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A broad coalition of stakeholders helps! Identify people in your community/state that would make good coalition leaders, organizers or members. Keep in mind that in most states that have been successful in EC pharmacy policy change, the pharmacy community was involved and a non-controversial organization led the coalition. This seems to be helpful in building broader support.
Coalition partners might include:
- Pharmacists
- State pharmacy association members
- Community/independent pharmacy representatives
- Chain pharmacy representatives
- School of Pharmacy faculty or administrators
- Physicians
- OB/GYNs, especially members of American College of Obstetricians and Gynecologists (ACOG)
- Family Physicians
- University School of Medicine
- State associations
- Pharmacy
- Public Health
- Physicians
- Nurse Practitioners
- Nurse Midwives
- Physician Assistants
- Hospitals
- Health Plans
- Public/Community health
- Public Health Commission members
- Local/County Health Officers
- Maternal Child Health program staff
- Community clinic staff (MDs, NPs, PAs, administrators, health educators social workers)
- Reproductive Health/Family Planning
- State Family Planning Council members
- Title X officer
- Planned Parenthood executives and/or clinical staff
- NARAL (now called NARAL Pro-choice America) staff
- Teen Pregnancy Coalition members
- Sexual assault and domestic violence organization staff
- Catholics for Reproductive Choice members
- Women’s Organizations
- National Organization for Women (NOW executives)
- League of Women Voters
- Business and Professional Women
- American Civil Liberties Union (ACLU) staff
- College/University student health center director or clinical staff
- Local government members (e.g. City council or State representatives)
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Become knowledgeable about EC and EC activity in your state.
- Find out if there is a history of legislative, regulatory, or advocacy activity related to EC in your state. Learn all you can about what happened and key players.
- Investigate current pharmacy practice regulations in your state to find out what authority pharmacists have under collaborative practice agreements.
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Launch an awareness campaign with Coalition members. Develop or adapt existing informational materials about EC. Don’t assume everyone on the Coalition is completely informed about EC. Include information such as:
- What is EC?
- Distinctions between EC and abortion pills (Clear up misunderstandings!)
- National (and state, if available) statistics on unintended pregnancy
- Abortion rates (national and/or state)
- EC safety and efficacy
- Latest research on EC dosage and timing (up to 5 days)
- Other states with EC pharmacy programs
- Resources for more information (websites, hotlines, fact sheets, pamphlets, professional organization endorsements, etc)
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Understand why some people or organizations may oppose EC and be prepared to respond to and address their concerns:
- Confusing EC with RU-486
- Liability issues
- Turf issues between physicians and pharmacists
- Access to adolescents
- Conscience clauses
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Once Coalition members are fully aware, make sure their constituencies are educated as well. Consider presenting at annual meetings, initiating roundtable discussions, publishing articles in newsletters, and placing notices on list serves.
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Educate the local media about EC. Meet with members of the media and provide them with awareness information described above. It is extremely important to work with the media to correct the public’s common confusion with medical abortion: RU486/abortion pill/mifepristone.
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Explore local partnerships between pharmacists and clinics. Many states technically allow pharmacists to initiate EC for patients of an authorizing physician. Find out if your state is one of these and take a look at successful pilot programs in states (e.g. California) that have facilitated new policies.
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Explore collaboration between physicians and pharmacists to increase access for women who may need EC without a physician’s prescription. (For example, in one state, a university health center physician encourages pharmacists to page him whenever a woman requests EC at their pharmacy.)
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Consider encouraging pharmacies that don’t carry dedicated EC products to refer patients to pharmacies that do. This could be particularly helpful if pharmacies are not carrying EC due to economic reasons or low demand. Keep in mind that pharmacists have sometimes not carried EC products because it was costly to keep a product with a short shelf life. However, the shelf life of EC products has recently increased to 4 years.
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Explore local and national websites and hotlines that list providers who will prescribe over the phone (1-888-NOT-2-LATE, ec.princeton.edu/providers etc). Encourage new providers to get listed.
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Work with health plans and hospitals to ensure that dedicated products are on their formularies.
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Conduct a survey about the availability of EC in pharmacies and pharmacists’ attitudes about EC. These have been very effective organizing tools for many states, including Connecticut, New Hampshire, Kentucky, Virginia, and Wyoming. The information you gather will help you target your education efforts, arm you with data about the number of pharmacists that are interested, and provide you with a group of pharmacists that could provide letters and testimony in support of pharmacy access efforts. View sample cover letters, surveys, or results from Connecticut, Wyoming, Colorado, Michigan and Montana. Click here for useful tips (PDF-156K). A pharmacist education toolkit (PDF-136K) has been developed for the 2005 Back Up Your Birth Control Campaign to help those conducting pharmacy surveys to prepare for visits, analyze results and execute follow-up.
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Gather EC info from PRAMS data in your state. Oregon researchers drew attention to the need for greater access to EC when they analyzed Pregnancy Risk Assessment Monitoring System (PRAMS) data for the state. Conducted by the state health department, PRAMS is an ongoing study of post-partum women about attitudes and experiences before, during and after pregnancy. The Oregon study examined women’s knowledge of EC and risk factors for not having heard of EC. Currently thirty-one states and New York City participate in PRAMS.
To view the Oregon study, click here.
For more information about PRAMS, visit www.cdc.gov/reproductivehealth/pramstates.htm
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Learn about EC use in your state from BRFSS. Funded by the Centers for Disease Control and Prevention, the Behavioral Risk Factor Surveillance System (BRFSS) is conducted every year for every state. The health surveys ask adults 18 and older questions related to behaviors that are associated with preventable chronic diseases, injuries, and infectious diseases. The questionnaire is made up of core questions and optional ones, but the state may request to add questions. New Mexico recently added two questions to their BRFSS: 1) Have you heard of EC and 2) Have you used EC? Contact your state department of health to explore adding a question about EC.
For more information about BRFSS, visit www.cdc.gov/brfss/faqs.htm
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Calculate the money saved from improved access to EC in your state. In November 2003, New York State Office of the State Comptroller released “Emergency Contraception in New York State” (PDF-124K) / Methodology (PDF-32K) outlining the fiscal benefit of improved access to EC in the state. Giving women in New York State increased access to emergency contraceptive pills would result in 122,000 fewer unintended pregnancies and 82,000 fewer abortions and as a result cut health care spending in New York State by $452 million annually, concludes Comptroller Alan Hevesi. New York has plans to help other states replicate the study.
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Set up a dial-EC or online-EC service in your state. States are looking into multiple ways to increase access to EC. One approach that has recently become popular is to establish hotlines or websites where consumers can call or visit to get EC. In most cases, the woman undergoes a medical assessment and receives counseling about EC, a clinician reviews the data and provides a prescription, and the product is picked up at a nearby pharmacy or clinic. View more information about these options in Massachusetts, North Carolina, Oregon, and Wisconsin.
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