Many Iowans may have considered a report issued by several collaborating agencies last year to be the end of a project documenting access to emergency contraception. The truth is, however, last year's findings were only the beginning.
"Since the initial report was issued we've had 10 volunteers make over 800 more phone calls over a 55-hour period," Karen Kubby, executive director of the Emma Goldman Clinic, said. "From those efforts, we have 300 more completed surveys."
Such new information is currently being added to the 2006 results of Project Pharmacy, a collaborative effort between the Emma Goldman Clinic, Planned Parenthood of East Central Iowa, Planned Parenthood of Greater Iowa, Planned Parenthood of Nebraska/Council Bluffs, Planned Parenthood of South East Iowa, the University of Iowa's Law Students for Choice, Iowa Chapters of the National Organization for Women and the University of Iowa's Feminist Majority Leadership Alliance. The aim of the project was to determine availability of emergency contraception at Iowa pharmacies as well as to educate and inform both pharmacists and the general public about emergency contraception.
The study initially found 42 percent of Iowa pharmacies did not stock or dispense emergency contraception — although all of the pharmacies carried other hormonal methods of contraception. In a report summary, such lack of access was attributed to "pharmacists and physicians not understanding how [emergency contraception] works, as well as anti-choice groups attempting to deliberately misinform and create confusion" about how it works.
"We began our study prior to the FDA granting approval of EC for over-the-counter sales," said Kubby. "We also did not include Wal-Mart Pharmacies in our initial study because, at that time, none of them carried EC. Since then Wal-Mart has issued a corporate policy, requiring their pharmacies to stock EC."
Kubby is quick to point out that stocking a pharmaceutical is a completely different thing than dispensing a pharmaceutical.
"One aspect of what we are doing is educating women on how to approach pharmacists," she said. "If a woman makes a request and is refused, she needs to know that she can ask if the pharmacy stocks EC. If so, she can then ask if there is another pharmacist on duty who will dispense. If all else fails, she can ask for a referral to another pharmacy or clinic."
Education of that nature, Kubby says, is a key part of Project Pharmacy.
"One of the things we are doing with the data we've collected is organizing it geographically," she said. "Once that is complete, we should be able to see if there are pockets within the state where EC is either not being stocked or not being dispensed," she said.
If such areas are identified, additional education-based outreach can be targeted to whatever specific needs are discovered.
"In some cases we might contact a county health department to both inform the agency of the lack of service and to, hopefully, involve them as a dispensing site," she said. "In another case we may wish to contact the Iowa Pharmacy Association to help get accurate information into the hands of pharmacists."
"One of the things that we've learned through this project is that not all the pharmacies who do not stock EC are doing so because of a moral objection. In some cases there is an economic factor."
Currently, pharmacies order emergency contraception — which has a shelf life of three years — by the case. In smaller communities or in pharmacies where there has not been a demand, product has expired and had to be thrown out.
"If economics is playing a factor, maybe we can work with the pharmacy to find a solution," Kubby said. "Maybe instead of purchasing a full case, we could find a way for the pharmacy to purchase a three-pack."
Because emergency contraceptive is effective if taken within 120 hours of protected sex, though most effective if taken within the first 72 hours, immediate access is important. According to the study, with proper access, emergency contraception could prevent 1.7 million unintended pregnancies and 800,000 abortions each year in the United States.
In the original study, funded by the National Network of Abortion Funds and the Emergency Contraception Access Campaign, phone surveys and mystery shopping was used to determine access and availability of emergency contraception in Iowa pharmacies. The phone survey consisted of eight questions and, originally, 648 pharmacists were targeted. Of those, 417 or 64 percent were given the survey. Both chain store pharmacies and independently owned pharmacies were included, although each type was broken into its own category.
Of the 183 chain store pharmacies contacted, 56 percent said they regularly stock emergency contraception. Only 29 percent, however, had emergency contraception in stock at the time of the call. Of the 80 stores that stated they did not stock emergency contraception, only three cited "moral or religious beliefs" as the reason they did not stock or dispense emergency contraception.
Of the 234 independently owned pharmacies contacted, 59 percent said they regularly stock emergency contraception and 42 percent had it in stock at the time of the call. Of the 95 stores that stated they did not stock emergency contraception, nine cited "moral or religious beliefs" as the reason. Of those nine pharmacies, four also refused to offer a referral to another pharmacist who would dispense.
Of the independently owned stores, there were 68 pharmacists who mistakenly believed emergency contraception would cause an abortion. Forty-six of the chain store pharmacists also held this mistaken belief.
Kubby anticipates the new findings will be released in late summer or early fall.