Flagstaff pharmacies give mixed messages
on emergency contraceptives
by Shannon Wells - Flagstaff Resident

Imagine trying to fill a prescription for your heart medication at a local pharmacy and being told they do not carry it. No, it’s not that they carry a generic form of it, or that they’re temporarily out of stock. The national headquarters has made a decision they will not carry the legal medication for “ethical” reasons. Now imagine there are no other choices in your small town for this medication because the national chain has run the competition out of business. The national chain is Wal-Mart. The medication is Emergency Contraceptive Pills (ECP).

ECP, commonly known as the “morning-after pill,” is the only non-surgical, postcoital option to prevent pregnancy in the United States. (It is not “RU486,” an antiprogestogen drug still being reviewed by the FDA.) ECP is taken prior to conception, so is not a medication that results in an abortion. ECP must be taken by a woman within 72 hours of intercourse (coitus). It also requires a clinician’s prescription. So there is a slim window of time between the sexual activity and when she must make an appointment with her clinician, receive a prescription, go to the pharmacy to fill the prescription and take the series of pills that will hopefully stop fertilization.

Wal-Mart’s refusal on ethical grounds to provide women a legal medication has naturally become a heated national debate. Some national women’s health organizations are encouraging communities to boycott Wal-Mart.

The scope of my investigation
We wondered what the availability of ECP was in Flagstaff pharmacies, including Wal-Mart. We also wondered about the accuracy of the information local pharmacists provide. Our research was couched within this framework: Either by visiting or phoning local pharmacies, I posed as a customer needing information about ECP. I asked pharmacists at the eight local pharmacies these four questions: What is ECP? How does it work? How can I obtain the medication? Does your pharmacy carry the medication? As you will notice in the following narrative, several pharmacists referred me to Planned Parenthood, indicating that they have more information regarding ECP and also prescribe/administer the medication. So I also called and stopped by the local Planned Parenthood affiliate and asked the same questions. First, here are the facts about the medication:

According to the most recent issue of Contraceptive Technology, the premier reference for family planning, ECP is a dose of hormones, similar to birth control pills, that reduce the possibility of a pregnancy occurring. The hormones reduce the likelihood that sperm will fertilize an egg. Treatment is most effective if initiated within the first 12-24 hours. Originally, birth control pills containing ethinyl estradiol and norgestrel were used in two treatment doses, taken 12 hours apart. Now, many clinicians are prescribing a commercial product specifically for postcoital use called “Plan B,” (as in “if Plan A doesn’t work …”). Plan B is progestin only, and involves two pills instead of four or eight, with fewer side-effects than the previous medication. Three decades of research demonstrate ECP’s safety and efficacy. 

None of the local pharmacies carry the newer Plan B option, so all of the information below concerns the original ECP medication.

Let the tests begin
The pharmacist at Flagstaff Pharmacy was very pleasant and helpful. She gave some accurate information regarding the medication but said that if there was an impregnated egg, ECP would stop it from implanting into the uterus. Now this is a big difference from the research demonstrating it doesn’t allow an egg to even get impregnated. She also indicated if taken more than 24 hours from coitus, it wasn’t very effective. She mentioned an ECP kit that included a pregnancy test, but said she didn’t stock them. They do stock the traditional ECP. She referred me to Planned Parenthood.

Albertson’s pharmacist repeated the inaccurate information that ECP prevents a fertilized egg from implanting and that it changes the environment of the uterus. He was accurate about timing and mentioned the new kits, which they don’t stock, and said he stocks the original ECP. He also referred me to Planned Parenthood, NAU’s Fronske Health Center or a walk-in clinic.

The pharmacists at Fry’s and Osco’s were the most inaccurate, as well as unpleasant. At Fry’s the pharmacist said ECP is a high dose of birth control pills, that “it depends on how they work,” that ECP “somehow terminates it. You take the birth control pills all at once or something.” When I pushed for further information, he suggested I see a physician and did acknowledge he carries ECP. When I asked Osco’s pharmacist about ECP, he asked if I meant condoms. When I used the older term “morning-after pill,” he said it’s a high strength hormone. “(You’ve) already conceived, so it stops a pregnancy. It aborts, basically.” He wasn’t sure of the time period to take the medication, and indicated he didn’t want to discuss this anymore.

At Safeway, the pharmacist said ECP is a high dose of progesterone taken at once to “take care of it.” She did indicate it worked on the aspect of the egg being penetrated by sperm. The time period was 48 hours, beyond that, she said it’s more questionable whether it will work. She does carry the medication.

At SavOn Drug, the information about number of pills and time to take was accurate, but the man behind the counter said ECP works the same as the pill, that I need to talk with my doctor, that they do carry them, and that most people go to Planned Parenthood.

With Walgreens, I also had to use the “morning-after pill” terminology. The pharmacist was quick to get me off the phone. She said “it’s like a birth control pill type of thing,” and that “the sooner you do it, the better off you are.” And yes, they do carry it.

Planned Parenthood most accurate
Planned Parenthood mirrored the information found in Contraceptive Technology in detail. All of the information was accurate. I spoke with a clinician who was pleasant and helpful. She said they see women on an appointment basis, do a thorough medical history and assessment, a pregnancy test and possibly an exam. They stock both the original ECP as well as Plan B. She also said Fronske, Flagstaff’s two walk-in clinics, the FMC Emergency Room and gynecologist’s offices prescribe and carry ECP. She even suggested I look at Planned Parenthood’s website for further information.

ECP’s not available at Wal-Mart
And now for the unfortunate, finale: Wal-Mart. First, I visited Wal-Mart and asked about ECP. An uncomfortable pharmacy aid needed further information. “You know, the morning-after pill,” I said. He quickly got a pharmacist. The pharmacist was pleasant, and when asked about whether they carry ECP, acknowledged that they did not. When asked why, he politely referred me to their general manager, handing me a sticky note with the general manager’s name and number on it. Knowing the answer is because Wal-Mart administration is attempting to pass on their morality choices to their customers, I did not call the number on the sticky note. I also called the local Wal-Mart store, hoping to hear a different answer. The pharmacist again was pleasant, told me accurate information about the medication, including that it “prevented fertilization of an egg.” He acknowledged that he doesn’t carry ECP, and when pushed further, deferred to company policy. “Unfortunately, we as pharmacists, don’t have a say,” he said sadly. “You’ll need to try another pharmacy.”

Corporate Wal-Mart does not shy from their political and moral choices. They are up front, and to heck with those who disagree. But what if a woman has no choice. She lives in a rural area where all other pharmacies were run out of town by the towering giant. She doesn’t want to become pregnant. Time is running out. Where does she go? How does she get there? Is it too much of a hassle, so she has another unwanted child?

Thank goodness that in Flagstaff, women have options. We can get our prescriptions filled at several other pharmacies. But what of the education? What if you want an option that prevents pregnancy, yet are told by your pharmacist that ECP results in an abortion? What about the time discrepancies? Let’s hope that would be clarified with an actual clinician’s prescription. Let’s hope the pharmacist doesn’t attempt to pass on his/her belief system. Let’s hope ECP becomes more accessible, and less expensive. Let’s hope women and their partners find reliable birth control prior to intercourse, and that options remain for those who do not.

Shannon Wells has worked as an advocate in women's health care for more than 15 years.  She is currently an RN at Flagstaff Medical Center and a volunteer with Northland Hospice.  She and her husband are expecting their first child this fall.