Emergency Contraception Fills in Massachusetts Spiked After This Policy Change

Making emergency contraception easier to get leads to more people getting emergency contraception. Who would've guessed?

Between August 2022 and October 2023, the number of people filling emergency contraception prescriptions in Massachusetts spiked. Was the state experiencing an epidemic of unprotected sex?

Probably not. Researchers attribute the increase to the state making it easier for pharmacists to dispense the emergency contraceptives ulipristal (sold under the brand name Ella) and levonorgestrel (sold as Plan B), thereby making it easier for women to walk into a pharmacy and quickly walk out with the medication.

Making emergency contraception easier to prescribe and easier to get leads to more people getting emergency contraception. Who would've guessed?

Removing Barriers to Access

"Emergency contraceptives are key in preventing pregnancy after unprotected sexual intercourse and contraceptive failure," note Dima M. Qato, PharmD, Jenny Guadamuz, and Rebecca Myerson in a research letter published by the Journal of the American Medical Association (JAMA).

More than two dozen states now allow birth control pills—including emergency contraception—to be picked up at a pharmacy without first obtaining a doctor's prescription. These medications are still technically prescription-only (as required by the U.S. Food and Drug Administration), but a pharmacist can write someone a prescription on the spot.

"However, these policies require pharmacists to undergo additional training and patients must complete a health questionnaire," the researchers explain in their JAMA letter. "Given these barriers, many pharmacies do not implement pharmacist-prescribed contraception services."

In an attempt to overcome pharmacy barriers, Massachusetts did something unusual: it deregulated. In August 2022, the state issued a statewide standing order allowing pharmacists to dispense the emergency contraceptives ulipristal and levonorgestrel without doing any extra training. Pharmacists could prescribe the medications to someone after asking just a few basic questions.

"The Massachusetts policy overcomes prescribing barriers by using the state as the prescriber," note Qato and colleagues, all professors in some form of health education (Qato at the University of Southern California's School of Pharmacy and Pharmaceutical Sciences*, Guadamuz at the University of California, Berkeley School of Public Health, and Myerson in the University of Wisconsin Madison's Department of Population Health Sciences). Their study "evaluated the association between Massachusetts' statewide standing order and emergency contraceptive fills at retail pharmacies."

They found that emergency contraception fills went up after the standing order was implemented—from 78.5 per 100,000 women of reproductive age in Massachusetts to 105.3 fills per 100,000 women.

Same Spike Not Seen in Other States

The increase in emergency contraception fills was associated with a spike in prescription-only ulipristal fills and no significant change for prescribed levonorgestrel, which is also available without a prescription. The authors note that ulipristal is effective for up to five days after unprotected sex, compared to three days for levonorgestrel, and is considered more effective in overweight and obese women.

OK, you might be thinking—but this was right after the Dobbs decision, which overturned Roe v. Wade. Couldn't fear about what the decision would mean for birth control or abortion access have led to an increase in emergency contraception prescriptions? That's indeed plausible.

But Qato and her colleagues didn't simply find an increase in Massachusetts residents picking up prescription emergency contraception. They also found an increase that was 32 percent larger than in comparison states.

The comparison states they used were Illinois and Connecticut. "Illinois and Connecticut did not implement statewide standing orders but otherwise resembled Massachusetts in their abortion and contraceptive policies, including requiring insurance to cover prescribed emergency contraceptives without cost sharing," note the researchers.

In Illinois and Connecticut combined, there were 45.8 emergency contraceptive fills per 100,000 women during the first period studied (July 2021 to May 2022) and 48.4 in the second period (August 2022 to October 2023). All in all, "the statewide standing order policy was associated with an additional 25.2 emergency contraceptive fills per 100,000 in Massachusetts vs comparison states," the researchers found.

Their conclusion: "Policies that reduce prescribing barriers may improve access to emergency contraceptives."

That takeaway may seem obvious, but it's still nice to have some data to back up our common sense. The study provides one more piece of evidence to suggest that activists and politicians aiming to prevent unintended pregnancies and reduce abortion numbers should figure out ways to remove access barriers to emergency contraception.

Alas, we can't really draw any conclusions about whether or how the Massachusetts policy change on emergency contraception affected abortion rates in the state, since the state concurrently saw an influx of out-of-state visitors seeking abortions. In general, evidence has been mixed on whether increasing access to emergency contraception brings down abortion rates.

More Sex & Tech News

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Breton is empowered to oversee enforcement of the Digital Services Act and can communicate independently with companies.

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• California's artificial intelligence bill threatens to derail open-source innovation, Andy Jung warns.

Today's Image

Conservative Political Action Conference, National Harbor, Maryland | 2017 (ENB/Reason)

*CORRECTION: This post previously misstated the name of USC's pharmaceutical school.

Comments

[Don't look at me!]

It’s retarded to have to fill out a questionnaire at a pharmacy for something that has been prescribed by a doctor.

[Rick James]

I believe that's pronounced "Retahded" in Massachusetts.

[GroundTruth]

Actually, the accent is harshening; these days it's more like "retayhed" .... not quite that bad, but going in that direction.

Hurts my ears to live around these people.

[Social Justice is neither]

How much of that is the things they say vs how they say it?

