Accessing Emergency Contraception After Sexual Assault

Not surprisingly, I have heard from many of you in the last 24 hours about your worries and concerns–there is a lot of angst about how many of you either work in facilities where patients are denied access to emergency contraception because it’s a religiously affiliated hospital or you’re hearing stories from others. There’s a lot to unpack here, and I can’t tackle all of it in this post, but I want to start with worst case scenarios. It’s never the ideal to have patients paying for/getting their own EC after a medical-forensic exam (it actually infuriates me that it still happens), but knowing that’s a reality, I did a search online for current prices, and here’s what it looks like for patients who must pay out of pocket at the biggest national retailers:

(Online prices, so they may differ in store; all brands listed were available in stores at the time of this search.)

For those folks purchasing Plan B One-Step, the manufacturer has an online coupon that can be redeemed for $10 off. Still costly, but if that’s the only brand your pharmacy carries, it’s not nothing.

Now, I am aware many of our patients don’t have even 10 extra dollars. I am aware some of our patients don’t have access to pharmacies in their area. I am aware that some states allow pharmacists to refuse to sell EC. I am aware some will refuse regardless of what the law allows. There are a lot of barriers out there. But there are some things we as clinicians can do:

  1. Know what’s available in your area and provide patients with regularly updated, accurate information. That should be part of the discharge plan.
  2. Instead of raising all your money for shiny new equipment, consider putting some of those dollars into store gift cards for patients who need to access EC but cannot get it from your agency. Ensure patients have a way to get there right after or have someone who can go get it for them. [Related: when people ask if they can donate items to your program, yes, gift cards.]
  3. Make sure you and your team are working with the most accurate science and know the current public policy issues related to EC. Guttmacher is my trusted resource for all thing policy. In regards to science, know what the research says about timeframes, potential weight impacts, and other considerations for the various types of EC. I am not providing you with a full research review on this (yet), but I have found articles like this one to be helpful in understanding the current evidence base.
  4. Ensure that all patients who can become pregnant are being offered EC. In this, the year 2019, it is frustrating that we must remind folks that people of all genders can become pregnant. Just because someone does not look like your idea of a pregnant person does not mean they cannot become pregnant. Just because someone is taking testosterone does not mean they cannot get pregnant. We need to ensure that our trans-/nonbinary/gender non-conforming patients are screened for pregnancy exposure, too.

This space will contain a lot on EC (and abortion) access in the coming months because what’s happening here in the US has a very real impact on our patients and our practices. We need to be having a national dialog on what this means moving forward, but all of you should be having these same conversations at the local level because that’s where much of the work will be done. I welcome suggestions for future topics of concern and question. And much as I love all of the private messages I get, it wouldn’t kill you to use the Comments section so others could benefit from your feedback 😉 [I know–after 10 years, I should be used to the fact that the Comments section is the least used section of this website. But a girl can hope.]

ADD: Transphobic garbage has me linking to an article in point #4, as if I should even have to do that. It’s but one example in the medical literature. I’m annoyed I have to even justify the statement, but I guess some folks are going to engage in nonsense, so here we are.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download. Plus, coming soon: the newest research compilation, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims.

Comments

  1. May 17, 2019 | 8:29 am

    Kim Day

    Jen, thanks again for providing great information and really practical suggestions for programs. Your #1 to have a list of local pharmacies, with the prices is a great one! I also suggest having the operation hours on that list for patients, so that they can decide where to go (although I think every program should fight to provide the meds on site!). The gift cards are a great idea, too- if someone is willing to donate funds for gift cards, they can be used for purchasing the meds or for paying for the transportation to get them. Transportation is a big deal for some of our patients, too, as you pointed out. Although the US birth rate is falling: https://psmag.com/news/the-us-birth-rate-is-still-falling it will be interesting to see what is happening in the year ahead. Thanks again for being at the forefront of encouragement for us to become active in local policies and make sure the voice of our patients is considered in legislative action.

  2. May 17, 2019 | 9:15 am

    Jen

    Thanks, Kim–the suggestion about adding hours is a vital one. And thanks for all the TA you provide on this and so many issues!

  3. May 17, 2019 | 11:08 am

    Michele Roland-Schwartz

    Thank you, Jen. I really appreciate your attention to this!

  4. May 17, 2019 | 3:42 pm

    Kriesha Britton

    Does anyone else recommend the Bedsider.org app? You can put in your zip code to find EC near you.
    https://www.bedsider.org/where_to_get_it We have the Plan B NOLA website in my area. Maybe there are similar websites in other areas, too.
    https://www.planbnola.com/

    • May 17, 2019 | 3:51 pm

      Jen

      Kriesha, I wasn’t familiar with Bedsider, but I really appreciate the intro! And thanks for the suggestion about local websites too.