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Geographically Constrained: An Examination of Emergency Contraception Accessibility in Colorado
Legal barriers to emergency contraception (EC) access disappeared Feb2014 when the FDA approved the unrestricted sale of all forms of levonorgestrel EC. Unwarranted barriers like age restrictions, and misinformation often remain. This survey of Colorado outpatient pharmacies quantifies commonly encountered barriers by individuals purchasing EC.
Methods
A pharmacy list was obtained from The Little Blue Book 2014, a phonebook for physicians. Only open pharmacies serving the general public were included. One of three female researchers phoned 690 listed pharmacies, and asked questions posing as a woman seeking EC. The script included questions about availability (in-stock), location of product, cost, weight-appropriateness, and age requirements. Completely accessible was defined as: in stock, on shelf, with no ID requirements. Geographic region were categorized as urban, rural, or frontier counties. Of 64 counties, 52 had less than 10 pharmacies, and 18 had none listed. Rates of in-stock, completely accessible, and weight-appropriateness were summarized with frequency and percent, and compared by county and pharmacy type using chi-square tests.
Results
Of 631 pharmacies, the majority were urban (85%) and chain (86%). Pharmacy technicians (62%) and females (71%) completed the survey most often. Most pharmacies stocked EC (87%), but only 23% had EC completely accessible. Neither EC stock nor completely accessible rate differed significantly by geographic region. Both EC stock and completely accessible rate differed across independent, chain and 24-hour type (p<0.01). 5% did not have any EC in-stock and were unwilling to order it. Only19.2% correctly identified a weight-dose effect, 10/105 of which offered alternatives for patients with higher weight.
Discussion
Rate of EC in-stock differs significantly by pharmacy type but not by geographic region. Access is restricted by behind-the-counter status and outdated ID requirements that are inconsistent with recent regulatory changes. Most pharmacies were unfamiliar with the weight concerns for levonorgestrel-based EC. In rural and frontier areas, the small number of pharmacy locations over a large geographic area is a barrier in itself, with a compounded effect of low rates of stock in the frontier region, and across the board high rates of barriers within the store.
Learning Areas:
Advocacy for health and health educationLearning Objectives:
List the various barriers to access to emergency contraception in Colorado
Describe the differences between access to emergency contraception in rural, urban and frontier counties in Colorado
State the current federal laws pertaining to access to EC in the US
Keyword(s): Contraception, Accessibility
Qualified on the content I am responsible for because: I am a student completing a summer internship through the LEADS (Leadership, Education, Advocacy, Development and Scholarship) program at the University of Colorado School of Medicine. My stipend is funded by The Colorado Health Foundation. I have been working closely with Dr. Carol Stamm, a board certified OB/GYN who has completed numerous granted funded research projects on women's health. This is her first study on emergency contraception accessibility.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.