Availability of emergency contraception in Massachusetts emergency departments

To determine the availability of emergency contraception (EC) in Massachusetts emergency departments (EDs) and to identify patient, hospital, and system factors that could affect access to EC.

This was a prospective, cross-sectional study of all Massachusetts EDs using two structured scenarios: one, a patient asking for EC for condom failure (patient scenario); and the other, a social worker asking about EC for a client who was sexually assaulted the night before (social worker scenario). Calls were made during day and night shifts requesting information from a nurse or doctor. The data collected included EC availability, whether pills or prescription would be given, cost, services available to rape victims, and other institutions where EC could be obtained. Descriptive statistics and chi-square were used for comparisons.

Responses were made by 248 of 288 nurses, ten of 288 physicians, and 30 of 288 clerks. Overall, EC was reported to be available in 80% of calls, not available in 15%, and up to the physician in 5%. In the patient scenario day shift, 53 of 72 (73%) responded that EC was available, 15 of 72 (20%) stated it was not available, and four of 72 (5%) said it was up to prescribing physician. In the social worker scenario day shift, 62 of 72 (86%) reported that EC was available, six of 72 (8%) reported it was not available, and four of 72 (5%) stated it was up to the prescribing physician. Availability did not vary comparing day vs. night shift for either scenario. Of the nine Catholic hospitals, for the patient scenario, one of nine (11%) reported that EC was available, seven of nine (78%) reported that EC was not available, and in one of nine (11%), it was up to the physician. In the social worker scenario, five of nine (56%) reported EC was available, three of nine (33%) reported it was not available, and in one of nine (11%), it was up to the physician.

There was significant variability in access to EC in Massachusetts EDs and in services for sexual assault survivors. Hospital type and provider preference affected availability. This study suggests that access to EC is limited, and that there are not consistent services for women seeking EC, including for victims of sexual assault.