No Plan B: Why Is the Indian Health Service Denying Native American Women Access to Emergency Contraception?
Published in partnership with the American Independent.
“No, ma’am,” says the pharmacy tech over the phone at the Choctaw Nation’s health clinic in Hugo, Okla., when I ask if the clinic carries emergency contraception.
At the Pokagon Band of Potawatomi Health Services clinic in Dowagiac, Mich., the pharmacy tech who answers the phone tells me the clinic does not carry Plan B or any other emergency contraceptive that can prevent pregnancy up to 72 hours following unprotected sex, failed contraception, or sexual assault. And no, she doesn’t know the nearest place to get any.
The person filling in at the Black Hawk Health Center in Stroud, Okla., after checking with staff, tells me the clinic does not carry any emergency contraceptive. He suggests trying Stroud Drug or the Walgreens or CVS in Edmond, about an hour drive from Stroud. I could also try the Walmart in Shawnee, he says.
I learn from the Citizen Potawatomi Nation tribal clinic in Shawnee that it does not carry emergency contraception either; though again, I’m referred to Walgreens, CVS, and Walmart.
Were I a Native American woman — which I’m not — I would have less incentive to go to a retail pharmacy like one at Walmart or CVS. Because at a pharmacy affiliated with the Indian Health Service — a federal agency that provides health services for American Indians and Alaska Natives — emergency contraception, like most medication, would be free. And even if I did have the fifty or so dollars it might cost for the so-called “morning-after pill,” I might not have a way to get to a retail pharmacy, if I don’t have a car or if I live on an isolated reservation.
About a month ago, I reproduced an informal phone survey originally conducted last September by the Native American Women’s Health Education Resource Center, based in Lake Andes, South Dakota. I called the same 63 centers (though I was not able to reach every one), all funded by IHS, asking the questions asked in the original survey: Does your pharmacy carry Plan B or another emergency contraceptive? And is it offered over the counter? I did not identify myself as a reporter.
Though some of the pharmacies contacted in that original survey, and in my own reproduction, said they offered emergency contraception over the counter, more often pharmacy techs or pharmacists said that either their clinics offered the drug by prescription-only, or not at all. In all, the NAWHERC study found that only 11 percent of the pharmacies surveyed carried emergency contraception over the counter, about half carried emergency contraception but required a prescription and a doctor’s visit, and about 43 percent of the pharmacies contacted did not carry Plan B at all.
In 2006, the Food and Drug Administration approved the over-the-counter use of Plan B for women 18 and older. In 2009, the FDA approved the over-the-counter use of Plan B and the updated Plan B One-Step, as well as a generic version of Plan B called Next Choice, for women 17 and older. And last year, the agency approved the generic Next Choice One Dose to be taken without a prescription for the same age group. (Other, prescription-only forms of emergency birth-control have been approved by the FDA, as well.)
According to the Centers for Disease Control and Prevention, if taken within 72 hours of unprotected sex, Plan B reduces the risk for pregnancy by at least 75 percent.
But for many Native American women, it can be difficult to obtain emergency contraception over the counter, which can in turn diminish the chances that the drug will prevent an unintended pregnancy. The time to schedule a doctor’s appointment, attend the appointment, obtain a prescription, and fill that prescription — and the fact that many IHS and tribal clinics close after 5 p.m. and during weekends — further reduces access to the drug.
A 2012 study assessing the accuracy of information on emergency birth control provided to teens and their physicians, published in the journal Pediatrics, noted that “with every 12-hour delay in taking the ﬁrst EC dose after unprotected intercourse, the odds of pregnancy increase by nearly 50 percent. Therefore, even minor delays in obtaining EC substantially increase the likelihood of pregnancy.”
Native women’s advocates spent the better part of 2012 calling for the Indian Health Service to implement a standardized policy on obtaining emergency contraception without a prescription. The agency has made no official move on this requested policy and has remained largely silent on the issue, repeatedly giving me and other reporters vague responses, to the effect that IHS is “in the process” of standardizing its procedures, without confirming any specific plans.
However, communications provided to me reveal that IHS claimed to be working on a policy months ago.
In the face of silence on when women can expect improved access to emergency contraception on tribal lands, Native women’s advocates — led by NAWHERC Executive Director Charon Asetoyer and consultant Pamela Kingfisher — have taken it upon themselves to help tribal communities learn more about their right to a reproductive health service enjoyed by the rest of the country. They have been collaborating with tribal groups across the nation, hosting workshops and roundtables with women’s shelter workers and community leaders, and pestering government officials for answers on any upcoming policies.
“I think it’s upon us women now to challenge our leadership, to step up and stand up for women, especially if the federal government is not going to do it,” said Kingfisher, a member of the Cherokee Nation in Oklahoma.