Executive Summary

History

Emergency contraception (EC) has been available for more than 25 years and could prevent 1.7 million unintended pregnancies and 800,000 abortions each year in the U.S. It is a safe and effective method of contraception, and women who have used it report high levels of satisfaction.

However, there is considerable public confusion about the difference between emergency contraception and medication abortion (performed with mifepristone/RU-486). Emergency contraception helps prevent pregnancy; medication abortion terminates pregnancy.

Because of this confusion, pharmacists in some states have recently refused to fill prescriptions for emergency contraception. Complicating this situation further is the fact that emergency contraception must be taken as soon as possible after unprotected sex. Taken within 72 hours the medication is 89 percent effective at preventing pregnancy.

Pharmacists have professional and ethical responsibilities to their patients. Health-related decisions made between a physician and patient should be respected by pharmacists, who, in Planned Parenthood of Greater Iowa’s (PPGI) opinion, should not act as barriers to safe, legal prescriptions.   

Highlights

Overall 242 (58%) pharmacies of the 417 reached were able to verify that they stock emergency contraception. This means that 175 (42%) pharmacies around Iowa do not carry emergency contraception. PPGI was unable to obtain information from 231 pharmacies.

These numbers indicate that only 58 percent of Iowa pharmacies allow women full access to emergency contraception.

Findings

Between January and May 2006 PPGI used phone surveys and mystery shopping to determine access and availability of EC in Iowa pharmacies.  The PPGI Project Pharmacy phone survey consisted of 8 questions that were to be asked of 648 pharmacists in Iowa. (The survey is attached for reference purposes.)

Volunteers were able to reach 417 (64%) pharmacists, the results of which will be broken down into two categories: chain store pharmacies (i.e. Hy-Vee and Target) and independently-owned pharmacies. 
 

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Chain Store Pharmacies

PPGI contacted 183 chain pharmacies around Iowa to check the availability of emergency contraception (EC) in their stores.

• 103 (56%) pharmacies said they stock EC regularly
• 53 (29%) pharmacies had EC in stock at the time of the call
• 14 (8%) pharmacies said they did stock EC regularly but didn’t have any on hand
• 8 (4%) claimed they had no EC in stock due to lack of demand or no requests for EC

Eighty chain pharmacies stated that they do not stock EC.

• 33 (41%) cited store and/or corporate policy
• 37 (46%) claimed a lack of demand for EC, saying they used to stock it
  and it would expire or they had never received a prescription for EC

Of the 80 pharmacies that do not stock EC, 3 pharmacists cited “moral or religious beliefs” as the reason they would not stock or dispense EC. These pharmacists are located at:

Medicap Pharmacy                              2527 Easton Boulevard                       Des Moines

Kmart Pharmacy                                  2803 East Kanesville Boulevard          Council Bluffs

Medicap Pharmacy                              108 2nd Avenue West                         Toledo

Pharmacists were also surveyed about their knowledge of EC. Pharmacists were read statements and asked if they agreed or disagreed with the statement.

EC can cause an abortion of an implanted fertilized egg.  FALSE:  Emergency contraceptive pills are ineffective if already pregnant.

• 46 (25%) pharmacists agreed with this statement
• 71 (39%) disagreed
• 46 (25%) were not sure
• 20 refused to answer the question or ended the call

EC is only effective if used within 72 hours of unprotected sex.  TRUE:  ECPs are most effective when taken as soon as possible after unprotected sex (and are effective up to 120 hours).

• 147 (80%) pharmacists agreed with this statement
• 3 (2%) disagreed
• 15 (8%) were not sure
• 18 refused to respond to this question or ended the call

EC is safe for teenagers.  TRUE:  ECPs are a high dose of the hormones found in regular oral contraceptive pills.

• 97 (53%) pharmacists agreed with this statement
• 14 (8%) disagreed
• 53 (29%) were not sure
• 19 refused to respond to this question or ended the call

Pharmacists were also surveyed about how they would individually respond to the following situations:

What would be your answer to a patient’s questions regarding how EC works?

