Complaining that emergency contraceptives are still not within easy reach of many women, health activists are trying to improve access to medication that they say could reduce the nation's high rate of unplanned pregnancies.
In Los Angeles, Planned Parenthood's 11 clinics have begun offering most patients a dose of the so-called morning-after pills to take home with them--for a fee of $5--just in case.
And the Los Angeles-based Pacific Institute for Women's Health recently published two guides--one for consumers and one for health practitioners--to promote awareness of the pills.
"We need to very much keep the pressure on and try to [make] this accessible to the man and woman on the street," says Francine Coeytaux, an associate of the nonprofit institute. "We do have a lot of barriers still."
Doctors had long known that certain combinations of ordinary birth control pills can be safely taken within a few days after unprotected intercourse to help prevent pregnancy. But the first dedicated emergency contraceptive, called Preven, became available in late 1998. A second product, called Plan B, arrived in 1999. (They are not the same as the so-called abortion pill, which induces abortion once a pregnancy is established and confirmed.)
The emergency contraceptives, which cause nausea in some women, must be taken within 72 hours after unprotected intercourse. Both are highly effective, giving rise to expectations that the products could make a dent in the estimated 3 million unintended pregnancies and 800,000 abortions that occur each year in the United States.
While surveys show that awareness of emergency contraceptive pills is rising, Coeytaux says: "I think that those who thought this would be the be-all and end-all and would help us reduce abortions are probably realizing now that that's not true."
It's no mystery why emergency contraceptive pills remain more promising than practical.
The problem is time.
"Unlike other [contraceptive] methods, this one has a window of time in which it has to happen, or it's not effective," Coeytaux says.
Women typically are not offered the pills to have handy for future use and then do not have enough time to obtain them in an emergency, say family planning experts.
Even individuals who call a national hotline listing emergency contraceptive health practitioners often have difficulty getting the pills. A survey of the hotline ( NOT-2-LATE) found that 14% of the calls resulted in failure to obtain an appointment or prescription within 72 hours of calling. The study was published in the February issue of the journal Obstetrics & Gynecology.
"The vast majority of providers do a good job. But we were certainly discouraged that people who self-selected to provide emergency contraceptives didn't do a better job," says James Trussell, an author of the study and professor of economics and public affairs at Princeton University and a leading advocate of the method. "The bottleneck [in the access process] is that physicians don't routinely counsel women or prescribe it in advance."
The study found that some callers failed to even make telephone contact with the provider, that doctors refused to see women who were not established patients, or that appointments were unavailable.
The survey was taken on weekdays, Trussell notes, suggesting that women who try to call for emergency contraceptives on a Saturday morning, when doctors' offices are usually closed, will encounter even greater obstacles.
And there have been other snags in bringing emergency contraceptives to the marketplace. Under some state laws, pharmacists can refuse to dispense emergency contraceptives if doing so would conflict with their moral or religious beliefs.
But even the majority of pharmacists who are willing to fill prescriptions for Preven or Plan B sometimes don't have the medication in stock, Coeytaux says. The sooner the medication is taken, the more effective it is.
"The pharmacists haven't ordered lots of them to have in stock," she says. "That's a huge problem. Pharmacists are business people. They only stock a product once they recognize there is a demand. It will take a while for them to realize that people want this."
Another barrier is cost and insurance coverage. Emergency contraceptives usually cost $20 to $25 (or less in family planning clinics) plus the doctor's office fee.
Under California law, all contraceptives must be covered by insurance. But emergency contraceptives require special billing procedures in order for providers to be reimbursed--a problem that has caused many rejected claims in California because of doctors' unfamiliarity with the process, Coeytaux says.
Despite the growing pains, family planning advocates say there are solutions to nearly all of the problems thwarting access to emergency contraceptive pills.
For example, Planned Parenthood is leading the charge to encourage all women of childbearing age to have a dose on hand or to obtain a prescription to fill in an emergency.