January 4, 2012
To the Editor: In 2009, the US Food and Drug Administration facilitated access to emergency contraception among adolescents by making it available over-the-counter to individuals aged 17 years or older. A disproportionate number of teen pregnancies occur among adolescents from disadvantaged neighborhoods.1,2,3 The availability and accessibility of emergency contraception in these neighborhoods relative to more affluent ones is unknown.
One possibility is that pharmacies in low-income communities are more likely to stock emergency contraception and are more versed in regulations regarding over-the-counter dispensing. Conversely, suboptimal access to many health services has been documented for low-income populations,4,5 and pharmacy staff could be less likely to convey accurate information. We sought to understand differences in availability of and access to emergency contraception across low- and non–low-income US neighborhoods.
From September to December 2010, female research assistants posing as adolescents who recently had unprotected intercourse were randomly assigned to call every commercial pharmacy in Nashville, Tennessee; Philadelphia, Pennsylvania; Cleveland, Ohio; Austin, Texas; and Portland, Oregon. We chose cities in geographically diverse states without pharmacy access laws that supersede uniform federal regulations. Lists of pharmacies were obtained from state boards of pharmacy. Calls were made weekdays between 9 AM and 5 PM, when pharmacies would presumably be fully staffed. Callers followed standardized scripts (Figure; details available on request) to simulate real-world calls and elicit specific information on emergency contraception availability and access. We examined same-day availability of emergency contraception, whether emergency contraception could be accessed by the caller, and whether the pharmacy communicated the correct age at which emergency contraception is accessible over-the-counter.