PATH helps emergency contraception become more accessible in Washington State

The morning after having unprotected sex, Hala calls the third doctor listed in the phone book. She needs emergency contraception, but as a new patient, she cannot get in to see a doctor this week. Frustrated, she hangs up. “Well, maybe I won’t get pregnant,” she tells herself and runs out the door for work.

Emergency contraceptiive pills (ECPs) are a safe and effective method of birth control that prevent pregnancy when taken within five days—preferably within 24 hours—after unprotected sex. Although quick access is essential to ECP effectiveness, until 1998, Washington State required women to get a prescription from a health care provider. Under this cumbersome prescription requirement, many women weren’t able to obtain the pills until after the critical five-day window had passed.

Removing barriers to access

In an effort to help women access emergency contraception pills more quickly, PATH developed a pilot project in Washington State—the first of its kind in the United States—that enabled pharmacists to provide ECPs directly to women. The project, which focused on densely populated areas in Western Washington, brokered “collaborative agreements” between pharmacists trained to offer ECPs and licensed prescribers, such as physicians and nurse practitioners. These agreements allowed women to obtain ECPs directly from trained pharmacists, without the need for a visit to a health clinic.

To raise awareness of emergency contraception and the new pharmacist program, PATH and a public relations firm developed a media campaign with radio spots and newspaper. Immediately after the media launch, there was a tenfold increase in calls to the EC hotline. Although call volume leveled off, a year later it was still four times greater than the volume of calls before the project began. Radio coverage, initially scheduled for eight stations over three months, was leveraged into 260 additional radio spot placements at no cost due to the public service nature of the message. When the pilot project ended in 1999, more than 1,000 pharmacists in Washington State had received training to provide ECPs, and pharmacists with ECP collaborative agreements had provided close to 12,000 ECP prescriptions directly to women.

Building links to better care

At the conclusion of the pilot project, PATH conducted surveys to assess clients’ and pharmacists’ experiences with pharmacy access to ECPs. The results showed that many women who received ECPs directly from a pharmacist did not have a regular health provider. By referring these women to other professionals who could provide additional care (particularly ongoing contraceptive care and treatment of sexually transmitted infections), pharmacists forged an important and often missing link between women and health care providers.

The project survey also found that many women went to the pharmacy on weekends or after normal business hours to obtain ECPs, further validating the need for access through pharmacies that offer more extensive hours. As one woman said, “I was relieved to find this available 24 hours. I could get information and the emergency contraception pills as soon as I needed them.”

Expanding reach

In 2001, with support from the Washington State Department of Social and Health Services, PATH expanded the pharmacy access initiative to rural areas in Eastern Washington, promoting and facilitating pharmacist ECP training and collaborative agreements, informing health providers, and raising public awareness of ECPs.

Today, the curricula of both of the state’s pharmacy schools include the provision of ECPs under a collaborative agreement. The Washington State Pharmacists Association also provides ECP training as part of their continuing education program. Many privately owned pharmacies as well as retail chains throughout the state now provide ECP services, giving women in Washington timely access to this important pregnancy-prevention method.

A national and international model

Advocates of expanded ECP access in other states have used the Washington State model to advance their work. To assist in these efforts, PATH held a workshop in 2004 for delegates from five states to share successful approaches, develop strategies, explore new ideas, and catalyze action at the state level. By the end of 2005, seven states had enacted legislation similar to Washington’s. PATH’s pharmacy-based EC project has also spurred similar initiatives in the United Kingdom, Canada, and other areas of the United States.

Photo: PATH.