Emergency contraception in a public health emergency: exploring pharmacy availability in Brazil.
Dedicated progestin-only emergency contraceptive pills (ECPs) have been available with a prescription in Brazil since 1999. However, utilization of emergency contraception has been limited. We conducted a mystery client study at retail pharmacies in three regions to assess current availability.



Using a predetermined client profile, we approached a random sample of chain and independent pharmacies in urban areas in the southeastern, northeastern and central-west regions. We documented product availability, price and the client-pharmacy representative interaction at each site. We analyzed these data with descriptive statistics and for content and themes.



We visited 122 pharmacies in early 2016. All but three pharmacies (97.5%) had ECPs in stock at the time of the interaction and offered our client the medication without a prescription. In general, pharmacy representatives did not ask questions or provide our client with information about emergency contraception. When prompted, over one third of the pharmacy representatives (37.7%) inaccurately reported that levonorgestrel ECPs could only be used immediately or within 12, 24 or 48h from the time of intercourse.



Despite the current regulatory status, our findings suggest that progestin-only ECPs are widely available without a prescription. Additional efforts to ensure that women have up-to-date and medically accurate information about progestin-only ECPs appear warranted. Our findings suggest that more work needs to be done to align national regulatory policies with international standards and evidence-based practices.



The Zika virus epidemic has shined a spotlight on the importance of providing timely access to emergency contraception in Latin America. This public health emergency offers a window of opportunity to advance national policies and practices to ensure that Brazilian women have access to a full range of reproductive health services.
Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
Marilia P
MP
Tavares
Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institute of Population Health, University of Ottawa, Ottawa, ON, Canada. Electronic address: angel.foster@uottawa.ca.
Angel M
AM
Foster
D000328:Adult; D001938:Brazil; D044363:Contraception, Postcoital / Q000379:methods*; D003281:Contraceptives, Postcoital / Q000600:supply & distribution*; D004638:Emergency Treatment; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016912:Levonorgestrel / Q000627:therapeutic use; D010593:Pharmaceutical Services / Q000706:statistics & numerical data*; D010595:Pharmacists; D011634:Public Health
D003281:Contraceptives, Postcoital; D016912:Levonorgestrel
EC; ECPs; Latin America; Postcoital contraception; Zika virus