During week 6 blog, we will look at the public sector influence on emergency contraception policy and what efforts have been made to increase access to the uninsured and underinsured. In addition to those populations, what efforts have been made to increase awareness about emergency contraception? When emergency contraception first emerged into public policy in 1999, many organizations spearheaded the movement including American College of Obstetrics and Gynecology, family planning agencies and the Center for Reproductive Health. The public sector that has influenced the policy mainly includes certain activist groups and religious affiliated organizations or groups. The general public did not seem to have much influence in the policy, probably due to the fact that the majority of the public had no idea what emergency contraception was, how it was used, or where it could be obtained (Brown, 2006). In the three-year period that it took to finally get the FDA to approve the many petitions asking for over the counter sale of Plan B, medical and citizen groups contributed to the policy by their persistence and constant petitioning to the FDA (Brown, 2006). Despite all of the petitions and groups becoming involved, the population still lacks awareness and knowledge about emergency contraception. This unawareness not only affects the United States, but also continues abroad. The U.S. Agency for International Development (USAID) has not added emergency contraception to its commodities list and is not offering the pills in their family planning programs abroad (Barot, 2010). By procuring emergency contraception in those underserved areas in the United States and abroad, access to the method would increase, as would knowledge about its use and benefits. The USAID would play an integral role in generating more demand for the product and providing more training and education to the public (Barot, 2010). USAID assistance in supplying emergency contraception would expand access in poor countries and underserved areas and provide women with an option for unintended, unwanted pregnancies (Barot, 2010).
Barot, S. (2010, Spring). Past due: Emergency contraception in the U.S. reproductive health programs overseas. Guttmacher Policy Review, 13(2), 8-11.
Brown, M. (2006, November). Public health and contraception. Position Paper from the Center for Inquiry Office. Retrieved from http://www.centerforinquiry.net/uploads/attachments/health-and-contraception-2.pdf
Emergency Contraception 
Nikki –
It was interesting to read about the policy origins and the current international aid policy on emergency contraception (EC). I am in no way surprised that EC is not part on international family planning efforts. Sadly the politics surrounding this topic are very chaotic and controversial. This is definitely an area where women in our own country even are faced with a profound health disparity. As you mentioned despite significant media coverage most women are not aware of the availability of EC. Beyond that though there are many barriers to women obtaining EC including: lack of over-the-counter approval for women under 17, pharmacist refusals, cost and insurance coverage issues (National Women’s Law Center, 2013). Women enrolled in Medicaid are particularly burdened by problems of cost and coverage. Only 8 states allow non-prescription coverage of EC for women over 17 and Mississippi does not cover EC in any form (Princeton Office of Population Research, 2013). Even states whose Medicaid programs cover EC may require women 17 and older to get a prescription first, solely for reimbursement purposes. The time it takes to do this could ultimately negate the effectiveness of the medication. I am most personally appalled by pharmacist refusals to dispense medications. That brand of sanctimonious judgment has no place in healthcare. I have heard numerous stories of small pharmacies in rural areas refusing to carry EC potentially removing any possibility of obtaining the drug in some rural areas. I sincerely believe that every woman has a fundamental human right to control her reproduction and that we are failing as a society to protect women because of these terrible EC policies.
References
National Women’s Law Center. (2013). Emergency contraception. Retrieved from http://www.nwlc.org/resource/emergency-contraception
Princeton Office of Population Research. (2013). State medicaid coverage of non-prescription emergency contraception. Retrieved from http://ec.princeton.edu/info/Medicaid.html
Nicole,
I have noted that the focus of your topic initially was to be on state policy. I am wondering what the access to emergency contraception by uninsured or under-insured women in Arizona on Medicaid is? Please correct me if you have changed your focus from state to federal policy. JMar
I apologize that I have not been reading your blog every week and you most likely have addressed this topic in an earlier post. The Affordable Care Act (ACA) has made incredible strides in increasing the availability and affordability of contraception in the United States. The ACA requires that health plans cover all FDA-approved contraception, including emergency contraception (like Plan B), without cost-sharing (National Women’s Law Center, 2013). Another important step forward in enhancing the accessibility of emergency contraception is the FDA approval of Plan B One-Step (levonorgestrel) to come out from behind the pharmacy counter and into the retail aisle; this change seeks to remove age restrictions, personal views of pharmacy staff, and even timing restrictions—i.e., if a woman arrives to a drugstore after pharmacy hours (Szabo, 2013). A study published in the New England Journal of Medicine evaluated over 700 women using emergency contraception; 98% used the contraception correctly, no adverse events were reported, and women that had used emergency contraception previously were no more likely to use EC repeatedly than were counterparts that had never used EC (Glasier & Baird, 1998). The researchers concluded that readily available emergency contraception does no harm and reduces the number of unintended pregnancies, underscoring the rationale for eliminating even the pharmacy counter as a barrier to obtaining EC.
However, despite improvement to prescription contraceptive coverage, cost may still play a factor in some women’s ability to obtain EC. The cost can be as high as $70 in some drugstores, and the ACA does not require plans to cover contraception that is available without a prescription unless the woman presents a prescription for it (National Women’s Law Center, 2013). Even more disheartening is the failure of some state Medicaid programs to cover emergency contraception at all; and in the states that do, some even require women to meet age requirements and obtain a prescription for reimbursement (National Women’s Law Center, 2013).
While the ACA is making improvements to contraception delivery and prevention of unwanted pregnancies, providers still need to pick up the slack and talk to their patients about birth control and a backup plan, especially if they practice in a state that still puts restrictions on EC. Do you know anything about AHCCCS specifically and its coverage of emergency contraception?
Thanks for your post!
References
Glaiser, A., & Baird, D. (1998). The effects of self-administering emergency contraception. The New England Journal of Medicine, 339, 1-4. doi: 10.1056/NEJM199807023390101
National Women’s Law Center. (2013 Apr 3). Emergency contraception. Retrieved from http://www.nwlc.org/resource/emergency-contraception
Szabo, L. (2013 Apr 30). FDA approves over-the-counter sales for Plan B. USA Today. Retrieved from http://www.usatoday.com/story/news/nation/2013/04/30/fda-plan-b-over-the-counter-emergency-contraception/2125131/
Emergency contraception and its availability has been a heated policy debate both federally and within states during the last decade. Atkins and Bradford (2013) estimated the impact of changes in state and federal level non-prescription access on the probability high school students’ sexual and contraceptive behaviors. The authors’ found that changing emergency contraception from prescription to non-prescription did not effect on the probability of sexual activity but that it significantly reduced the probability that public school students used condoms by between 5.2% and 7.2%. The findings suggest that despite the contention around these policy changes that sexual activity for high school was not altered. The statistical changes in condom use is concerning and I wonder if broadening school systems sexual education program to include contraception and safe sexual practices would be a benefit?
References
Atkins, D., & Bradford, W.D. (2013). The Effect of Changes in State and Federal Policy for Non-Prescription Access to Emergency Contraception on Youth Contraceptive Use: A Difference-in-Difference Analysis Across New England States. Social Science Research Network. Retrieved from http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2369997
Plan B is an OTC product so access is the same for everyone with the barrier of cost to those who can’t afford it. The same effect of the OTC product can be mimicked by taking several prescription oral contraceptives as directed by the provider to equal an equivalent hormonal dose. I think using it abroad is a good idea for some practical applications. Among the world’s poorest people, unwanted pregnancy is a huge burden.