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Surveys show roughly a quarter of American women have, at some point in their lives, used emergency contraception pills to prevent an unintended pregnancy. This type of contraception is effective, safe and legal throughout the U.S., and yet researchers are finding it is not always available when people need it. NPR's Maria Godoy has this report.
MARIA GODOY, BYLINE: Imagine this scenario that untold numbers of women find themselves in each year. You've had sex, but something went wrong. Maybe the condom broke. Maybe you forgot to take a couple of birth control pills. Maybe you're a teenager with no access to birth control. You don't want to get pregnant, so you rush to the pharmacy for emergency contraception. All the while, the clock is ticking.
SONYA BORRERO: These are medications that are incredibly time-sensitive.
GODOY: Dr. Sonya Borrero is a professor of medicine at the University of Pittsburgh who focuses on reproductive health equity. She says emergency contraception needs to be taken within five days after unprotected sex.
BORRERO: But the sooner the better.
GODOY: But there's a problem. She says you can't always find emergency contraception pills when you need them. Take, for example, Plan B, which is supposed to be available over the counter, on the shelf, stock for all ages. But when Borrero sent a team of medical students to pharmacies across western Pennsylvania to see what they actually had on hand, they found a third of pharmacies didn't stock Plan B at all. And when they did have it...
BORRERO: Most of the time it wasn't really on the shelf. It was either behind the counter or in one of those lock boxes, like, really constraining access.
GODOY: Because having to ask somebody to actually get the emergency contraception pills for you could be a real deterrent for some people.
BORRERO: So you can imagine, especially for a teen, going and asking for one of these products, being concerned about potential judgment can be a significant barrier to purchasing.
GODOY: Pharmacists say there are good reasons for putting Plan B under lock and key. Don Downing was a practicing pharmacist. He also helped develop Plan B. He's a professor at the University of Washington School of Pharmacy. He says many pharmacists have told him over the years that Plan B is frequently a target of theft. He says he'd rather see it locked up in the store than not available at all.
DONALD DOWNING: If they could make it available by keeping it behind the counter, that may be ultimately more helpful to a woman than not stocking it at all.
GODOY: And keeping a drug in stock is even more of an issue when it comes to the other form of emergency contraception pills, ella, which requires a prescription. Borrero's study found only 5% of pharmacies had it available for immediate purchase.
BORRERO: So 5% was abysmal. I really was very surprised. I was really thinking it would be something like 50%. Like, 5% is crazy.
GODOY: Think about it. Emergency contraception has to be taken within a very narrow window. If the pharmacist has to order it, even if it arrives the next day, for some people, that could be one day too late. And the problem isn't just confined to Pennsylvania. Studies conducted in pharmacies across the U.S. have found pretty much the same thing, and the pills tend to be even harder to find in independent drugstores.
Rebecca Stone is a clinical pharmacist at the University of Georgia. She says one reason why many pharmacies don't stock ella is because it doesn't get prescribed very often.
REBECCA STONE: It's not very well known by prescribers - meaning, you know, physicians, nurse practitioners, any type of traditional prescriber - nor by pharmacists.
GODOY: And if providers aren't prescribing it, pharmacies are less likely to keep it in stock. Kelly Cleland of the American Society for Emergency Contraception says that's really concerning because ella can be a better choice, particularly for certain people.
KELLY CLELAND: There is an issue with Plan B and its generics potentially not working for people who weigh more than 165 pounds. And for those folks, it seems like ella is more effective, so it's important that ella is available in stock and that people know about it.
GODOY: People who work in reproductive health want to see more education on emergency contraception for pharmacists, for women and for doctors. Laura Bellis is already on the case. She's the executive director of Take Control Initiative, a contraception access program in Tulsa County, Okla. The program just rolled out training for doctors and other providers after many of them said they had lots of questions about emergency contraception.
LAURA BELLIS: Sometimes clinicians are like, can I just hand this to anyone? And the answer's yeah. If someone's, you know, of reproductive age, it's safe to have on hand. They can put it in their medicine cabinet at home.
GODOY: Bellis says having emergency contraception on hand is especially critical in places like her home state. In May, Oklahoma adopted the nation's most restrictive abortion law. It's now illegal in all but a few cases.
BELLIS: And so with that, we know how critical it is that folks have access to last lines of defense like emergency contraception.
GODOY: Advocates say this access will become more critical throughout the U.S. in a post-Roe v. Wade America. Maria Godoy, NPR News.
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