Barriers to adolescents' getting emergency contraception through pharmacy access in California: differences by language and region.
BACKGROUND
In California, emergency contraception is available without a prescription to females younger than 18 through pharmacy access. Timely access to the method is critical to reduce the rate of unintended pregnancy among adolescents, particularly Latinas.


METHODS
In 2005-2006, researchers posing as English- and Spanish-speaking females-who said they either were 15 and had had unprotected intercourse last night or were 18 and had had unprotected sex four days ago-called 115 pharmacy-access pharmacies in California. Each pharmacy received one call using each scenario; a call was considered successful if the caller was told she could come in to obtain the method. Chi-square tests were used to assess differences between subgroups. In-depth interviews with 22 providers and pharmacists were also conducted, and emergent themes were identified.


RESULTS
Thirty-six percent of all calls were successful. Spanish speakers were less successful than English speakers (24% vs. 48%), and callers to rural pharmacies were less successful than callers to urban ones (27% vs. 44%). Although rural pharmacies were more likely to offer Spanish-language services, Spanish-speaking callers to these pharmacies were the least successful of all callers (17%). Spanish speakers were also less successful than English speakers when calling urban pharmacies (30% vs. 57%). Interviews suggested that little cooperation existed between pharmacists and clinicians and that dispensing the method at clinics was a favorable option for adolescents.


CONCLUSIONS
Adolescents face significant barriers to obtaining emergency contraception, but the expansion of Spanish-language services at pharmacies and greater collaboration between providers and pharmacists could improve access.
Sampson
Olivia
O
Department of Family and Community Medicine, University of California-San Francisco, CA, USA. oli.sampson@yahoo.com
Navarro
Sandy K
SK
Khan
Amna
A
Hearst
Norman
N
Raine
Tina R
TR
Gold
Marji
M
Miller
Suellen
S
de Bocanegra
Heike Thiel
HT
D000293:Adolescent; D017677:Age Distribution; D001291:Attitude of Health Personnel / Q000208:ethnology; D002140:California; D044363:Contraception, Postcoital / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D007802:Language; D010594:Pharmacies; D010595:Pharmacists / Q000523:psychology*; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D011369:Professional-Patient Relations; D019035:Rural Health Services; D019037:Urban Health Services; D044465:White People / Q000523:psychology