Emergency contraception (EC) is birth control used after sex to prevent pregnancy before it starts (that means it’s not the same thing as a medication abortion). Depending on the type, EC can be effective in preventing pregnancy up to 120 hours (5 days) after sex, although EC pills are more effective the sooner they are taken.
Why is EC access so important?
Widespread impacts of the US Supreme Court decision in Dobbs have become evidence over the last two years. While new models of abortion care, such as medication abortion via telehealth, have increased, people are crossing state lines in increasing numbers to access abortion care. Providers have been leaving states with abortion restrictions and bans, leading to maternity care desserts; and we’ve seen impacts on medical student and resident training. Contraceptive care has also been impacted, with some states increasing barriers to accessing contraceptives, including EC.
Access to the full spectrum of birth control, including EC, has never been more important for people to make their own decisions about getting pregnant on their own terms and timelines.
What are some current barriers to EC access?
There are many barriers!
Misinformation: Some EC misinformation includes that EC pills are the same thing as medication abortion (they aren’t), that it increase risky sexual behavior (it doesn’t), and that it not safe to be used multiple times per cycle (also incorrect). The truth is that all types of EC are only effective before pregnancy starts and are therefore not the same as medication abortion. Studies support that EC does not increase risky sexual behavior or rates of unintended pregnancy. And EC pills can safely be used multiple times within the same cycle.
Financial: Insurance plans vary in coverage of over-the-counter (OTC) products, such as levonorgestrel-based oral EC, often requiring a prescription. Out-of-pocket costs of OTC EC and provider visits for ulipristal acetate prescription EC pills or in-person visits for IUD placement vary as well.
Education and practice barriers: Although not necessary, patients may be unaware that physical examination or testing of any kind are not needed before dispensing oral EC. Others may be unaware of the OTC status of oral EC or the ability to get it delivered directly from online resources.
Health system barriers: Patients living in under-resourced communities may lack access to clinics, pharmacies, and hospitals offering these sexual and reproductive health care. In addition, in many areas, health care may only be provided by centers that are religiously affiliated and may refuse to provide EC pills or IUD placement.
Pharmacy barriers: Although approved for all ages as OTC, pharmacy stock, and pharmacy dispensing of oral EC can vary. Pharmacists or pharmacies may refuse to stock or dispense EC medications, stock it behind the counter, or in clamshell packaging further limiting access to EC.
How can health care providers help patients access EC?
There are many ways providers can help, and major organizations support them. Offer patients evidence-based EC care based on clinical guidance from the American College of Obstetricians and Gynecologists and the Society of Family Planning. The AAFP provides a useful tool for answering frequently asked questions about EC from patients.
Health care providers should counsel patients about the existence of EC and possible benefits, such as ongoing pregnancy prevention in the case of an IUD placement. Consider writing advanced prescriptions for patients to keep oral EC on hand if needed for more immediate access. Continue to support public and provider education and social media campaigns clarifying EC misinformation. Collaborate with pharmacies that stock and dispense EC and with providers able to place IUDs as EC if you aren’t able to place them yourself.
Bottom line
EC is an important option for pregnancy prevention. Despite the importance and need for access to EC, many barriers still exist. As a health care provider, you can take steps to make sure your patients can easily access EC if the need arises in addition to supporting health systems and policy changes to improve access to EC.
