What if A condom broke or slipped

What if ? A condom broke or slipped off, you had sex when you didn’t expect to, you didn’t use any birth control that weekend, you stopped taking birth control pills temporarily, or missed several pills, your diaphragm slipped out of place…. .

Options • Do nothing because you don’t know about EC • Call a provider and get an appointment • Fill an advance prescription • Take meds your provider gave you at your last annual exam • Go to the drugstore and buy meds

Do nothing because you don’t know about EC • Kaiser Family Foundation Study, 2004 – 57% of women had heard of ECPs/morning-after pills – Only 7% had heard about it from a health care provider – Only 6% of women had ever used ECPs – 50% confused it with the “abortion pill”

Call a provider and get an appointment • Study using callers posing as women who had a condom break and called 1 -888 -not-2 -late for assistance. – 76% of attempts resulted in an appointment or telephone Rx within 72 hours.

Fill an advance prescription • No studies to determine if this effective but…………

Rx Availability of EC in Albuquerque • All pharmacies in ABQ visited by two research assistants. One assistant in her 40 s, one in her 20 s • Presented a written Rx for either Preven or Plan B – “I would like to know if I could get this filled and how much it will cost? ”

Rx Availability On shelf Plan B visits 6 (7%) Preven visits 13 (15%) Total visits 19 (11%) Within 24 hrs > 24 hrs 35 (39%) 27 (30%) 62 (35%) 26 (29%) 30 (34%) 56 (31%) Never 21 (24%) 15 (17%) 36 (20%)

Rx Availability Day of Week Fri, Sat, Sun Mon-Thurs On shelf 4 (8%) 14 (12%) Within 24 hrs 6 (12%) 56 (46%) > 24 hrs 35 (70%) 21 (17%) Never 5 (10%) 30 (25%)

Helpfulness of Pharmacy Providers Over 24 hours Never available Total Helpful 16 (31%) 2 (6%) 18 (21%) Somewhat helpful 16 (31%) 15 (44%) 31 (36%) Unhelpful 19 (37%) 17 (50%) 36 (42%)

Reasons not available Plan B Preven Total Lack of need 45 (68%) 43 (69%) 88 (65%) Corporate policy 2 (3%) 6 (10%) 8 (6%) Individual ethics Carry other product Don’t know 6 (9%) 3 (5%) 9 (7%) 7 (11%) 2 (3%) 9 (7%) 6 (9%) 8 (13%) 14 (11%)

Conclusions • There is a lack of availability of dedicated products for EC in Albuquerque • The main reason for a pharmacy not to have such medications is lack of demand for the products • Availability on weekends is less than during the week

Take meds your provider gave you at your last annual exam • Raine et al, 2000 – Patients given meds 3 x more likely to use EC than those only counseled – No increase in risk behaviors • Glaiser et al, 1997 – Significantly more likely to use meds if they had been given them vs. told how they could get them – No difference in number who used >1 x

Provider Practice: Good News The Henry J. Kaiser Foundation 2001

Provider Practice: Bad News The Henry J. Kaiser Foundation 2001

The Clinical Bottleneck • Clinicians overwhelmingly think ECPs are safe and effective, and the majority have prescribed in the last year • Clinicians are waiting for women to ask for EC

The Clinical Bottleneck • But women do not know to ask • Kaiser Family Foundation Study, 2004 – 57% of women had heard of ECPs/morningafter pills – Only 7% had heard about it from a health care provider – Only 6% of women had ever used ECPs – 50% confused it with the “abortion pill”

Go to the drugstore and buy meds without a prescription • Maybe… – Currently • If you are in one of 6 states in the US • If you go to the right pharmacy at the right time – Future • If becomes OTC

Emergency Contraception BTC • ECPs are available directly from pharmacists without having first to get a prescription from a clinician in: –WA, CA, NM, AK, HI, ME –British Columbia –France –United Kingdom –South Africa –Portugal –Belgium –Albania –Denmark –Sweden

“Behind the Counter” • Currently about 160 pharmacists in NM are trained • Can find out about availability at – http: //ec. princeton. edu

Current Status of OTC-EC in the U. S. • Petition filed by 70 organizations in 2/2001. • Barr Corp. filed for OTC status 4/2003 • FDA advisory panel voted 23 -4 in 12/03 to make Plan B OTC. • FDA issued “Not approvable” letter, 5/2004 • Barr submitted revised application 7/2004 • President Bush re-elected 11/2004

Strategies to Improve Use of EC • Routine discussion of EC during office visits • Provide advance prescriptions/meds • Abandon unnecessary requirements such as pregnancy testing/physical examination for women seeking EC • Make products available over the counter • Increase demand!

Increasing Demand • Provider education – ACOG “call to action” in 4/02 and mailing in 2/02 • Patient education – State EC working group – Clinical Prevention Initiative subcommittee on unintended pregnancy recently formed – “Back up Your Birth Control” program by Reproductive Health Technologies project • Useful websites – plannedparenthood. com – Backupyourbirthcontrol. org – Ec. princeton. edu

• A 27 yo G 3 P 3, married patient calls your office saying she and her husband noted the condom was broken after sex the night before. What should she do? ?

What I really want you to know! • What form of EC is most effective – IUD>progestin only>combination • Talk to every reproductive age woman at risk for pregnancy about EC • Provide EC in advance • Support ECP to be available over the counter.