Project Pharmacy: Educating and Informing about Emergency Contraception

Lynda Waddington

Project Pharmacy's aim is 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.

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.

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"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.

Roundups Law and Policy

Gavel Drop: Welcome to the New World After ‘Whole Woman’s Health’

Imani Gandy & Jessica Mason Pieklo

With the recent U.S. Supreme Court ruling, change may be afoot—even in some of the reddest red states. But anti-choice laws are still wreaking havoc around the world, like in Northern Ireland where women living under an abortion ban are turning to drones for medication abortion pills.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts.

The New York Times published a map explaining how the U.S. Supreme Court’s ruling in Whole Woman’s Health v. Hellerstedt could affect abortion nationwide.

The Supreme Court vacated the corruption conviction of “Governor Ultrasound:” Former Virginia Gov. Bob McDonnell, who signed a 2012 bill requiring women get unnecessary transvaginal ultrasounds before abortion.

Ian Millhiser argues in ThinkProgress that Justice Sonia Sotomayor is the true heir to Thurgood Marshall’s legacy.

The legal fight over HB 2 cost Texas taxpayers $1 million. What a waste.

The Washington Post has an article from Amanda Hollis-Brusky and Rachel VanSickle-Ward detailing how Whole Woman’s Health may have altered abortion politics for good.

A federal court delayed implementation of a Florida law that would have slashed Planned Parenthood’s funding, but the law has already done a lot of damage in Palm Beach County.

After the Whole Woman’s Health Supreme Court ruling in favor of science and pregnant people, Planned Parenthood is gearing up to fight abortion restrictions in eight states. And we are here for it.

Drones aren’t just flying death machines: They’re actually helping women in Northern Ireland who need to get their hands on some medication abortion pills.

Abortion fever has gone international: In New Zealand, there are calls to re-examine decades-old abortion laws that don’t address 21st-century needs.

Had Justice Antonin Scalia been alive, explains Emma Green for the Atlantic, there would have been the necessary fourth vote for the Supreme Court to take a case about pharmacists who have religious objections to doing their job when it comes to providing emergency contraception.

News Law and Policy

Supreme Court Rejects Challenge to Washington Law Requiring Pharmacies to Stock Plan B

Jessica Mason Pieklo

On Tuesday the Roberts Court turned away a challenge by a pharmacy-owning family who claimed a Washington state law that requires pharmacies to stock Plan B or other emergency contraception violated their religious beliefs.

The Supreme Court on Tuesday refused to hear a challenge by a pharmacy owner who claimed religious objections to a Washington law requiring pharmacies to stock and dispense Plan B or other emergency contraception.

In 2007, the Washington State Board of Pharmacy adopted rules governing the mandatory stocking and delivery of emergency contraception. The rules do not require any individual pharmacist to dispense medication in conflict with their religious beliefs. Instead, if a pharmacy employs a pharmacist who objects to dispensing emergency contraception for religious reasons, the pharmacy must keep on duty at all times a second pharmacist who does not object to dispensing those drugs.

The Stormans family—who own a local grocery store and pharmacy in Olympia, Washington—challenged the rules in 2012, arguing that the rules required them to violate their religious beliefs. Those beliefs, they said, include a conviction that life begins at conception; therefore, emergency contraception acts as an abortifacient, which they also object to providing.

The medical community does not consider emergency contraception to be an abortifacient.

A district court agreed with the Stormans that the rules could force them to violate their religious beliefs by stocking the medication. But in 2015, the U.S. Court of Appeals for the Ninth Circuit reversed and rejected the Stormans’ claim.

On Tuesday the Supreme Court let stand that Ninth Circuit ruling. However, Chief Justice John Roberts and Justices Samuel Alito and Clarence Thomas dissented from that decision. Writing for the dissenting justices, Alito called the case “an ominous sign” for religious liberties protections in the country.

“There are strong reasons to doubt whether the regulations were adopted for—or that they actually serve—any legitimate purpose,” wrote Alito. “And there is much evidence that the impetus for the adoption of the regulations was hostility to pharmacists whose religious beliefs regarding abortion and contraception are out of step with prevailing opinion in the State. Yet the Ninth Circuit held that the regulations do not violate the First Amendment, and this Court does not deem the case worthy of our time,” continued Alito.

“If this is a sign of how religious liberty claims will be treated in the years ahead, those who value religious freedom have cause for great concern,” he continued.

American Civil Liberties Union Deputy Legal Director Louise Melling disagreed with Justice Alito’s assessment of the case. “The court properly refused to take this case,” Melling said in a statement following the order. “When a woman walks into a pharmacy, she should not fear being turned away because of the religious beliefs of the owner or the person behind the counter. Open for business means opens for all,” said Melling.

“Refusing someone service because of who they are—whether a woman seeking birth control, a gay couple visiting a wedding catering company, or an unwed mother entering a homeless shelter—amounts to discrimination, plain and simple. Religious freedom is a core American value and one that we defend, but religious freedom does not mean a free pass to impose those beliefs on others,” Melling wrote.

Meanwhile, Alliance Defending Freedom Senior Counsel Kristen Waggoner, who represented the plaintiffs in the case, expressed disappointment in the decision. “All Americans should be free to peacefully live and work consistent with their faith without fear of unjust punishment, and no one should be forced to participate in the taking of human life,” said Waggoner in a statement after the denial. “We had hoped that the U.S. Supreme Court would take this opportunity to reaffirm these long-held principles.”