Advancing Sexual and Reproductive Health and Rights
Perspectives on Sexual and Reproductive Health
Volume 41, Number 2, June 2009

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

By Olivia Sampson, Sandy K. Navarro, Amna Khan, Norman Hearst, Tina R. Raine, Marji Gold, Suellen Miller and Heike Thiel de Bocanegra

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.

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.




Olivia Sampson is former research fellow, and Norman Hearst is professor, both in the Department of Family and Community Medicine; Sandy K. Navarro is social scientist, Bixby Center for Reproductive Health Research and Policy; and Amna Khan was a medical student in the School of Medicine—all at the University of California, San Francisco (UCSF). Tina R. Raine and Suellen Miller are associate professors, Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF. Heike Thiel de Bocanegra is academic coordinator and director, Family PACT UCSF Program Support and Evaluation, Bixby Center for Global Reproductive Health, UCSF. Marji Gold is professor, Department of Family and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.