By Linda Carroll

(Reuters Health) – Teens seeking to buy emergency contraception at pharmacies continue to face significant roadblocks, a new U.S. study suggests.

Researchers checking on the accessibility of the “morning after pill” at pharmacies in four Southwestern states found that just 28 percent made it simple and straightforward for teens to purchase the emergency contraception, according to the results published in the Journal of Adolescent Health.

The U.S. Food and Drug Administration initially cleared over-the-counter emergency contraception access only for people ages 18 and older. Later, the FDA lowered the age for non-prescription access to 17 before ultimately extending access to people of all ages in 2013.

“Despite the FDA ruling . . . that emergency contraceptives should be sold over-the-counter without age or identification restrictions, this is not being fully implemented into the pharmacy setting as anticipated,” said the study’s lead author, Jasmine Uysal, research coordinator at the Center on Gender Equity and Health at the University of California, San Diego.

“Pharmacy staff impose barriers. They don’t seem to understand that adolescents can get emergency contraception without IDs. Also, the medication is often still placed in locked boxes behind the counter instead of in the aisles.”

To take a closer look at how easy, or difficult, it is to get emergency contraception – often referred to by its brand name Plan B – at pharmacies, Uysal and her colleagues recruited 15 undergraduate and graduate students from the University of California to be “mystery callers.” The 10 women and five men called pharmacies in April and May of 2016, posing as heterosexual 16-year-olds whose condom had broken during sex the previous night. The mystery callers asked pharmacy clerks “if there was any way to prevent pregnancy.”

If the pharmacy staff member told them about emergency contraception, the mystery callers than asked further questions about price, location of the emergency contraception in the store, and if they could “just come in on their own” to get it.

In all, 1,475 pharmacies in California, Arizona, New Mexico and Utah were included in the study. National chains, such as Walgreens or CVS, were significantly more likely than regional chains or individually-owned retailers to carry the morning-after pill. The researchers found major differences between the pharmacy types when answering two mystery caller questions: “Can I come in on my own?” and “Where is the product located in the store?”

While 94 percent of national chain pharmacies said the callers could come in on their own, just 67 percent of the individually-owned pharmacies did. Similarly, 52 percent of national chains versus 9 percent of individually-owned stores had the product readily available on a shelf rather than in a locked box or behind the counter.

Overall, one in five pharmacies did not have the morning after pill in stock at all. Once again, national chains were a better bet, with 91 percent reporting availability versus 57 percent of individually-owned pharmacies. This could turn out to be a bigger issue for teens who live in rural areas, “where maybe the individually-owned pharmacy is the only one accessible to you,” said study coauthor Paula Tavrow of the Fielding School of Public Health at the University of California, Los Angeles.

Another issue that might be embarrassing and off-putting to teens: 3 percent of the callers reported being asked personal questions, such as their name or their birth date.

Dr. Ian Bishop welcomed the new research. “I was very glad to see the publication of this article,” said Bishop, a clinical fellow in family planning at NewYork-Presbyterian/Columbia University Medical Center. “It raises a lot of concerns for young people who don’t always have access to timely care (from a physician).”

Since those young people will need to purchase the product at a pharmacy, “it’s extremely important to highlight the many real-life barriers,” said Bishop who was not involved in the new research. “I think a lot of this has to do with misinformation about the medication and a big part of that has to do with educating pharmacists about it, emphasizing that it is safe and most effective when it is taken quickly.”

Bishop suspects that some of the misinformation is related to the abortion debate. This product doesn’t cause abortion, Bishop said. “Plan B works by delaying ovulation,” he explained. “And the hope is that with the delay, sperm and egg won’t meet and a pregnancy won’t develop.”

SOURCE: Journal of Adolescent Health, online October 26, 2018.