Pennsylvania State College of Medicine, Hershey, PA, United States.
Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, United States.
Contraception. 2022 Aug;112:120-123. doi: 10.1016/j.contraception.2022.02.006. Epub 2022 Mar 3.
We aim to investigate whether the availability of over-the-counter EC varies by neighborhood income level, independent vs chain pharmacies, or urban vs rural pharmacies.
We conducted a cross-sectional "mystery shopper" telephone survey in July 2019 to ascertain whether sampled pharmacies stocked EC. Pharmacies located in 12 Pennsylvania counties were randomly sampled after stratification by neighborhood income level.
Of 200 pharmacies sampled, 195 responded. Only 76% had EC available for same day purchase, which did not differ by neighborhood-level income. The odds that chain pharmacies stocked EC were nearly 10 times the odds that independent pharmacies stocked EC, with 96/105 chain pharmacies versus 52/90 independent pharmacies having EC available for same day purchase (91% vs 58%; OR 9.50, 95% CI 4.03-22.42). The mean number of barriers (stocking over-the-counter EC behind-the-counter, cost >$40, and requiring identification for purchase) was lower among chain vs. independent pharmacies. Pharmacies in low/moderate-income areas (64% vs 44%, p = 0.02) and independent pharmacies (94% vs 32%, p < 0.01) were more likely to keep over-the-counter EC behind-the-counter. Independent pharmacies were more likely to require identification for purchase (29% vs 59%, p < 0.01).
More than a decade after over-the-counter approval, EC is still not uniformly available at pharmacies in Pennsylvania. Barriers including behind-the-counter stocking and identification requirements disproportionally limit access in low-income neighborhoods and independent pharmacies, threatening equitable access to this contraceptive method.
Pharmacies in lower-income neighborhoods and independent pharmacies were more likely to impose undue barriers to EC access and purchasing, disproportionally affecting residents in lower-income areas. A multidisciplinary approach in advocacy and policy reform is necessary to ensure equitable access to EC.
我们旨在调查非处方紧急避孕药的供应是否因社区收入水平、独立药店与连锁药店、城市药店与农村药店而有所不同。
我们于 2019 年 7 月进行了一项横断面“神秘顾客”电话调查，以确定抽样药店是否有库存 EC。在按社区收入水平分层后，对宾夕法尼亚州 12 个县的药店进行随机抽样。
在 200 家抽样药店中，有 195 家做出了回应。仅有 76%的药店可当天购买 EC，且这一比例与社区收入水平无关。连锁药店储备 EC 的可能性是独立药店的近 10 倍，105 家连锁药店中有 96 家（91%）和 90 家独立药店中有 52 家（58%）可当天购买 EC（95%CI 4.03-22.42）。连锁药店与独立药店相比，储备非处方 EC 时遇到的障碍（将 EC 放在柜台后面、成本超过 40 美元以及购买时需要身份证明）要少。低收入/中等收入地区的药店（64%比 44%，p=0.02）和独立药店（94%比 32%，p<0.01）更有可能将非处方 EC 放在柜台后面。独立药店更有可能要求购买时提供身份证明（29%比 59%，p<0.01）。
在获得非处方批准十多年后，宾夕法尼亚州的药店仍然不能普遍提供 EC。包括将 EC 放在柜台后面和需要身份证明等障碍不成比例地限制了低收入社区和独立药店获取 EC 的机会，威胁到这种避孕方法的公平获取。
收入较低社区的药店和独立药店更有可能对 EC 的获取和购买施加不必要的障碍，不成比例地影响低收入地区的居民。需要采取多学科的方法进行宣传和政策改革，以确保公平获得 EC。
