Wisconsin’s Family Planning Health Services put 20,000 emergency contraceptive
pills (Plan B) in the hands of 10,000 women last year. Is preventing
unwanted pregnancy as simple as that? Yes. No.

Last week the Journal of the
American Academy of Pediatrics published a study showing that urban
minority teen girls lacked knowledge about emergency contraception.
Almost all of the sexually active adolescents had heard of emergency
contraception, but were not knowledgeable about how it works or when
to take it. Girls who were not sexually active had less information.

In 2006, FPHS did a Wisconsin
study on whether teens who called family planning clinics, emergency
rooms, and crisis pregnancy centers got information to help them get
EC. The findings were that while family planning clinics
did well, emergency rooms were not prepared to deal with telephone inquiries,
and crisis pregnancy centers typically did not have accurate or useful
contraceptive information.

As family planning providers,
here’s what we are doing about it (with a lot of collaboration):

We explain to every woman and
girl of reproductive age who calls the hotline or visits our clinics
that she should have Plan B on hand and should understand when
to take it. The most common reasons are that she may forget to
take birth control pills, a condom may beak, or unplanned/non-consensual
sex may put her at risk of an unwanted pregnancy. The woman at risk
makes the decision when to take Plan B. Having it on hand enables her
to act promptly.

Every female patient of reproductive
age who visits any one of our seven clinic locations or who calls the
statewide toll-free response line (866-EC FIRST) is offered Plan B and receives education
that emergency contraception is more effective the sooner it is taken
after unprotected sex. Most of our callers are low-moderate income
and underinsured, so they are eligible for Wisconsin’s Medicaid
Family Planning Waiver.
For them, prescription Plan B will be provided at no charge.

How can she get the pills?

• She can receive
  them in the mail to an address of her choice.
• She can pick up
  EC at any one of 62 family planning
  clinics throughout
  the state.

If it is an emergency and she
can’t get to a local family planning clinic:

• She can have EC
  shipped via overnight express.
• She can go to a
  local pharmacy where we have faxed her prescription.
• She could go to
  one of several sexual assault service agencies with our EC on hand.
• She can go to an
  off-hours lock-box at one of our seven clinic sites.

That is focusing on the practical
— as for dealing with other dimensions such as the moral, the medical,
the historical and the political, there are good sources of information
about emergency contraception and how we came to be where we are:

Health Care Education and Training
has an excellent website about how EC works at http://www.hcet.org/ec/default.htm.

The Wisconsin Family Planning
and Reproductive Health Association (WFPRHA) took several preparatory
steps on the way to wide EC access, including:

1. an assessment tool to help nursing professionals determine
   whether and when a report must be made for a sexual assault under Wisconsin
   law.
2. several coalition-building conferences to build public/policy support.
3. statewide training
   for reproductive health professionals in 2005 on how EC works and what
   are the best medical practices for its use. The association is
   planning to review and update the training in 2009.

The most important piece of
the puzzle is that Wisconsin’s
Department of Health Services
implemented policies that enable uninsured and underinsured low and
moderate income women to receive Medicaid-paid contraceptive services
and supplies. Being able to give EC at no charge in advance of
need is the foundation on which EC access is based.

As for results: at FPHS
clinics, positive
pregnancy tests as an annual percentage of total patients has dropped
from (pre-Family Planning Waiver) 5.5% (about 350 positive pregnancy
tests) to 2% (about 180 positive pregnancy tests) for the last three
years. There may be a non-EC explanation, but it’s not likely.
Because preventing unwanted pregnancies is how we can define EC success,
for FPHS, free EC in advance has been a success. Maybe it
is as simple as that.