Advocacy Anecdotes
New Mexico
Dale Tinker, Executive Director of New Mexico Pharmaceutical Association
Pharmacist Leadership
When Dale Tinker first heard a presentation about emergency contraception made by Planned Parenthood to the New Mexico Board of Pharmacy four years ago, he didn’t think much about it. So what inspired him to get involved? Initially Dale recognized that “providing emergency contraception is part of providing good patient care. Pharmacists have the capability and training to provide important services to the public. EC timing is critical. It made sense that in New Mexico access should be enhanced using available resources, like pharmacists.”
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“Everyone needs
to work together
to avoid access
becoming a turf
issue.”
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Dale and members of the New Mexico Pharmaceutical Association proceeded to work collaboratively with the NM Board of Pharmacy and both nurses and physicians to approve a statewide protocol. “Working together with all three vested health groups was the most positive aspect about creating change in New Mexico,” recounts Dale. It was not an accident that pharmacy access to EC happened in New Mexico. Dale attributes New Mexico’s success to “following an appropriate process with input and support from various stakeholders to craft carefully written regulatory language.” His words of wisdom for other states? “Everyone needs to work together to avoid access becoming a turf issue.”
For Dale this has been a challenging adventure. “It takes a while to get regulation written that everyone can agree on. Knowing however, that there won’t be as many unintended pregnancies is the most rewarding part.”
Dale had encouraging words for others interested in improving access to EC through pharmacies. “It is important for other states to know how many valuable resources are available around the country. I’ve found it very helpful to talk to folks in states like Washington and California and learn what has and hasn’t worked.”
What lies ahead for New Mexico? “It is going to take a while to really increase public awareness about pharmacy access in our state because we have limited funding. But we are working creatively with the Department of Health to seek funding. It’s comforting to know that a lot of the groundwork has already been laid out and that we don’t have to reinvent the wheel. With these types of resources available, it will be easier for more states to expand access to EC.”
Hawaii
Nancy S. Partika, MPH, Executive Director, Healthy Mothers, Healthy Babies Coalition of Hawaii
Statistics Can Be Powerful
“Statistics can be powerful”, says Nancy Partika, Executive Director for Healthy Mothers Healthy Babies, when asked why their small non-profit organization got involved in forming an EC workgroup to lead the Hawaii effort to expand access to emergency contraception.
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”We anticipated and were initially concerned that this issue would be highly polarized community issue but in reality, there has been little negative response.”
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“We looked at the PRAMS (the Pregnancy Risk Assessment Monitoring System which is a surveillance project of the Centers for Disease Control and Prevention (CDC) and state health departments) data in our state impacting the health and well-being of mothers and infants. Unintended and unwanted pregnancies are a major perinatal health issue for Hawaii, because an unintended pregnancy is an at-risk pregnancy. We knew emergency contraception could significantly contribute to the prevention of unintended pregnancy. We also knew from a 2002 survey HMHB had done that access to EC was problematic for teens and women. Providing access through pharmacies was an integral part of the solution.”
In 2002, EC access legislation was introduced with few advance key stakeholder discussions or education, “There was limited support for EC access at that time. Since then, we’ve learned from past mistakes and have strongly focused on the educational aspects for pharmacists, physicians and policymakers”. Nancy points out some of Hawaii’s key challenges are, “we do not have a school of pharmacy, and we also are also geographically isolated and dispersed across six islands. We don’t have some of the supporting infrastructure that some other states have.”
Bringing in Don Downing, a pharmacist who was involved in implementing pharmacy access to EC in Washington State, was instrumental. “In one week he made it to a number of islands and educated key clinicians and community partners, including pharmacists and physicians. Having a clinical expert here from a state that has already achieved measurable success in improving EC access, and who could both inspire a vision and answer technical questions, made a huge difference.”
It took another year (2003) to introduce and successfully pass Hawaii State legislation allowing direct pharmacy access to EC. The most rewarding part of the experience? “Seeing the visible progress made with real partnerships between the pharmacist, physician, and other community partners. Also, our collaboration with the Hawaii Legislative Women’s Caucus, which was a powerful policy voice in support of this bill.”
Nancy’s shared some wisdom gleaned from Hawaii for other states interested in advancing pharmacy access:
- Don’t be afraid of the EC issue. “We anticipated and were initially concerned that this issue would be highly polarized community issue but in reality, there has been little negative response.”
- Look for broader community partners — not only physicians and pharmacists. “Go beyond reproductive and women’s health circles. This is a public health issue, so it makes sense to reach out to organizations that care for and about families in general. Partnerships with a broad-based coalition strengthen the message, because they provide opportunities to extend the message in different ways and from different perspectives.”
