By Alan Mozes
NEW YORK, Feb 04 (Reuters Health) -- Even when women contact doctors
associated with a national emergency contraception hotline, about 1 in 10 don't
get the "morning after" pills they need to help prevent pregnancy after
unprotected sex, research suggests.
Overall, about 25% of women who contact the toll-free 24-hour hotline
either won't get an appointment or prescription within the recommended 72-hour
period, or they may be referred to another doctor not associated with the
hotline, according to researchers from Office of Population Research (OPR) at
Princeton University in New Jersey.
"The vast majority of the more than 3,000 providers do an excellent job of
providing women with access to emergency contraception," said lead study author
Dr. James Trussell. But it was "very worrisome" that 14% of providers did not
provide a prescription or appointment to women within 72 hours of being
contacted, Trussell said.
Women who take a specific combination of oral contraceptives within 72
hours of having unprotected sex can reduce their risk of pregnancy.
In the study, two investigators posed as students seeking emergency
contraception after a condom break. The two women called 200 doctors registered
with the Emergency Contraception Hotline (1-888-NOT-2-LATE), a service operated
jointly by the Reproductive Health Technologies Project in Washington, DC and
the Office of Population Research. The hotline, which has a related website
(not-2-late.com), provides the number of five local doctors who can offer
emergency contraception.
According to the report published in the February issue of Obstetrics &
Gynecology, the women were able to get an appointment or telephone prescription
76% of the time. However, 11% of the physicians referred them to other doctors
or services in place of an appointment or prescription. Fourteen percent of the
time they were either unable to reach the provider or were told that the doctor
would not see them -- either because they were not regular patients or there
were no available appointments.
When the women could get an appointment, they found that 31% required a
pregnancy test and 27% required a pelvic exam -- even though no major medical
organization indicates these procedures as necessary. Emergency contraception
will not work if a woman is already pregnant, and research suggests that the
medication does not harm the fetus if the women is pregnant or becomes pregnant,
according to the report.
About 15% of doctors charged nothing, 36% charged $25 or less, and 10%
charged $100 or more.
The results were both "encouraging and disappointing," said Trussell, in
an interview with Reuters Health.
The researchers stressed that it is important to improve women's access to
emergency contraception given that each year in the US, 50% of all pregnancies
are unplanned and about half of those unplanned pregnancies end in abortion.
The authors suggest that one way to increase access would be to make
emergency contraception available over-the-counter without a prescription, as
they currently do in France. Doctors should also provide medication or
prescriptions "in advance for later use should the need arise; prescribe by
phone; and eliminate unnecessary pregnancy tests and physical exams" to help
women get access to emergency contraction, Trussell said.
