The Joplin Globe, Joplin, MO

National News

October 25, 2012

Native women face patchwork of policies for Plan B

FLAGSTAFF, Ariz. — Months after the federal Indian Health Service said it was finalizing a policy that would make emergency contraception more accessible to American Indian women, advocates say they’re still waiting. And in the meantime, Native women face a patchwork of policies at hospitals and clinics that don’t always ensure timely access to the medication.

Across the country, any woman 17 or older can buy emergency contraception from behind the counter at retail pharmacies. But the Indian Health Service has no retail pharmacies. Instead, Native women typically must visit a clinic, urgent care facility or emergency room and have a consultation before being prescribed the medicine that is dispensed on-site.

Critics say that system is time-consuming and burdensome, and they’ve been pushing for change. In May, they scored a victory when the Indian Health Service’s chief medical officer, Susan Karol, said the agency was working on a new policy aimed at allowing pharmacies to give Plan B directly to patients.

But that policy hasn’t been released yet, and until it is, Native women face an unreliable assortment of rules that can vary from clinic to clinic, said Charon Asetoyer, director of the South Dakota-based Native American Women’s Health Education Resource Center.

“There’s not consistency and continuity that women should be able to expect through the system in terms of being able to access Plan B or its generic counterpart,” Asetoyer said.

A recent informal survey by the resource center found that some facilities don’t carry the medication at all, some hand it out only at the direction of a physician, and others have expanded the list of people who can provide it to patients.

Karol wrote to Asetoyer in May saying many IHS facilities and tribal sites already have authorized clinicians to provide the medication to patients, and “this is the direction we want all our facilities to go.”

IHS spokeswoman Dianne Dawson declined to discuss when the policy would be released, saying only that “IHS is in the process of standardizing our procedures to ensure patients have access to the medicines they need.”

More than half of the IHS budget is administered by tribes through self-determination contracts or self-governance contracts, which means policies at clinics operated by tribes can be different from those at IHS-run sites. The agency stocks medication from a list that includes emergency contraceptives like Plan B or an equivalent.

On the Puyallup reservation in Tacoma, Wash., for example, longtime pharmacist Don Downing in 2002 gave other pharmacists the authority to dispense the drugs directly to patients after verifying their age. The women also were offered a glass of water to take the medication on the spot.

While women must pay for the medication at retail pharmacies, American Indian and Alaska Native women get it for free at IHS facilities because the federal government has a trust obligation to provide health care to them. Wait times at IHS facilities on and off reservations can depend on patient volume, and not all clinics and urgent care centers operate around the clock.

Those facilities also can be hours away, cutting into the 72-hour period after a woman has unprotected sex that emergency contraception is most effective. Having to wait to see a physician and getting a prescription further cuts into that time, advocates say.

“If you set up too many hoops to jump through and too much time to wait, there’s a tendency of women to not go after the service at all and just hope that ‘I don’t get pregnant.’ Those barriers are real,” said Downing, clinical professor at the University of Washington’s School of Pharmacy who works with tribes on the issue.

Alan Spacone, chief medical officer at the Tuba City Regional Health Care Corporation on the Navajo Nation, said there are several benefits to having women see a health care provider before they get emergency contraception. He said women can be counseled on safe sex practices and learn whether they’re allergic to the drug or if they’ll have an adverse response to it because of other medications they’re taking.

“There are other things we offer,” Spacone added. “If you’ve been sexually assaulted, you can offer to follow up with counseling, and make sure they’re treated for sexually transmitted diseases at that time. I think it’s rather simplistic to think all you need to do is make sure you’re not pregnant.”

Spacone said he’s hopeful any IHS policy on emergency contraception would include a way to follow up with patients to see if they’d like regular birth control and make sure they’re not taking undue risks. That might be tricky, he said, but patients otherwise could get a false sense of security from Plan B.

Downing said he can appreciate the reasoning behind the consultations that typically are required for any drug dispensed at IHS facilities, including ibuprofen and cough syrup, to ensure patients get the right medication for their ailments. But he said Plan B shouldn’t fall in the same realm as other restricted drugs because it’s time-sensitive and doesn’t carry the same abuse factors.

“The medical risks of using it without appropriate reason are essentially zero,” Downing said.


Text Only
National News
  • Obama Medal of Honor.jpg Obama bestows Medal of Honor on NH veteran

    President Barack Obama bestowed the Medal of Honor Monday on a former Army staff sergeant who fought off enemy fighters during one of the bloodiest battles of the Afghanistan war.

    July 21, 2014 1 Photo

  • Obama LGBT employment rights.jpg Obama gives protection to gay, transgender workers

    President Barack Obama on Monday gave employment protection to gay and transgender workers in the federal government and its contracting agencies, after being convinced by advocates of what he called the “irrefutable rightness of your cause.”

    July 21, 2014 1 Photo

  • James Garner Obit 2.jpg Film, TV legend James Garner, reluctant hero, dies

    Few actors could register disbelief, exasperation or annoyance with more comic subtlety.

    July 21, 2014 3 Photos

  • Gay Marriage Oklahoma_Cast.jpg US appeals court tosses Oklahoma's gay marriage ban

    A federal appeals court ruled Friday that Oklahoma must allow gay couples to wed, prompting a fast, angry response from leaders of a state that has vehemently fought policy changes brought on from outside its borders.

    July 18, 2014 1 Photo

  • Ricin Letters Texas.jpg Texas woman who sent ricin gets 18 years in prison

    A Texas actress who tried to blame her husband after sending ricin-laced letters to officials including President Barack Obama was sentenced Wednesday to 18 years in prison.

    July 16, 2014 1 Photo

  • Helicopter Dispute.jpg Senate derails Army bid to take Guard helicopters

    The Army has lost an initial Senate skirmish over a hotly disputed plan to take Apache attack helicopters away from National Guard units in a budget-cutting move that has infuriated governors and state military leaders.

    July 16, 2014 1 Photo

  • Fashion-Nordstrom Dis_Cast.jpg Nordstrom ads feature models with disabilities

    It’s not easy to find models with disabilities in ads for the fashion and beauty industry — unless you look in the Nordstrom catalog.

    July 16, 2014 1 Photo

  • Peace Corps allowing its applicants more choice

    The Peace Corps launched a new online application Tuesday that allows applicants to choose the countries and programs where they want to serve and removes red tape that was dissuading people from completing the international service organization’s application process.

    July 15, 2014

  • House to take up highway bill as deadline looms

    With an August deadline looming, the House is poised to act on a bill that would temporarily patch over a multibillion-dollar pothole in federal highway and transit programs while ducking the issue of how to put the programs on sound financial footing.

    July 15, 2014

  • Got a rash? iPad, other devices might be the cause

    Unexplained rash? Check your iPad. It turns out the popular tablet computer may contain nickel, one of the most common allergy-inducing metals.

    July 15, 2014