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| Helping pharmacy & health communities improve access to Emergency Contraception (EC) |
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Hawaii
In 2002 Hawaii introduced its first legislation (HB 2806) for EC pharmacy access. Prior to introduction, there were few discussions with key stakeholders, and minimal education or outreach occurred. There seemed to be some support from the Hawaii Medical Association (HMA), but not enough for it to pass. The Board of Pharmacy and the Hawaii Pharmacy Association (HPhA) did not support HB 2806 because they were devoting their attention to HB 1842 which would enable pharmacists to provide clinical services in a broader range of settings including community pharmacies and health care facilities. The more general bill (HB 1842) did pass and became law in July of 2002 and served the starting point for crafting new EC pharmacy legislation for 2003. The second, successful EC pharmacy bill (HB 123) was introduced in the 2003 legislative session. It cleared both houses by May and was signed by the Governor in June 2003. Education and OutreachConsiderable outreach occurred between the first and second EC pharmacy bills, and in large part this was responsible for Hawaii’s success. In 2002, the Healthy Mothers Healthy Babies Coalition of Hawaii (HMHB) received a small grant from Advocates For Youth (as part of a regranting effort funded by the Open Society Institute) to improve EC access for adolescents in Hawaii. The grant was used to form an EC Workgroup that initially focused on education and included partners from the Hawaii State Dept. of Health-Family Planning Services Section (DOH-FPSS) and Food and Drug Branch, and other pharmacists. Participants believed that pharmacists and physician collaboration was essential to the successful policy change, but many local pharmacists and physicians did not understand EC or the fact that it could be more accessible through pharmacies without a physician seeing the women first. Sharon Schnare, RN, FNP, CNM, MSN, a noted speaker in women’s health arena provided the first educational session for nurses in Feb. 2002. Sharon was already scheduled to speak at the annual family planning and reproductive health conference and agreed to do an additional session in the evening at Kapiolani Medical Center. The second educational component consisted of bringing Donald Downing, R.Ph, from the University of Washington, School of Pharmacy to Hawaii for a week in August 2002. HMHB organized a number of EC informational sessions statewide on Oahu, Hawaii, and Maui. As a pharmacist, Downing was instrumental in coordinating pharmacy policy and training work on EC in Washington State. He helped educate over 300 public health professionals, pharmacists and physicians in Hawaii statewide during his one-week visit, and offered highly-specific responses to both technical and implementation questions. The second part of the EC Access Workgroup’s educational campaign consisted of providing information to lawmakers, particularly groups concerned with women’s issues and members of both the State Board of Pharmacy and the State Board of Medical Examiners, as well as groups such as ACOG-Hawaii. Drafting LegislationIn Fall 2002 a large number of organizations, including HMHB, members of the EC Workgroup, the Women’s Coalition of Hawaii, Planned Parenthood, the Hawaii Pharmacists Association, the Hawaii Medical Association, the Dept. of Health-Family Planning Services Section and Food and Drug Branch, and the American College of Obstetricians and Gynecologist Hawaii Chapter provided input into drafting the EC pharmacy bill for the 2003 legislative season. The Workgroup opted to add a new short section on emergency contraception to the existing pharmacy practice law. It presumed that current Hawaii law — allowing teens age 14 and above to receive full range of family planning services without parental consent — would continue to apply. No special language relating to teens was inserted in the EC pharmacy access bill, although discussions with key policy-makers underscored the need for adolescent girls to be covered in the new policy. Support for LegislationThe proposed EC bill was also presented in the Fall of 2002 to the Hawaii Board of Medical Examiners and the Hawaii Board of Pharmacy. Both organizations initially voiced concerns regarding the concept of “open collaborative agreements”. There was concern by some with the concept of prescriptions being written by physicians for women that they hadn’t seen. However, presenting to both Boards in advance gave them time to process the issues at hand and allowed the EC Workgroup to provide answers to their questions, which strengthened their support of HB 123. HBHM approached the Women’s Legislative Caucus in the Fall of 2002 to ask for their support with two bills: one relating to EC and the other promoting better access to prenatal care through Medicaid presumptive eligibility. Currently Hawaii’s unintended pregnancy rate is 53% in all women of childbearing age, and 78% in teens age 15-19 years old. The compelling case presented to them and other policy makers, emphasized that EC does offer women an option to a possible unintended pregnancy and would help to reduce Hawaii’s high unintended pregnancy and abortion rates. The second bill addressed the needs of pregnant women by ensuring all pregnant women would be as healthy as possible through fast tracking Medicaid eligibility. By December 2002 the Hawaii Women’s Legislative Caucus had committed to including these two bills in their package, as did the Hawaii Keiki (Child) Caucus, a group of legislators who deal with children’s issues. The Hawaii Keiki Caucus decided to support the EC access bill because of the child related problems that stem from unintended pregnancies such as child abuse, neglect, foster care, family stress, and violence. 2003 Legislative SessionThe Hawaii Women’s Caucus and the Hawaii Keiki (Child) Caucus formally introduced the EC bill into the 2003 legislative session. The HMHB Coalition led the advocacy effort via a coordinated partnership with the EC Workgroup. No paid lobbyists were utilized, and the voluntary efforts on the part of participants in the EC Workgroup helped to guide the bill through legislative session. HB 123 received almost unanimous support from over 23 organizations and individuals. There was little to no opposition to HB 123 in the first month or two of the legislative session. A third bill, SB 658 (Relating to EC for Sex Assault Survivors in Emergency Rooms), sparked controversy because of its mandatory requirements for hospitals, and towards the end of the legislative session this attention also spilled over to HB 123. Anti-abortion organizations in Hawaii were objecting to any birth control method that would prevent implantation. (Religious groups, including the Catholic Church in Hawaii, vigorously opposed the mandatory requirements associated with SB 658. The Governor eventually vetoed SB 658.) Hawaii’s Republican Governor Lingle signed HB 123 into law on June 24, 2003, making Hawaii the second state in the country after California to achieve EC pharmacy access through a legislative process. Hawaii Pharmacy BoardThe Pharmacy Board plans to take the following steps to guide implementation of HB 123: 1) the protocols and procedures approved for the collaborative agreement will be adopted only after a full and fair rule rulemaking process, including properly noticed hearings and the Board's careful consideration of public input; 2) the Board will work with representatives of the Hawaii Medical Association, the John A. Burns Medical School, and the local chapter of the American College of Obstetricians and Gynecologists to determine the protocols and procedures; and 3) the Board will not approve procedures and protocols that officially designated representatives of these physician groups do not agree provide adequate protection of the health and safety of women.
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