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Although levonorgestrel emergency contraception is available in nearly three-quarters of pharmacies located in Texas, many barriers still exist for adolescents who want to receive the medication, such as age requirements, needing a prescription for access and mandatory counseling from a pharmacist, according to research presented at the Pediatric Academic Societies 2018 Meeting.

Furthermore, the researchers observed that pharmacists’ and pharmacy technicians’ knowledge of the medication, including the time frame in which it should be taken, was minimal.

According to Maria C. Monge, MD, director of adolescent medicine at Dell Children’s Medical Center of Central Texas, this medication has been available to all individuals regardless of age for 5 years and over-the-counter for 10 years.

“Texas has the fifth highest rate of teen pregnancy and the highest rate of repeat teen pregnancy in the United States, but comprehensive sex education and contraception services are not readily available to all adolescents across the state, thus emergency contraception is often used as a substitute for more effective contraceptive methods,” Monge said in a press release.

To examine Texan teenagers’ access to levonorgestrel emergency contraception and pharmacy staffs’ knowledge about this medication, the researchers separated pharmacies into six geographically based sections. Of the pharmacies in each of these regions, 25% were randomly selected to participate in this study and were contacted for a survey that was conducted via telephone interview. All pharmacy staff contacted gave consent before participating in the study.

Monge and colleagues asked six questions regarding emergency contraception, three of which focused on availability and three of which inquired about pharmacy knowledge of the medication. RedCap was used to notate and accumulate data, which had identifying features removed excluding the zip code of the pharmacy. The researchers then performed a Chi-square test of independence to determine whether the availability of emergency contraception, age requirement for purchase or knowledge of the medication differed based on geographic location.

Of the 1,203 pharmacies contacted by the researchers, 771 staff members participated. Most of these employees were pharmacists or pharmacy techs (97%). All participants responded to a minimum of one question.

According to Monge and colleagues, levonorgestrel emergency contraception was available in more than three-fourths of pharmacies (76.1%), and a prescription was needed for 6.3% of the pharmacies. Little variability in geographic location or county population was observed regarding the availability of the medication.

Although most pharmacies carried the levonorgestrel emergency contraception, nearly half required the requesting individual to be of a certain age (46.5%). Geographic location was not a variable for this requirement. More than half (51.8%) of participating pharmacies had a policy in which consultation with a pharmacist was mandatory to receive the medication.

When knowledge of the medication by pharmacists was questioned, only 10% knew that a weight limitation may be required for the use of levonorgestrel emergency contraception, and only 1% knew the time frame in which the medication can be effective (up to 120 hours after unprotected sex).

“As Texas faces ongoing challenges in improving maternal health outcomes and decreasing teen pregnancy rates, removing barriers so that adolescents may more easily access over-the-counter emergency contraception is an important piece of this puzzle that deserves additional attention,” Monge said. –by Katherine Bortz


Monge MC, et al. Barriers to obtaining and effectively using emergency contraception in Texas adolescents. Presented at: The Pediatric Academic Societies 2018 Meeting; May 5-8, 208; Toronto.

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