- And lastly, stay focused and positive. “Don’t be discouraged when things temporarily go slowly, or even backwards at times. Our Republican Governor signed the EC access bill on June 24th, and the process of affecting policy of this magnitude was well worth the effort!”
Alaska
Terry Babb, PharmD
President Elect, Alaska Pharmacists Association and
Collaborative Pharmacy Agreement Coordinator, Alaska EC Project
Get the Facts
“It makes sense to expect resistance when you work to create change,” says Terry Babb, President Elect, Alaska Pharmacists Association and Collaborative Pharmacy Agreement Coordinator of the Alaska EC Project. “It also helps to know that you are supporting change for the right reasons.” For Terry, these reasons are quite clear.
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“I strongly encourage pharmacists to keep an open mind and get the facts before making a decision about providing EC.”
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During his work as a pharmacy consultant in adolescent psychiatry, Terry saw first hand the profound negative effect unintended pregnancy has on young people and their families. He explains, “Unwanted and unintended pregnancies are not only damaging to families, they also hurt our communities. EC safely prevents pregnancy. Improving access to EC reduces abortions which is good for Alaska.”
While this seems obvious to Terry and others in Alaska, pharmacists don’t always share this view. “I’ve been surprised to find that while physicians in Alaska have lined up to participate in collaborative practice agreements, pharmacists have expressed discomfort in doing this work.”
Many pharmacists have a misinformed understanding of EC, and often confuse the method with RU-486. “I strongly encourage pharmacists to keep an open mind and get the facts before making a decision about providing EC,” says Terry.
Terry states that formal positions encouraging increased access to EC from national organizations like the American College of Obstetricians and Gynecologists (ACOG) and the American Medical Association (AMA) have helped move direct pharmacy access forward in Alaska. “Having the opportunity to network with other states and learn what their successful strategies have also been vital.”
Massachusetts
Rebekah E. Gee, M.D., M.P.H.
Clinical Fellow – in Obstetrics/Gynecology and Reproductive Medicine
Harvard Medical School
What makes a physician advocate for EC pharmacy access in their state?
Dr. Rebekah Gee explains, “We live in a country with the largest rate of unintended pregnancy in the developed world. In a country with so many resources, this public health predicament is unacceptable.” Dr. Gee worked with the Massachusetts Medical Society to support Massachusetts’s legislation that would allow women to go directly to a pharmacist for emergency contraception. “EC is not ideal but when we lose our first line of defense [contraception can fail], it is fortunate that we have a second line of defense available. EC is one important way for women to protect themselves against unintended pregnancy and avoid devastating personal and public health consequences.”
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“We live in a country with the largest rate of unintended pregnancy in the developed world.”
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Dr. Gee, like many of her colleagues at American College of Obstetricians and Gynecologists and the American Medical Association, supports EC going over the counter. “However, only the FDA can make that decision. That process will take time. Meanwhile, there is a lot that can and needs to be done to improve access. Making EC directly available in pharmacies is an effective way to improve access leveraging existing resources.”
In a time of managed care and an increasingly litigious environment, physicians are concerned about medical liability when considering signing collaborative practice agreements with pharmacists. However, Dr. Gee points out that “there have never been any suits around EC and the potential for lawsuits is very low.” Education is key. “EC has no serious adverse side effects and no contraindications other than an established pregnancy, where it would not be effective. EC does not interrupt a pregnancy, which makes it a viable option even for those that are pro-life.”
Physicians and pharmacists want what’s best for their patients. “A woman is wasting precious time if she has to contact a physician to get a prescription for EC. Sex doesn’t always happen during office hours and patients are not able to reach a physician when EC is needed. Working collaboratively with pharmacists also represents an opportunity for patient continuity of care. This can be seen in California, where pharmacists who see women for EC often refer them to a physician for ongoing contraceptives.”
Dr. Gee recalls doing a grand rounds presentation on EC at a Harvard teaching hospital. Upon starting her introductory remarks, a physician colleague stood up to argue she would never provide EC to a patient. She calmly responded, “it is valid that you think that way because many people are misinformed about EC. That’s why I am here — to help educate you about an important way to prevent unintended pregnancy.” For Dr. Gee, it is not surprising that many people, including health care professionals at a Harvard teaching institution, are misinformed about EC. “The more people understand about EC, the more accepting they will be of laws for greater access. Educating physicians and promoting improved EC access is incredibly rewarding.”
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