Saturday, March 31, 2012

Putting Compassion into Contraception


From Life magazine April, 1971


True or False?
There are about 3/4 million teenage pregnancies in the US every year.
85 % of these are unintended.

Both statements are True.

Without getting into the papal and microbiological details of how the "morning after pill" (better now named mornings after pill because it can be used for up to five days following unwanted sperm contact) actually works, suffice it to say that there is an existing, legal and safe solution to many of these unintended pregnancies.

Emergency Contraception is a safe method of pregnancy prevention (and therefore birth control) that can be used when other methods (condoms, rhythm, withdrawal, diaphragm, nuvaring, pills) have failed.  Its most common version, sometimes called Plan B,  is essentially a potent dose of progestin, one of the hormones in most typical birth control pills.  

For everything you want to know about EC, have a look here. It is available over the counter to women aged 17 and over.

And that is the point of this post. Its availability.

A recent study in the journal Pediatrics neatly demonstrated that access to EC is not always as simple as it is meant to be.  The researchers in this study had female callers make scripted calls to almost 1000 pharmacies in 5 US cities where teens over 17 can legally purchase emergency contraception.  Some of the callers posed as 17 year old teens and others posed as female physicians to inquire about availability.   Here is what they found:

*80% indicated to adolescent callers, and 81% to physician callers, that EC was available on the day of the call.  That sounds like a good thing. 

*However, 19% incorrectly told the adolescent callers that it would be impossible to obtain EC under any circumstances, compared with 3% for physician callers. What is this? Contraceptive counseling after the fact, over the phone?  Or is this passive-aggressive punishment? Or is this just mean?

*Pharmacies conveyed the correct age to dispense EC without a prescription in 431 adolescent calls (57%) and 466 physician calls (61%).  This sounds like ignorance of the law to me!

*Compared with physician callers, adolescent callers were put on hold more often (54% vs 26%) and spoke to self-identified pharmacists less often (3% vs 12%, P < .0001). I don't think this will surprise anyone whose ever tried to talk to a pharmacist and I know from where I make calls that I can use my MD voice to get through.

*When EC was not available, 36% and 33% of pharmacies called by adolescents and physicians respectively offered no additional suggestions on how to obtain it. Again, is this about being too busy to stop and care? Is this too busy to have a list of alternatives if they've run out (like it's the day after prom or something?) Is this just lack of concern or is it ignorance and mean spirited?  

Then I wonder what happens when that pharmacist hangs up and turns to the next person in line who happens to be an 18 year old mother with a crying infant on her hip waiting to fill her prescription for Amoxacillin for the baby's ear infection.  What then?  Does she get an attitude too?

3 comments:

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  2. It's sad to hear that more teenage ladies are becoming mothers in such an early age. Despite their mistake, we still have to support them and encourage them to live a better life with their child. nurofen

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