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Barriers to Adolescents' Getting Emergency Contraception Through Pharmacy Access in California: Differences by Language and Region

Authors

  • Olivia Sampson,

    Corresponding author
    1. Olivia Sampson is former research fellow, and Norman Hearst is professor, both in the Department of Family and Community Medicine;
      oli.sampson@yahoo.com
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  • Sandy K. Navarro,

    1. Sandy K. Navarro is social scientist, Bixby Center for Reproductive Health Research and Policy; and
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  • Amna Khan,

    1. Amna Khan was a medical student in the School of Medicine—all at the University of California, San Francisco (UCSF).
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  • Norman Hearst,

    1. Olivia Sampson is former research fellow, and Norman Hearst is professor, both in the Department of Family and Community Medicine;
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  • Tina R. Raine,

    1. Tina R. Raine and Suellen Miller are associate professors, Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF.
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  • Marji Gold,

    1. Marji Gold is professor, Department of Family and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
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  • Suellen Miller,

    1. Tina R. Raine and Suellen Miller are associate professors, Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF.
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  • Heike Thiel De Bocanegra

    1. Heike Thiel de Bocanegra is academic coordinator and director, Family PACT UCSF Program Support and Evaluation, Bixby Center for Global Reproductive Health, UCSF.
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oli.sampson@yahoo.com

Abstract

CONTEXT: In California, emergency contraception is available without a prescription to females younger than 18 through pharmacy access. Timely access to the method is critical to reduce the rate of unintended pregnancy among adolescents, particularly Latinas.

METHODS: In 2005–2006, researchers posing as English- and Spanish-speaking females—who said they either were 15 and had had unprotected intercourse last night or were 18 and had had unprotected sex four days ago—called 115 pharmacy-access pharmacies in California. Each pharmacy received one call using each scenario; a call was considered successful if the caller was told she could come in to obtain the method. Chi-square tests were used to assess differences between subgroups. In-depth interviews with 22 providers and pharmacists were also conducted, and emergent themes were identified.

RESULTS: Thirty-six percent of all calls were successful. Spanish speakers were less successful than English speakers (24% vs. 48%), and callers to rural pharmacies were less successful than callers to urban ones (27% vs. 44%). Although rural pharmacies were more likely to offer Spanish-language services, Spanish-speaking callers to these pharmacies were the least successful of all callers (17%). Spanish speakers were also less successful than English speakers when calling urban pharmacies (30% vs. 57%). Interviews suggested that little cooperation existed between pharmacists and clinicians and that dispensing the method at clinics was a favorable option for adolescents.

CONCLUSIONS: Adolescents face significant barriers to obtaining emergency contraception, but the expansion of Spanish-language services at pharmacies and greater collaboration between providers and pharmacists could improve access.

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