Access to emergency contraception in Kansas City clinics

Abstract

Objective: To assess the accessibility of ulipristal acetate (UPA) and copper intrauterine devices (IUDs) for emergency contraception (EC) in reproductive health centers in the Kansas City metropolitan area.

Study design: Using a secret shopper method, two female investigators called the reproductive health centers listed as EC providers on the nonprofit website bedsider.org that were located within 25 miles of the University of Kansas Medical Center. We categorized clinics as Title X providers vs. not according to the grantee list from the Office of Population Affairs. Investigators inquired about obtaining a UPA prescription by phone, the availability of the copper IUD for EC and time to first available appointment for EC. We evaluated correlates of EC access and provision with Fisher's Exact Tests.

Results: We identified 40 clinics as potential EC providers. Some clinics reported that UPA could be prescribed by phone to existing patients (13/40, 32%), while others reported that women must meet with a provider first (15/40, 38%). Few clinics offered copper IUDs as EC (3/40, 8%). Title X clinic status did not predict provision of UPA by phone or copper IUDs as EC. The average time to next available appointment was 9±9 days to discuss EC and 13±9 days for a copper IUD.

Conclusions: Accessing the most efficacious forms of EC in a timely fashion presents many logistic challenges for women.

Implications: Healthcare systems should streamline protocols, train providers and improve rapid-access referral networks to facilitate timely provision of UPA and copper IUDs for EC.

Keywords: Bedsider; Copper intrauterine device; Emergency contraception; Ulipristal acetate.