is really important.

There is still a lot of work to be done to guarantee access, and the battle isn’t over just because it is over-the-counter now.

What do you think is causing pharmacists to give out incorrect information about whether they can provide EC? Is the problem a lack of education for pharmacists about the rule change, ideological opposition to EC, or something else?

It is really hard from our study design to comment on what the sources of misinformation regarding EC are, unfortunately. The calls were designed to be “real world,” and so we didn’t get to ask any questions that would seem out of the ordinary for a teenager to ask when they called a pharmacy.  I do think a lot of misinformation stems from years of changes around EC rules and also packages whose labeling wasn’t updated until two years after they removed all restrictions.  There is still confusion within the medical community, lay press, and public as a whole as to how EC works and what it does—a lot of people think it is an abortifacient—which leads to a feeling that there should be some restriction on its use and sales. Regardless of the source of misinformation, this study shows that there is still a lot of work to be done to guarantee access and that the battle isn’t over just because it is over-the-counter now.

In addition to your research, you’re a reproductive health care provider who works with adolescent patients. Were there particular stories from patients that stuck with you while you were conducting research for this study?

Most of my research is stemmed from stories from my patients. They often describe barriers they face to reproductive health care access (whether that is over-the-counter or prescription medication, referrals, etc.), and that is a constant reminder of how the implementation of laws and policies doesn’t always equate to actual experiences of our patients.

I had a patient a few years ago who couldn’t get her insurance to cover the birth control that I had prescribed. A few weeks later, she had unprotected sex and went to the pharmacy to get emergency contraception. However, when the pharmacy told her she couldn’t get EC because she was 16, she ended up contacting our clinic for an appointment. Instead of getting EC that day, she got it two days later when she came in for her appointment—which was also the first time we learned about the issues she had with her prescription. This situation was reminder to me of how important EC access is for everyone—regardless of your age and regardless of whether you have been prescribed birth control.

What can advocates for reproductive health do to work to improve this situation?

Advocates can help by working on education of adolescents, pharmacy staff, clinicians, and the public on factual information regarding reproductive health topics.  EC is not the only topic that is surrounded by misinformation, so there is a lot of work to be done.

What should a young person do if they are denied EC by a pharmacist?

The first thing is to know that you are legally allowed to get EC.  If this happens, first ask to speak to a supervisor and try to get a reason for the denial. Next, go to another pharmacy (if that is possible). A vast majority of pharmacists are eager to help patients and consumers navigate the system.  Another option is to get an appointment with your doctor—they can always prescribe EC, or even give you a dose in the clinic.  I also always recommend my patients have EC ahead of time.  Just like you have Tylenol in your medicine cabinet for when you have a headache, you should have EC for that “uh-oh” moment.  That way, you can take it soon and have the greatest chance of it working, and you don’t have to stress trying to get it at a pharmacy when you need it.

Do you have plans for further research on EC access? What else are you working on next?

We are working on analysis of some more data from this study—which should be out soon!  I am also working on other projects that focus on overall access to contraception—not just EC.  As a general pediatrician, there are a lot of things to improve in terms of making sure all adolescents are given access to the same information and options when it comes to pregnancy prevention and safe sex.

Learn more about how health care providers can help young people access EC: Our ARSHEP module “Emergency Contraception and Adolescents” examines the need for EC among adolescents, clinical components of EC, and challenges and opportunities for increasing EC use. Download the presentation.