Wisconsin's Family Planning Health Services [11] put 20,000 emergency contraceptive pills (Plan B) in the hands of 10,000 women last year. Is preventing unwanted pregnancy as simple as that? Yes. No.
Last week the Journal of the American Academy of Pediatrics [12] published a study showing that urban minority teen girls lacked knowledge about emergency contraception. Almost all of the sexually active adolescents had heard of emergency contraception, but were not knowledgeable about how it works or when to take it. Girls who were not sexually active had less information [13].
In 2006, FPHS did a Wisconsin study on whether teens who called family planning clinics, emergency rooms, and crisis pregnancy centers got information to help them get EC. The findings [14] were that while family planning clinics did well, emergency rooms were not prepared to deal with telephone inquiries, and crisis pregnancy centers typically did not have accurate or useful contraceptive information.
As family planning providers,
here's what we are doing about it (with a lot of collaboration):
We explain to every woman and girl of reproductive age who calls the hotline or visits our clinics that she should have Plan B [15] on hand and should understand when to take it. The most common reasons are that she may forget to take birth control pills, a condom may beak, or unplanned/non-consensual sex may put her at risk of an unwanted pregnancy. The woman at risk makes the decision when to take Plan B. Having it on hand enables her to act promptly.
Every female patient of reproductive
age who visits any one of our seven clinic locations or who calls the
statewide toll-free response line (866-EC FIRST) [16] is offered Plan B and receives education
that emergency contraception is more effective the sooner it is taken
after unprotected sex. Most of our callers are low-moderate income
and underinsured, so they are eligible for Wisconsin's Medicaid
Family Planning Waiver [17].
For them, prescription Plan B will be provided at no charge.
How can she get the pills?
- She can receive them in the mail to an address of her choice.
- She can pick up EC at any one of 62 family planning clinics [18] throughout the state.
If it is an emergency and she can't get to a local family planning clinic:
- She can have EC shipped via overnight express.
- She can go to a local pharmacy where we have faxed her prescription.
- She could go to one of several sexual assault service agencies with our EC on hand.
- She can go to an off-hours lock-box at one of our seven clinic sites.
That is focusing on the practical
-- as for dealing with other dimensions such as the moral, the medical,
the historical and the political, there are good sources of information
about emergency contraception and how we came to be where we are:
Health Care Education and Training has an excellent website about how EC works at http://www.hcet.org/ec/default.htm [15].
The Wisconsin Family Planning and Reproductive Health Association (WFPRHA) took several preparatory steps on the way to wide EC access, including:
- an assessment tool [19] to help nursing professionals determine whether and when a report must be made for a sexual assault under Wisconsin law.
- several coalition-building conferences [20] to build public/policy support.
- statewide training for reproductive health professionals in 2005 on how EC works and what are the best medical practices for its use. The association is planning to review and update the training in 2009.
The most important piece of the puzzle is that Wisconsin's Department of Health Services [21] implemented policies that enable uninsured and underinsured low and moderate income women to receive Medicaid-paid contraceptive services and supplies. Being able to give EC at no charge in advance of need is the foundation on which EC access is based.
As for results: at FPHS clinics [22], positive pregnancy tests as an annual percentage of total patients has dropped from (pre-Family Planning Waiver) 5.5% (about 350 positive pregnancy tests) to 2% (about 180 positive pregnancy tests) for the last three years. There may be a non-EC explanation, but it's not likely. Because preventing unwanted pregnancies is how we can define EC success, for FPHS, free EC in advance has been a success. Maybe it is as simple as that.