Study Finds Emergency Contraception Less Available in Some Rural Pharmacies

Patients in Georgia, and particularly those in rural towns, may have challenges finding emergency contraception at pharmacies, according to research from the University of Georgia.

Emergency contraception is a time-sensitive medication that must be taken soon after sex in order to be effective. However, only 57% of pharmacies in Georgia stocked levonorgestrel (Plan B), according to the study. Furthermore, less than 1% reported stocking the more effective, prescription-only emergency contraceptive ulipristal acetate (Ella).

Furthermore, rural pharmacies were even less likely to have levonorgestrel than stores in metropolitan areas. This lack of availability reflects historical challenges for women in rural and low-income areas who are seeking access to preventive care, including contraception. The findings suggest that poor access to emergency contraception could exacerbate already high rates of unintended and teen pregnancies in rural areas.

“Reproductive care can sometimes be hard to access, particularly in the South,” lead author Rebecca Stone said in a press release. “Georgia has poorer reproductive care outcomes than many other parts of the country, such as higher rates of unintended pregnancy and maternal mortality. Emergency contraception is like other reproductive health services: We need to take steps to ensure equal access for everybody in our state.”

In the study, investigators contacted 518 pharmacies in both metropolitan and rural areas of Georgia. Pharmacists were asked whether the store had “something that [they could] use after sex to not get pregnant.”

Most pharmacists discussed Plan B with the caller, regardless of whether it was in stock at the pharmacy. More than 10% of those who did not have it stocked still provided counseling to the patient and offered to order the drug or referred them to another pharmacy that may have the medication. However, 1 out of every 4 pharmacists said emergency contraception was not available at the store and ended the call.

Of the pharmacists who discussed Plan B as an option with the caller, 80% said the drug would not work or that they were unsure whether it would work after 72 hours. Although this follows the information in the package insert, it is outdated information. Plan B is most effective in the first 3 days after sex, but it can still help prevent pregnancy for up to 5 days, according to the study.

“In our current environment, pharmacists are extremely busy and may be hard-pressed to spend a lot of time answering patient questions and still get their work done,” Stone said in the press release. “They often rely on the manufacturer package insert information to answer questions, and in this case, it isn’t fully accurate. I think that unfairly sets pharmacists up to provide inaccurate information.”

The study authors noted that in many European countries, ulipristal acetate is sold OTC. However, the United States is often slower to grant medications OTC status, and reproductive health medications receive an extra level of scrutiny over other medications. As a result, many health professionals are not even aware that an alternative to Plan B exists.

Less than 2% of pharmacists contacted in the study mentioned ulipristal acetate as an option for emergency contraception, and only 0.4% told the caller it was in stock at their pharmacy. A follow-up call showed that around 3% of the pharmacists actually did have the medication in stock.

“Ella works better at preventing pregnancies than Plan B, particularly for women who are overweight or are using emergency contraception 4 to 5 days after sex,” Stone said in the press release. “But studies have shown that many physicians don’t know this drug is available. Patients don’t know about it. And our research showed that most Georgia pharmacists don’t know about it either.”

Stone added that she is working with industry partners to offer continuing education courses on emergency contraception.

“I’m a strong advocate for pharmacist-prescribed contraception and emergency contraception because it expands patient access to these products,” Stone said in the press release. “In states where pharmacists prescribe these products, pharmacists have more opportunities to keep their clinical skills fresh with continuing education courses that are developed as part of their state prescribing protocols. And if they’re prescribing it, they may be more likely to keep it in stock.”

REFERENCE

Emergency contraception is hard to find in Georgia, rural pharmacies. News release. EurekAlert; February 10, 2022. Accessed February 11, 2022. https://www.eurekalert.org/news-releases/943062