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A pharmacy requires shoppers to ask the pharmacist for Plan B, an over-the-counter emergency contraceptive.
In much of the United States, even a trip to the emergency room may not guarantee survivors of sexual assult access to the “morning-after pill,” a common and safe pregnancy prevention drug.
In fact, researchers at the Alan Guttmacher Institute found that only twenty states and Washington, D.C., mandate that medical staff offer the pill to sexual assault survivors. This lack of access can have dire consequences because, to be effective, the pill must be ingested within seventy-two hours of unprotected intercourse.
Barriers include “conscience clauses,” which allow pharmacists to refuse to stock or sell contraceptives if they personally consider them “morally objectionable.”
And that’s just one of many barriers to emergency contraception access.
Reproductive health activists are frustrated, and charge that while the morning-after pill was approved by the Food and Drug Administration nearly a quarter of a century ago, its availability has been limited by a patchwork of state policies and regulations. But this could be changing, as a renewed push for greater emergency contraceptive availability is now underway, in advance of the very possible overturning of Roe v. Wade by a largely anti-choice U.S. Supreme Court.
Some of the major roadblocks, activists say, are logistical. Although some brands of emergency contraceptives—Plan B, After Pill, Athentia, My Way, EContra EZ, Next Choice One Dose, Opcicon, and Take Action—have been available for over-the-counter, non-prescription sale since 2014, many pharmacists keep the medication in theft-proof lock boxes or store it behind the counter. This, of course, necessitates a request for the medication.
Additionally, many pharmacists demand to see identification and restrict access to those over the age of seventeen.This is done despite the fact that the FDA removed all age barriers more than eight years ago, making it theoretically available to anyone, at any age, in every state.
Then there’s the issue of cost. While many health plans cover emergency contraceptives if they are prescribed, the over-the-counter pill typically costs between $40 and $50 per dose, putting it out of reach for many would-be-users.
Other barriers include “conscience clauses,” which allow pharmacists to refuse to stock or sell contraceptives if they personally consider them “morally objectionable.”
Pharmacists are not the only workers who can invoke these clauses. The Guttmacher Institute reports that forty-six states allow doctors, nurses, and even entire hospital systems to opt out of providing abortion care because of religious objections; twelve allow opt-outs for the delivery of contraceptives.
Hospital mergers poses an additional hindrance. According to Community Catalyst, a Boston-based consumer health advocacy group, 15 percent of the nearly 8,000 hospitals in the United States were Catholic-run in 2020, a 50 percent spike since 2001. In many cases, this was the result of mergers and the gobbling up of once-secular health providers by Catholic medical networks, including Ascension, Bon Secours Mercy, Christus, Common Spirit, Providence St. Joseph, and Trinity Health systems.
These health providers, Community Catalyst notes, operate under the aegis of the U.S. Conference of Catholic Bishops and are explicitly barred from providing reproductive health services including abortion, contraception, sterilization, or gender-affirming surgery. What’s more, a survey conducted by the group found that fifty-two hospitals that abide by Catholic dictates are the sole providers of short-term care for residents in their rural locales.
This poses an enormous obstacle to women seeking emergency contraception.
“Any delays in accessing EC can mean the difference between becoming pregnant and preventing pregnancy,” Kelly Cleland, executive director of the American Society for Emergency Contraception (ASEC) tells The Progressive. This is especially important for teenagers: “They are usually already stressed out because they had unprotected intercourse or were sexually assaulted, and having some pharmacist force them to jump through hoops, show an ID, and ask for the pills out loud, makes everything so much worse.”
And while access is certainly impeded by pharmacists’ religious or political beliefs, Cleland says other factors are often also at play . “It is sometimes simply an educational issue. Most pharmacy schools don’t put enough focus on teaching about contraception. This is also true of medical schools.” Additionally, she blames the FDA for not doing more to let people know that the age and prescription requirements for most pill purchases are no longer in place.
That said, Cleland blames the conflation of emergency contraception with abortion– the morning-after pill stops ovulation and does nothing to end a pregnancy– for ramping up stigma around its use. This, she says, situates the fight for increased access squarely within the larger struggle for reproductive justice—a struggle that, in 2021 alone, led to the enactment of 108 abortion restrictions in nineteen states.
“This is an issue of control and who gets to determine if an individual gets pregnant and has a baby,” she says. “Emergency contraception will be more and more important if Roe is eviscerated by the Supreme Court. The stakes in preventing pregnancy will be higher, but contraception will never be a substitute for abortion. No matter how good contraceptives are, and no matter how widely available they are, abortion will always be needed as a back-up.”
ASEC is currently campaigning to bring emergency contraceptive vending machines and peer-to-peer networks for information sharing to college campuses throughout the country.
“Many campuses have variable access to sexual health services,” Cleland says. “On campuses where emergency contraception is not distributed by the health center, students may need to travel to a pharmacy that is inaccessible and it may be hard for them to do so. But even in schools with comprehensive care, health centers are not open 24/7.”
Emergency contraception, she says, is going to become more important as access to abortion tightens, especially in low-income communities. “That’s why,” she adds, “we’re working to make sure that robust options are available for pregnancy prevention and ensure that everyone who wants emergency contraception can easily obtain it.”