In 2013, the FDA removed age restrictions on the use of levonorgestrel emergency contraception—the morning-after pill—making it available for consumers without a doctor’s prescription. However, recent research indicates that teens may still have difficulty buying the contraceptive at some pharmacies.
In 2015 and early 2016, investigators at the Indiana University School of Medicine, Indianapolis and elsewhere, set out to compare the availability and access to the contraceptive for female adolescents with the results of a similar 2012 study they had undertaken, using the same study design. To their dismay, they found that access to the drug has not improved, even though FDA had modified regulations to optimize adolescent access. This is a cause for concern, given that unintended teenage pregnancies each year in the U.S. cost more than $9 billion.
“It is very important for everyone, especially adolescents, to have access to emergency contraception,” said Tracey Wilkinson, MD, MPH, Assistant Professor of Pediatrics at Indiana. Wilkinson, who led the study, noted, “After the FDA policy change in 2013, many people believed emergency contraception would be available to anyone, but that’s not the case.”
The FDA previously approved OTC emergency contraception only for those at least 18-years old, out of concern that younger females might not use the drug appropriately. Eventually, after several administrative and legal proceedings, the FDA lowered the age for non-prescription access to 17, before allowing access to anyone in 2013.
In the 2012 study, investigators found that adolescents in low-income neighborhoods found it difficult to purchase emergency contraception at drug stores. For the current study, researchers used phone callers who posed as adolescents and undertook scripted telephone calls to pharmacies in five major U.S. cities to learn how accessible emergency contraception was. They found that the situation has not improved.
Of 979 pharmacies contacted by females posing as 17 year olds, 827, or 83%, indicated that emergency contraception was available. This percentage did not change by pharmacy neighborhood income level. It was not significantly different from 2012. But 8.3% of the pharmacies contacted said it was not possible for the young females to purchase the drug under any circumstances. This was the case more often in low income areas. The proper information about OTC access was conveyed on the phone only 51.6% of the time.
Wilkinson noted that drug stores would more likely say that emergency contraception isn’t available under any circumstances in low-income areas. She surmised that this could be the result of a number of issues, including:
- A “haphazard” transition to OTC status in which some product labels carried incorrect user information.
- Pharmacy staff turnover.
- Lack of pharmacy staff education.
Another possible contributing factor: “On top of this confusion, some people hold certain opinions about unprotected sex,” Wilkinson noted. She also theorized that people might be more successful in purchasing emergency contraception if they went to a pharmacy in person.
One limitation of this study was that the investigators did not call all of the same pharmacies as they did in the original study. Despite this and other study limitations, the scientists indicate that their research shows how impediments to buying emergency contraception continue to exist, even after the FDA 2013 policy modifications which eliminated age restrictions. The FDA made its decision to expand access specifically to consumers who would be most helped by avoiding unplanned pregnancies.