America’s Plan B problem: The contraception misinformation epidemic

Emergency contraception is supposed to be available to teens, but pharmacists are telling them they're too young

Topics: Plan B, emergency contraception, Contraception, Birth Control, Editor's Picks,

America's Plan B problem: The contraception misinformation epidemic (Credit: flickr/Cory Doctorow/Salon)

In spring 2005, at the not-so-tender age of 26, I was on the receiving end of my first (and only) condom malfunction. The incident sent me into a frenzied state of paranoia that had me up all night and found me and my partner bleary-eyed early the next morning at the university emergency clinic in my town, in desperate need of some emergency contraception. This was during the days of the Bush administration, before Plan B — more popularly known back then as the “morning after pill” — was available over the counter. To get it required a prescription and to get a prescription usually required a medical appointment and examination.

In order for me to get Plan B, I had to have a pelvic exam and then sit there while a well-meaning but patronizing nurse subjected me to a speech on how to properly use a condom, complete with a step-by-step demonstration involving a plastic speculum. I was well into my 20s and had used condoms countless times without any problem (as I told the nurse before she launched on her lecture). But sometimes condoms break, which is when Plan B comes in handy. That is, if you can actually get your hands on it.

Even though it was first approved for prescription use in the United States in 1999, Plan B did not become available over the counter until 2006 for women 18 and older. The age requirement was then dropped to 17 in 2009. Age restrictions were finally dropped altogether this past July as mandated by a U.S. District Court Judge — despite much resistance and an appeal by the Obama administration’s Department of Justice. However, as part of a compromise reached by the court and the DOJ, this ruling only applied to Plan B One Step. Generic brands — which are often cheaper–would still only be for sale at pharmacies without a prescription for those over 17 and with a government-issued ID.

But even before age restrictions for Plan B One Step were dropped, research has indicated that pharmacists were misinforming teenagers about the rules regarding its access. At least, those are the findings of a study published in December in the Journal of Adolescent Health.

In the study, researchers called pharmacies in several different cities around the country posing as teenage girls seeking emergency contraception. Approximately 20 percent of the pharmacy staff they contacted wrongfully informed the callers that because they were teenagers they could not legally have access to emergency contraception at all. Of the remaining 80 percent of respondents, only about half of them got the exact age requirements for Plan B correct.



Even more interesting were some of the other things pharmacy staff told the callers. Many cited ethical reasons or personal religious beliefs for not offering the medication. Other pharmacists inaccurately told the callers that a parent or guardian would have to come with them to pick up the medication (even if they had a prescription) or that an older friend or boyfriend above the age restriction could not buy Plan B over the counter for them. In fact, some callers were even told Plan B wasn’t sold to men, which also isn’t true.

Though this study was conducted before age restrictions for over-the-counter Plan B One Step were dropped, its implications are still current.

“Our society is pretty uncomfortable about sex and very little healthy sexual decision making is portrayed in the media, so there seems to be a lot of judgment in these situations along with all these rules and restrictions,” said Dr. Tracey Wilkinson, a pediatrician at the Children’s Hospital of Los Angeles and lead author of the study.

Wilkinson first became compelled to do the study when she noticed that some of her teenage patients were having difficulty getting their Plan B prescriptions filled because pharmacists either didn’t stock it or refused to fill it. Even patients who were 17 or older reported having trouble buying it over the counter.

“We have fought some really big battles and [Plan B] is now available over the counter. Yet there are still a lot of barriers to actually getting it,” said Wilkinson.

Megan Kavanaugh, a senior research associate at the Guttmacher Institute — an organization  that researches and advocates for reproductive health and rights — found the results of Wilkinson’s study “discouraging, but unfortunately not very surprising.”

Kavanaugh notes that among women who are sexually active, teens have some of the highest rates of unintended pregnancy. When used correctly, Plan B is 95 percent effective in preventing unintended pregnancies if taken within 24 hours of unsafe sex and nearly 90 percent if taken within 72 hours. And yet, teenagers aged 15-19 only comprised 14 percent of the 5.8 million women who used emergency contraception between 2006 and 2010, according to Centers for Disease Control statistics.

“There is clearly a need among teenagers to be able to access emergency contraception given their increased risk,” says Kavanaugh.

Kavanaugh also suggests that dropping the age restriction for just Plan B One Step while keeping it in place for the other brands has likely added to the confusion for both teenagers and pharmacists, making access to emergency contraception more difficult than it should be.

To see what might be going on now that the law has changed again, I decided to investigate a bit on my own. I called up a dozen different pharmacies in several different cities and asked if I could get Plan B. I also asked how old I would have to be to get it. The results were not very heartening.

Half of the pharmacies I called didn’t have any brand of emergency contraception in stock. A pharmacist at one of these locations even brusquely informed me that his pharmacy never stocked Plan B and that he didn’t know where I could get it, before abruptly hanging up. When I inquired about the age requirements for Plan B at these pharmacies, the responses I received were all over the map including “16,” “17,” “16 or 17,” “17 or 18,” and even “18.” Only one pharmacist cited the new law in informing me there was no age restriction for the main brand.

Still curious if age was the only barrier, I visited my family-owned neighborhood pharmacy in the Boston suburbs and found that it also didn’t stock any version of Plan B (it also does not sell condoms). I then ventured to a few of my local CVS chain stores, where I did find Plan B One Step on the shelves, but displayed in a locked plastic box. To get it required going up to the counter and requesting it, something that could be a harrowing prospect for a teenage girl.

“When a woman fears she might become pregnant, she needs fast access to emergency contraception, not delays or misinformation at the pharmacy counter,” says Dr. Deborah Nucatola, senior director of medical services at the Planned Parenthood Federation of America.

