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Getting 'Morning-After Pill' Not Always Easy


WebMD Health News

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 already pregnant.

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.

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