Evaluating Community Pharmacy Responses About Levonorgestrel Emergency Contraception by Mystery Caller Characteristics

J Adolesc Health. 2018 Jul;63(1):32-36. doi: 10.1016/j.jadohealth.2017.11.303. Epub 2018 Feb 21.


Purpose: Since restrictions on nonprescription sales were removed in 2013, levonorgestrel emergency contraception (EC) should be available without a prescription at pharmacies for consumers of all genders and ages. Using mystery callers, we assessed variations in availability of and access to EC.

Methods: In 2015-2016, three sets of mystery callers (two female physicians, two adolescent females, and two adolescent males) each called all licensed retail pharmacies in five U.S. cities using standardized call scripts. Scripts assessed same-day availability and subsequent access to EC for 17-year-olds. Data on various characteristics of calls were collected and compared by caller type.

Results: Among the 993 pharmacies called, same-day availability for EC was approximately 80%, with no differences by caller types (p = .34). However, 10.7% of calls made by the adolescent male caller and 8.3% made by the adolescent female caller resulted in incorrectly being told they could not obtain EC based on age, compared to only 1.6% of calls made by the physician (p < .01). Pharmacy staff stated correctly that EC was available over-the-counter more often to adolescent male callers (62.0%) than adolescent females (51.6%) or female physicians (57%) (p < .01). Physicians were more likely to be placed on hold, talk to a pharmacist, or be transferred to a pharmacist (p < .01) than adolescents.

Conclusions: Persistent barriers to accessing EC exist for adolescents despite regulatory changes to make EC available over-the-counter, especially for females. Additional work to remove these barriers is needed to assure timely access for those who require effective pregnancy prevention.

Keywords: Access to health care; Adolescent health services; Adolescents; Contraception; Emergency contraception; Pharmacy; Pregnancy.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Community Pharmacy Services / statistics & numerical data*
  • Contraceptives, Oral, Synthetic / supply & distribution*
  • Contraceptives, Postcoital / supply & distribution*
  • Female
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Levonorgestrel / supply & distribution*
  • Male
  • Pharmacies / statistics & numerical data
  • Pharmacists / statistics & numerical data


  • Contraceptives, Oral, Synthetic
  • Contraceptives, Postcoital
  • Levonorgestrel