Last Updated: January 10, 2006
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It has been over eight (1997) years since the Food and Drug Administration (FDA) approved a specific regime for emergency contraception (EC). It has been over four years since the Center for Reproductive Rights (formerly the Center for Reproductive Law and Policy) petitioned the FDA to make EC available over the counter (OTC). Yet EC is still not available OTC, and many women are still unaware of EC or are unable to obtain EC in a timely manner. Increasingly, states have become aware of the potential for EC to decrease the number of unplanned pregnancies and abortions, and are taking action to increase access to EC.
Pharmacy Access to EC
Until the FDA makes EC available OTC, a doctor’s prescription is required to obtain EC. This is problematic since EC must be taken within a short time period after intercourse (preferably 24 - 72 hours, but up to 120 hours) to be effective in preventing pregnancy. Many women have difficulty accessing their doctors within this short time frame – especially in rural areas or over weekends.
In 1998, Washington became the first state to allow women to obtain EC through a pharmacist directly. Washington’s pilot project set up collaborative drug therapy agreements between doctors and pharmacies based on prescriptive protocols. Under the agreements, pharmacists were able to dispense EC to women who met screening criteria outlined in the protocols.
Washington’s program has become a model for other states. In the past few years, Alaska, California, Hawaii, New Mexico, Maine, New Hampshire and Massachusetts have begun allowing pharmacists to dispense EC directly to women without an individual doctor’s prescription. Other states have been considering similar legislation to provide direct pharmacy access to EC.1
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Increased access to EC is supported around the world: women in Albania, Belgium, Canada, Denmark, Finland, France, Israel, Morocco, Norway, Portugal, South Africa, Sweden, the United Kingdom and other countries can get EC without a prescription.
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EC in Emergency Rooms
Despite EC’s proven ability to prevent unwanted pregnancy, many hospital emergency rooms (ERs) do not inform women about EC nor make EC available to them. Sexual assault advocates have been particularly concerned about the failure of ERs to make EC a standard practice of care for women who have been sexually assaulted. In 2001, Illinois became the first state to legislate on this issue, enacting a law requiring hospitals to provide rape survivors with medically accurate information about EC. Since then, Washington, California, New Mexico, New York, South Carolina, New Jersey and Massachuestts have passed laws requiring hospital ERs to provide rape survivors with information about EC and to dispense EC upon request. Other states and the U.S. Congress are considering similar legislation.2
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Given EC’s efficacy in preventing pregnancy, EC should be a standard of care for all women in ERs who want to prevent unwanted pregnancy. |
EC Education
Polling data consistently shows that many women in the United States are unaware of EC. For example, in a study released in November 2000 by the Kaiser Family Foundation, one-fourth of the women aged 18-44 surveyed said they had never heard of EC, and nearly two-thirds said they didn’t realize it was available in the United States.3 A more recent study shows that 68% of American women know there is something they can do within days of unprotected intercourse to prevent pregnancy, but are often confused as to the exact details.4 The same study shows that only 6% of American women have ever used EC.5
Given the lack of awareness about EC, several states are contemplating the passage of legislation that would raise awareness about EC through the creation of public education campaigns.6 These bills are a crucial step towards increasing awareness and access to EC.
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Short timeline of EC
Late 1970s - Doctors first begin to use doses of several regular birth control pills as EC
1997 - FDA approves six common types of births control pills to be safe and effective for use as EC
1998 - Preven, the first specific emergency contraception regime, is approved by the FDA
1999 - Plan B is approved for sale by the FDA
2001 – The Center for Reproductive Rights petitions the FDA to make EC available OTC
2003 – The manufacturer of Plan B petitions the FDA to make Plan B available OTC
2005 - CRR files a lawsuit against the FDA for failing to make EC available without a prescription.
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1. Bills relating to pharmacy access were introduced in several state legislatures in 2003, including Maryland, Maine, New York, Oregon, Texas and West Virginia.
2. Bills requiring hospitals to provide sexual assault victims with medically accurate information about EC and/or to provide EC upon request were introduced in several legislatures in 2005, including Arkansas, Arizona, Colorado, Hawaii, Minnesota, Missouri, New Jersey, Pennsylvania, South Dakota, Tennessee, Texas, Wisconsin and West Virginia. The U.S. House of Representatives also introduced a federal version, entitled the "Compassionate Assistance for Rape Emergencies Act," H.R. 2527, 108th Congress (2003).
3. See e.g., Leslie Lawrence, Special Report: The Last Chance Contraceptive, Kaiser Family Foundation: Daily Reproductive Health Report (Jan 2002), at http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=2&DR_ID=8923 (discussing 2000 study). A 1997 study by the Kaiser Family Foundation showed that 66% of women surveyed had heard of EC but only 52% of the 66% knew that EC could prevent pregnancy after intercourse; 72% were unaware that EC was available in the U.S.; and only 11% actually knew the key facts about EC. See Summary of Findings: Survey of Americans on Emergency Contraception at http://www.kff.org/content/archive/1352/contraception_2.html.
4. Kaiser Family Foundation/SELF magazine, National Survey of Women on their Sexual Health (June 2003).
5. Id.
6. In 2005, an EC public education bill was introduced in West Virginia and several bills calling for study of EC were introduced in Hawaii.
Last Updated: January 10, 2006
For more information about EC, see:
Emergency Contraception (EC) An Affirmative Agenda to Improving Access
Resources For Emergency Contraception
Emergency Contraception (EC): A Safe and Effective Way to Prevent Unplanned Pregnancy
Emergency Contraception (EC) for Sexual Assault Survivors in the Emergency Room updated, January 2006