“The bottom line,” says Nucatola,“is that all women should have accurate information about the full range of contraceptive options and be able to access the best method of emergency contraception for them quickly and without barriers.”

Laura Kiesel is a Boston freelance writer who has written for The Street, Earth Island Journal, Z Magazine and Al-Jazeera America. She is currently working on a collection of personal essays tentatively titled "The Drug Addict's Daughter." Follow her on Twitter @SurvivalWriter.

More Related Stories

Featured Slide Shows

  • Share on Twitter
  • Share on Facebook
  • 1 of 22
  • Close
  • Fullscreen
  • Thumbnails

    Once upon a time on the Bowery

    Talking Heads, 1977
    This was their first weekend as a foursome at CBGB’s, after adding Jerry Harrison, before they started recording the LP “Talking Heads: 77.”

    Once upon a time on the Bowery

    Patti Smith, Bowery 1976
    Patti lit up by the Bowery streetlights. I tapped her on the shoulder, asked if I could do a picture, took two shots and everyone went back to what they were doing. 1/4 second at f/5.6 no tripod.

    Once upon a time on the Bowery

    Blondie, 1977
    This was taken at the Punk Magazine Benefit show. According to Chris Stein (seated, on slide guitar), they were playing “Little Red Rooster.”

    Once upon a time on the Bowery

    No Wave Punks, Bowery Summer 1978
    They were sitting just like this when I walked out of CBGB's. Me: “Don’t move” They didn’t. L to R: Harold Paris, Kristian Hoffman, Diego Cortez, Anya Phillips, Lydia Lunch, James Chance, Jim Sclavunos, Bradley Field, Liz Seidman.

    Once upon a time on the Bowery

    Richard Hell + Bob Quine, 1978
    Richard Hell and the Voidoids, playing CBGB's in 1978, with Richard’s peerless guitar player Robert Quine. Sorely missed, Quine died in 2004.

    Once upon a time on the Bowery

    Bathroom, 1977
    This photograph of mine was used to create the “replica” CBGB's bathroom in the Punk Couture show last summer at the Metropolitan Museum of Art. So I got into the Met with a bathroom photo.

    Once upon a time on the Bowery

    Stiv Bators + Divine, 1978
    Stiv Bators, Divine and the Dead Boys at the Blitz Benefit show for injured Dead Boys drummer Johnny Blitz.

    Once upon a time on the Bowery

    Ramones, 1977
    “The kids are all hopped up and ready to go…” View from the unique "side stage" at CBGB's that you had to walk past to get to the basement bathrooms.

    Once upon a time on the Bowery

    Klaus Nomi, Christopher Parker, Jim Jarmusch – Bowery 1978
    Jarmusch was still in film school, Parker was starring in Jim’s first film "Permanent Vacation" and Klaus just appeared out of nowhere.

    Once upon a time on the Bowery

    Hilly Kristal, Bowery 1977
    When I used to show people this picture of owner Hilly Kristal, they would ask me “Why did you photograph that guy? He’s not a punk!” Now they know why. None of these pictures would have existed without Hilly Kristal.

    Once upon a time on the Bowery

    Dictators, Bowery 1976
    Handsome Dick Manitoba of the Dictators with his girlfriend Jody. I took this shot as a thank you for him returning the wallet I’d lost the night before at CBGB's. He doesn’t like that I tell people he returned it with everything in it.

    Once upon a time on the Bowery

    Alex Chilton, Bowery 1977
    We were on the median strip on the Bowery shooting what became a 45 single sleeve for Alex’s “Bangkok.” A drop of rain landed on the camera lens by accident. Definitely a lucky night!

    Once upon a time on the Bowery

    Bowery view, 1977
    The view from across the Bowery in the summer of 1977.

    Once upon a time on the Bowery

    Ramones, 1977 – never before printed
    I loved shooting The Ramones. They would play two sets a night, four nights a week at CBGB's, and I’d be there for all of them. This shot is notable for Johnny playing a Strat, rather than his usual Mosrite. Maybe he’d just broken a string. Love that hair.

    Once upon a time on the Bowery

    Richard Hell, Bowery 1977 – never before printed
    Richard exiting CBGB's with his guitar at 4am, about to step into a Bowery rainstorm. I’ve always printed the shots of him in the rain, but this one is a real standout to me now.

    Once upon a time on the Bowery

    Patti Smith + Ronnie Spector, 1979
    May 24th – Bob Dylan Birthday show – Patti “invited” everyone at that night’s Palladium show on 14th Street down to CBGB's to celebrate Bob Dylan’s birthday. Here, Patti and Ronnie are doing “Be My Baby.”

    Once upon a time on the Bowery

    Legs McNeil, 1977
    Legs, ready for his close-up, near the front door of CBGB's.

    Once upon a time on the Bowery

    Suicide, 1977
    Rev and Alan Vega – I thought Alan was going to hit me with that chain. This was the Punk Magazine Benefit show.

    Once upon a time on the Bowery

    Ian Hunter and Fans, outside bathroom
    I always think of “All the Young Dudes” when I look at this shot. These fans had caught Ian Hunter in the CBGB's basement outside the bathrooms, and I just stepped in to record the moment.

    Once upon a time on the Bowery

    Tommy Ramone, 1977
    Only at CBGB's could I have gotten this shot of Tommy Ramone seen through Johnny Ramones legs.

    Once upon a time on the Bowery

    Bowery 4am, 1977
    End of the night garbage run. Time to go home.

  • Recent Slide Shows

Comments

Loading Comments...