·         90 (49%) EC works one of three ways as described by the FDA:  preventing ovulation, fertilization or the implantation into the uterus

·         50 (27%) were unsure about the way EC works (possibly refer back to her physician)

·         3 (2%) said EC causes an abortion

·         33 (22%) were unsure, refused to answer or ended the call prior to this question or at this point

Would you refill a prescription for EC if written “as needed”?

·         62 (34%) said yes

·         55 (30%) said no

·         37 (21%) were unsure

·         29 refused to respond to this question or ended the call

Would you dispense EC to patients age 16 and under?

·         85 (46%) said yes

·         49 (27%) said no

·         12 (7%) were unsure

·         37 refused to respond to this question or ended the call

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Independent Pharmacies

PPGI contacted 234 independently-owned pharmacies around Iowa to check the availability of emergency contraception (EC) in their stores.

• 139 (59%) pharmacies said they stock EC regularly
• 97 (42%) pharmacies had EC in stock at the time of the call
• 39 (17%) pharmacies said they did stock EC regularly but didn’t have any on hand
• 27 (12%) claimed they had no EC in stock due to lack of demand or no requests for EC

Ninety-five independent pharmacies stated that they do not stock EC.

• 6 (6%) cited store policy
• 5 (5%) said it was because of supply or distribution systems (i.e. they did not have access to a distributor or did not have relationships with other pharmacies that would allow them to trade stock)
• 72 (76%) claimed a lack of demand for EC, saying they used to stock it and it would expire or they had never received a prescription for EC

Of the 95 independent pharmacies that do not stock EC, 9 (9%) pharmacists cited “moral or religious beliefs” as the reason they would not stock or dispense EC. These pharmacists are located at:
 

Lutz Pharmacy                                     120 8th Street Southwest                    Altoona

Drug Town Pharmacy                          1440 32nd Street Northeast                    Cedar Rapids

Fifth Avenue Pharmacy                       411 10th Street Southeast                   Cedar Rapids

Valley Pharmacy                                  800 North 2nd Street                           Cherokee

Oard-Ross Drug                                  701 16th Avenue                                 Council Bluffs

*Ryan Pharmacy                                  1100 1st Street East                            Independence

*Laporte City Pharmacy                       601 Highway 218 North                        La Porte City

*Marion Family Pharmacy                    3701 Katz Drive                                   Marion

*West Liberty Pharmacy                      105 East 3rd Street                             West Liberty

* Did not offer a referral

Pharmacists were also surveyed about their knowledge of EC. Pharmacists were read statements and asked if they agreed or disagreed with the statement.

EC is only effective if used within 72 hours of unprotected sex.  TRUE:  Emergency contraceptive pills are most effective when taken as soon as possible after unprotected sex (and are effective up to 120 hours).

• 187 (80%) pharmacists agreed with this statement
• 11 (5%) disagreed
• 24 (10%) were not sure
• 12 refused to respond to this question

EC is safe for teenagers.  TRUE:  ECPs are a high dose of the hormones found in regular oral contraceptive pills.

• 153 (65%) pharmacists agreed with this statement
• 9 (4%) disagreed
• 59 (25%) were not sure
• 13 refused to respond to this question

EC can cause an abortion of an implanted fertilized egg.  FALSE:  ECPs are ineffective if already pregnant.

• 68 (29%) pharmacists agreed with this statement
• 103 (44%) disagreed
• 51 (22%) were not sure
• 12 refused to answer the question

Pharmacists were also surveyed about how they would individually respond to the following situations:

What would be your answer to a patient’s questions regarding how EC works?

·         151 (65%) EC works one of three ways as described by the FDA:  preventing ovulation, fertilization or the implantation into the uterus

·         24 (11%) were unsure about the way EC works (possibly refer back to her physician)

·         6 (3%) said EC causes an abortion

·         53 refused to respond to this question or ended the call

Would you refill a prescription for EC if written “as needed”?

·         90 (39%) said yes

·         87 (37%) said no

·         38 (16%) were unsure

·         19 refused to respond to this question or ended the call

Would you dispense EC to patients age 16 and under?

·         144 (62%) said yes

·         41 (18%) said no

·         29 (12%) were unsure

·         20 refused to respond to this question or ended the call

Project Pharmacy Volunteers

Planned Parenthood of Greater Iowa greatly appreciates the time and support of our dedicated volunteers for helping conduct Project Pharmacy research.

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