Surveying the persistence of age- and gender-based restrictions on over-the-counter emergency contraception across pharmacies in Los Angeles County, CA.

Background: Over-the-counter levonorgestrel emergency contraception (OTC EC) is safe and effective but underutilized for postcoital pregnancy prevention. Unnecessary restrictions imposed by pharmacies and pharmacy workers may impede EC uptake.

Objective: To assess the persistence of age- and gender-based barriers to OTC EC access among pharmacists and pharmacy staff across Los Angeles, CA.

Methods: We conducted a cross-sectional survey of registered community pharmacies randomly chosen from regions with the highest unintended pregnancy rates in Los Angeles County. Using an adaptation of the 2017 American Society for Emergency Contraception EC Access and Price Survey, we interviewed pharmacy staff about their attitudes and practices related to OTC EC, with attention to age- and gender-based barriers.

Results: We surveyed 139 staff members (45% pharmacists, 20% technicians, 26% retail) from 93 publicly accessible pharmacies. Thirteen pharmacies did not stock EC. Half of respondents cited age-based restrictions; only 4% noted gender-based restrictions. More than 75% reported being asked for EC by a man; 7% reported refusing to sell to a man. Nearly 40% reported that men never or rarely purchased EC. Pharmacists were more likely than technicians or retail staff to believe men rarely purchased EC (P = 0.01). The most frequently cited concern about selling to men was inability to confirm the female partner's age.

Conclusion: Although gender-based restrictions to EC are rare, more than half of pharmacy staff continue to report age-based restrictions. Inability to verify the female partner's age may underlie cases where men are unable to purchase OTC EC.