[NoVaNick]

Ruh-tah-ded, at least that’s how it was pronounced when I was growing up there in the 1980s

[Nelson]

I believe that the questionnaire is for people who don't have a prescription from a doctor. At least that's how I read it.

[sarcasmic]

Am I the only one who, at first glance, thought it said "Constipation Pills"?

[SQRLSY]

At first glance, thought it said “Constitution Pills”, which almost all of us REALLY-really NEEEED, badly... Especially the nine so-called "justices" of the SCROTUS! Scrote 'em, SCROTUS! Scrote 'em good and hard!

[Don't look at me!]

It makes sense, as you are full of shit.

[John F. Carr]

The standing order allows for advance purchase so you can stock up in advance of a wild weekend. Possibly the extra pills in Massachusetts go unused.

[Mickey Rat]

I suppose, the bright side of this is the potential extinction of Massholes.

[Rick James]

Birth Rate Ranking: Massachusetts has a birth rate of 9.4 births per 1,000 people, ranking 7th lowest among states, compared to the national average of 10.8 births per 1,000 people (Source: 24/7 Wall St., January 19, 2022).

I am 737% for blue states pushing these policies.

[MK Ultra]

737 was a nice pull.

https://youtu.be/UbHQT73w8Mg?si=W5AT-BBQhLDcBFX4

[NoVaNick]

Could also be that even the people who have uteruses admit what a shithole the state has become and don’t want to bring up any kids there.

[Rick James]

78.5 per 100,000 women of reproductive age in Massachusetts to 105.3 fills per 100,000 women.

What does this do to the ratio of childless cat ladies?

[mad.casual]

Ctrl+f ‘mifeprist’: 0 results.
Ctrl+f ‘misopros’: 0 results.

Wait, wait, wait. I thought there was only one emergency contraceptive that women could take to prevent pregnancy and if there wasn’t an amendment to The Constitution to protect it, women around the country would be forced to shove coathangers in their hoohahs in back alleys in order to attain the ability to work anywhere outside the kitchen?

Now you’re telling me that there are a myriad of ways for women (and men) to have sex *and* avoid getting pregnant (*and* work outside the kitchen), both before and after the fact, that don’t even approach being an abortion, that nobody gives a shit about, and that don’t require a federal amendment to prevent A Handmaid’s Tale from being institutionalized in this country?

Next you’ll probably tell me that Alabama’s abortion law didn’t, in fact, have any impact on IVF providers in the state and that the whole hullabaloo about legal liability for IVF (malpractice) and the Governor passing protection for it into law was so that IVF and reproduction could be brought under the law as an affirmative right (in a totally-not-A-Handmaid’s-Tale fashion).

[Nelson]

Emergency contraceptives are contraceptives. The ones you're thinking of are abortion drugs. They are very different things.

One of the many, many, many false things anti-abortionists believe is that emergency contraception is the same as abortion. Because they are incapable of understanding nuance or accepting things they don't like.

[markm23]

If you are a mystic who thinks that a human soul comes along with the sperm, then the morning after pill may do an abortion depending on how quickly the sperm fertilized the egg. If it's been 3 days, either the egg's been fertilized or it won't be, so a pill taken 3 to 5 days later was either not needed or definitely an abortion.

OTOH, if you are a thinking human who realizes that humans are distinguished from animals by their nervous system, then the point where the fertilized egg becomes a human is somewhere between 16 weeks and full-term. Since I once had an ob/gyn misjudge my wife's stage of pregnancy by 4 to 6 weeks, I'd go by quickening - the point where the nervous system has grown enough that it triggers random limb movements. It's still inferior to a new-born puppy's nervous system, but it's doing _something_ more than a metronome beat.

[Bubba Jones]

The availability of Plan B increases the frequency of unprotected sex.

Surprise.

I don't oppose Plan B, but ffs, condoms are cheaper and easier.

[MWAocdoc]

And less effective, even if used correctly.

[Nelson]

"The availability of Plan B increases the frequency of unprotected sex."

You struggle with reading comprehension, don't you? Nothing like that was said, it's just you making unsupported declarations. Typical of anti-abortionists.

[Liberty_Belle]

The availability of Plan B increases the frequency of unprotected sex.

Surprise.

1. That statement is opinion and has no basis in evidence.
2. What business of it is yours what other consenting adults do ?

[MWAocdoc]

"Breton is empowered to oversee enforcement of the Digital Services Act and can communicate independently with companies."

Well, let's see now ... a cage fight between Breton and Musk. Breton threatens to hold Musk personally liable. Musk halts all access to his platforms for everyone inside the EU. Breton caves. ROFL!

[charliehall]

Oral contraceptives, including emergency contraceptives (which are the same thing but with different dose) should have been over the counter for decades. But politics....

[markm23]

A few percent of women react badly to having their hormones manipulated to simulate pregnancy and then not-pregnancy once a month. That gives the doctors who want the money and power from forcing sexually active women to come to them an opening to argue that selling contraceptives without a doctor’s permission is unsafe.

But I’ll bet those doctors never refuse a prescription because they anticipate bad side effects, and never know about the side effects until their patients complain. So what they are claiming is that women are too stupid to stop something that they know is hurting them, but smart enough to tell their doctor about it, even though he never asked… Or in other words, they are engaged in illogic or deception for profit.