Low-income communities have the highest teen pregnancy rates in the U.S., yet emergency contraception may be hardest for girls in those areas to get their hands on, according to a new study.
While pharmacies in underserved communities are just as likely to stock the morning-after pill as pharmacies in more affluent ones, researchers from Boston Medical Center found that pharmacists in poorer areas were more often misinformed about the law and mistakenly were denying 17-year-old girls access to Plan-B.
Plan B, or levonorgestrel, prevents a fertilized egg from attaching to the wall of the uterus, if taken within 72 hours of unprotected sex. The drug is sometimes confused with the so-called abortion pill, RU-486, but unlike RU-486, it cannot be used to terminate a pregnancy.
In 2006, Plan B became available for purchase by adults in the U.S. without a prescription. Three years later, in 2009, the FDA lowered the age at which Plan B could be dispensed without a prescription to allow 17 year olds access to the drug without a prescription.
According to the study, pharmacists and pharmacy staff may not be adequately apprised of the change in the law.
"We were very surprised by the results" of the study, said Dr. Tracey Wilkinson, its senior author and a pediatrician at Boston Medical Center. "There is a lot of misinformation about emergency contraception."
Wilkinson also suggested that the box labels on the contraception -- as well as the advertising -- may not be clear, and may be contributing to the problem.
In the study, published in the Journal of the American Medical Association, graduate assistants posed as 17-year-old adolescents and called more than 900 pharmacies in diverse neighborhoods throughout the U.S. to see whether pharmacists would dispense the morning-after pill to the "teen" customers.
Eighty percent of pharmacies said they had Plan B in stock, and the availability of the pill was consistent accross the diverse communities, researchers said. But 19 percent of all the pharmacists told the "teenagers" that they could not obtain the pill under any circumstance, and they said the misinformation occurred more often (23.7 percent versus 14.6 percent) in low-income neighborhoods.
While this study focused on pharmacies, Wilkinson said there is a lot of confusion about Plan B within the medical community at large, not just the pharmacies. Given the controversy surrounding the drug, and the changes in the rules and guidelines surrounding access, it's "not really surprising that it permeates everywhere,'' she said.
Whatever the reason for the misinformation, whether it's a problem with staff education in the pharmacies, high turnover, the relative rarity of teens asking for the drug, she said, "at the end of the day, it puts adolescents in poor neighborhoods at a disadvantage," she said.
In addition to a lack of knowledge about the rules, the rules themselves are also preventing access to the drug for some teens. "The fact that a 17-year-old would need an ID to prove she is 17 is an issue sometimes," said Wilkinson. "If the teenager lives in a city where she doesn't have to drive, she may not have a license. Then there have you another problem."
Susan Wood, director of the Jacobs Institute of Women's Health in Washington D.C., told ABCNews.com that emergency contraceptives should be compared to and accessabile as other products like condoms, tampons and pregnancy tests are.
"Some of these might be considered male or female-oriented, but clearly, anyone 17 or older can purchase these products for themselves or someone else," Wood said in December. "This would be better than having a gatekeeper who may not approve or understand the reason for providing it to the customer."
Dr. Diane Harper suggests that pharmacies need to work harder to serve their clients of all ages -- and all income levels -- appropriately. "It is very surprising that the populations at highest risk for unintended pregnancy had the least informed access to emergency contraception," she said. "It is imperative that as we move to a patient-centered medical home-model of health care, that pharmacies be a part of this movement and provide appropriate information about emergency contraception."
U.S. Department of Health Blocks Move to Make Drug More Widely Available
Last February, Teva Pharmaceutical Industries Ltd., the maker of Plan B, received approval from the FDA to sell Plan B over the counter, which would make it available to all consumers regardless of age. The company argued that safety studies that show that women of all ages can take the drug safely and effectively.
But, in an unprecedented decision, U.S. Department of Health and Human Services defied the FDA and prevented the drug from becoming available for sale over the counter in December.
Wilkinson said the Department of Health and Human Services' decision to leave block over-the-counter sales of Plan B likely has exacerbated the problem and misinformation continues to run rampant throughout the U.S.
"I hope that this study highlights something that could be changed from multiple different avenues," said Wilkinson. "Not one person or area to blame, but if the FDA is going to leave regulations as they are now, we're going to have to figure out a way to combat this misinformation."