A woman’s ability to delay and plan for childbirth is essential to her health, as well as her education and career goals, said Dr. Sally Rafie, pharmacist at the University of California San Diego Health and assistant clinical professor at Skaggs School of Pharmacy and Pharmaceutical Sciences at UC San Diego. “There’s a lot of evidence that when a woman has control over when she has children, and how many, she is more likely to stay in school, earn an advanced degree and work, which in turn positively contributes to her family’s income and stability, as well as her own and her children’s mental and physical health,” she said.
But in order to use birth control, a woman must be able to get what she needs in a timely and affordable manner, whether that be in the form of a pill, implant, patch, shot, intrauterine device or vaginal ring. (This may also apply to transgender or gender non-conforming/non-binary individuals, but for simplicity’s sake, we’ll just use “woman” and “she/her” in this article.)
“Birth control access in this country is challenging,” Rafie said. “Most of our methods are only available with a prescription, and there are a lot of steps involved in getting and filling that prescription.” In order to get a prescription, a woman is typically required to make an office or clinic visit, but Rafie said not everyone has the insurance, time, transportation and child care needed to get to an appointment during normal working hours. Then the woman must visit a pharmacy to fill the prescription, and insurance companies have different strategies for what’s covered. That means women often have to negotiate to get the best birth control method for them, at the best price. “And these barriers most affect women who are already socioeconomically disadvantaged, making their lives even more difficult,” Rafie said.
In California and some other states, women can now obtain many forms of prescription birth control directly from a pharmacist without going to the doctor first. That’s great news, Rafie said, but pharmacies aren’t required to do it and since only some have opted into the service, that puts the burden on women to find those that do. To make it easier, Rafie and colleagues created Birth Control Pharmacies, an easy-to-use map that now includes more than 1,000 birth control-prescribing pharmacies nationwide. These grassroots efforts have made Rafie a go-to expert. Legislators in states that don’t yet offer birth control prescriptions at pharmacies are reaching out for her expertise as they seek to implement new policies.
In addition to standard birth control, Rafie wants to understand the challenges that keep pharmacies from opting to provide emergency contraception, also known as the morning-after pill or Plan B. To this end, she and Dr. Sheila Mody, director of the Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences at UC San Diego Health, recently received a pilot Dissemination and Implementation (D&I) grant from the UC San Diego Altman Clinical and Translational Research Institute to survey and conduct interviews with pharmacies statewide. They are interviewing pharmacists and pharmacy technicians throughout California to assess their knowledge of emergency contraception and the barriers to prescribing it.
So far, they are uncovering a number of organizational and logistical challenges.
“For example, pharmacists need to be able to carve out extra time in their normal workflow to provide the required counseling when a woman requests emergency contraception,” Mody said. “They aren’t necessarily compensated for that extra time, and so the pharmacy may not have the incentive to offer it.”