I was flipping through one of my many journals and a recent study in Pediatrics intrigued me. The article was a discussion about adolescents access to emergency contraception.
Emergency contraception (EC) has been available without a prescription since 2009. At that time the FDA licensed EC to be available over the counter to individuals age 17 years and older, but it is not really OTC but rather BTC (behind the counter) as you must ask the pharmacist for the medication and show proof of age. The medication is not in the aisle with the condoms, foams or tampons.
While knowing that the teen pregnancy rate is declining, there are still about 750,000 teenage pregnancies in the U.S. each year, and about 85% of these are unintended. If emergency contraception was taught and then utilized, it is estimated that half of all unintended pregnancies could be prevented.
It is also known that EC is safe, and when used in the first 120 hours (better still within 72 hours) after unprotected sex it is most effective. That means you have to know where and how to access the medication in a timely manner. So (of course) a study was undertaken to see just how an adolescent might obtain EC.
The study looked at almost 1,000 different pharmacies in varying areas of the country and how they responded to phone calls from both adolescents who desired EC, as well as to physicians who called to inquire for their patients. In both cases phone calls were staged and a script was used so that the questions asked to each pharmacy were uniform.
Interestingly, while most pharmacies reported having EC in stock (about 80%) there were wide variations in the information about its availability. In 19% of the fictitious adolescent phone calls the pharmacies told the caller it would be impossible to obtain EC, while this only occurred in 3% of the fictitious physician calls. Pharmacies only correctly conveyed the correct age to dispense EC without a prescription to between 57 - 61 % of phone calls (both teen and doctor generated). Additionally, around 35% of the pharmacies offered no additional suggestions for obtaining the medication (again for both teen and doctor).
I found this study quite interesting as it related to my own practice. I discuss sex with all of my teenage patients. I also discuss abstinence as well as protected pre-marital sex. I tell all of my patients that I am their doctor, not their mother and my job is to educate them as much as possible to ensure their well being. I am open to discussing anything with them.
I am also comfortable discussing birth control methods and the use of condoms to prevent STD's (which I cover rather graphically). I tell all of my teenage patients that unprotected sex is not only STUPID, but risky. There really is no excuse. But with that being said, I do mention that there are emergency contraceptives should it be necessary. I do not routinely walk my patients through how they might obtain EC after unprotected intercourse. I guess I assumed that it was easier than it really is.
After reading this article I realized that while the debate continues on who should be able to obtain EC, the reality is that there are many barriers, even for those of legal age. I guess I will be adding another scenario to my adolescent visits in hope that they will be smarter than those who are giving out information over the pharmacy phones.
That's your daily dose for today. We'll chat again tomorrow.