The Indian Health Service (IHS) released a long overdue policy last week that will make over-the-counter emergency contraception more accessible for Native American women of all ages.
The policy comes more than two years after the U.S. Food and Drug Administration (FDA) lifted age restrictions on certain emergency contraceptive pills and more than six months after a group of U.S. senators called on the Department of Health and Human Services (HHS) to develop a policy that would ensure access for women who rely on IHS.
A 2014 survey by the Native American Women’s Health Education Resource Center found that access to emergency contraception (EC) varied widely at 69 IHS centers. Some Native American women are in rural areas where the next-closest pharmacy may be hundreds of miles away, and they may not have transportation.
EC is a high dose of the hormones found in birth control pills that can prevent pregnancy by inhibiting ovulation. EC can work if taken up to five days after unprotected sex, but the sooner it is taken, the more effective it can be. That’s why immediate access is important. It is also why advocates for access to this method of birth control fought for almost a decade to make it available without a prescription.
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In July 2009, the FDA approved one of the available versions of EC—marketed as Plan B One-Step— for over-the-counter sale, but limited the sale to women 17 and older. Younger women still needed a prescription.
The FDA in April 2013 lowered the age restriction to 15. A few months later, however, the FDA agreed to comply with a district court ruling and declared that Plan B One-Step would be available without a prescription for “all women of reproductive potential,” regardless of age.
A group of lawmakers led by Sen. Barbara Boxer (D-CA) asked HHS in March for a policy that would ensure that pharmacies run by IHS would follow the new guidelines and make EC easily available, as Rewire reported.
Though HHS promised it was working on the policy in 2013, it released nothing until this week. When Boxer and colleagues readdressed the issue earlier this year, Boxer had conducted a survey of 20 IHS pharmacies and found that some did not offer EC at all, some continued to require a prescription, and others only allowed women of certain ages to access the pills.
The need for EC among women who rely on IHS is clear. As the ACLU has noted, Native Americans face rates of sexual assault that are more than twice as high as other women in this country: One out of three Native American women will be raped during her lifetime. Access to EC is vital for rape survivors.
The policy was finally released last week and is fairly simple. It states, “It is IHS policy the Plan B One-Step emergency contraception pill is easily available through the IHS facilities’ pharmacy, Emergency Department (ED), and in health clinics that are equipped with secure medication storage areas.”
The challenge now is to make sure it is widely implemented.
“The updated policy IHS released today is a long overdue and important step toward ensuring that Native American women have equal access to emergency contraceptive care,” Georgeanne Usova, legislative counsel for the ACLU, said in a statement. “The policy must now be rigorously enforced so that every woman who relies on IHS for her health care can walk into an IHS pharmacy and obtain the services she needs and is legally entitled to.”