Getting 'Morning-After Pill' Not Always Easy
Feb. 17, 2000 (New York) -- Emergency contraception, sometimes referred to
as the "morning-after pill," can prevent pregnancy when taken within 72
hours of unprotected intercourse, but a study published in the February issue
of Obstetrics and Gynecology suggests that getting the contraceptives
from a health care provider in time can be difficult. Approximately 25% of
attempts to obtain emergency contraceptives failed.
Lead author James Trussell, PhD, of the Office of Population Research at
Princeton University, tells WebMD that the results of the study are worrisome.
"If clinicians are serious about [providing emergency contraception
services], they have to do one of several things. One is prescribe in advance
so women have it when they need it. The second is make sure women can get in to
see you as soon as they call. The third thing is prescribe over the phone.
There's absolutely no reason why anybody has to see a physician to get access
to emergency contraceptives."
Emergency contraception pills contain the same active ingredients as regular
birth control pills -- estrogen plus progestin, or progestin alone -- but in
higher doses. They can be used when a condom breaks, after a sexual assault, or
whenever contraception is not used or fails to work properly. Emergency
contraceptive pills interfere with contraception, but do not work if a woman is
In Trussell's study, two study investigators posing as women who had a
condom break the previous night called 200 doctors in 40 states, plus the
District of Columbia and the U.S. Virgin Islands, who had registered to be
listed on a university-operated hotline. All calls were placed on weekdays
during normal business hours, and the same caller made three attempts to
contact each doctor.
In about 76% of attempts, the caller was offered an appointment or telephone
prescription for emergency contraception within 72 hours. Approximately 31% of
providers who offered appointments required a pregnancy test, and 27% required
a pelvic exam before they would prescribe contraceptives.
Fourteen percent of the calls were classified as failures, meaning no
appointment or prescription was offered. Reasons for failures included
inability to make phone contact with the provider, refusal of the provider to
see a non-established client, and unavailability of appointments. The remaining
calls, roughly 11 percent, resulted in referrals to another provider.
The cost of the emergency contraceptives included flat fees ranging from
free to $220 and sliding scale systems that discounted fees for students and
ranged from free to $54.
Trussell and colleagues say that wider access to emergency contraception
services is needed, particularly on weekends and holidays when offices are
closed. They suggest backup systems, such as information left on voice mail or
with answering services, and collaboration with pharmacies. Washington state,
for instance, allows pharmacists to prescribe emergency contraceptives to women
without seeing a clinician. Trussell and colleagues say that providers
themselves should consider over-the-phone prescribing. In the study, only 12
providers offered a telephone prescription.