On Aug. 29, 2006, the U.S. Food and Drug Administration approved a change to over-the-counter licensing for progesterone-only emergency contraception, sold as Plan B. As of November, emergency contraception is available without a prescription for women 18 and older, and as a prescription drug for adolescents under age 18. Because of its dual-license status, emergency contraception will be a behind-the-counter drug, available in drug stores only when a pharmacist is on site.

Research demonstrates that emergency contraception is safe and effective for teenagers as well as adults. Since adolescents are more likely than adults to engage in unplanned, unprotected intercourse, the FDA decision to limit over-the-counter access to women 18 and older creates a barrier for a population at high risk for unintended pregnancy.

Following the passage of SB 1169 in 2002, 25 percent of California pharmacies voluntarily offer direct access to emergency contraception without a prescription and without age restrictions. In these pharmacies, the FDA requirements do not apply--women under age 18 and those without government-issued identification may still purchase emergency contraception directly from the pharmacist.

However, the FDA restrictions will impact the millions of women and adolescents who patronize the remaining 75 percent of the state's pharmacies that do not voluntarily offer direct access to emergency contraception.

Although California women no longer need a prescription to obtain Plan B, financial and logistical barriers to emergency contraception still exist. Physicians play a vitally important role in improving access to emergency contraception, especially by providing education and prescriptions in advance of need.

What is Emergency Contraception?
Emergency contraception is birth control used after unprotected sexual intercourse (including sexual assault and contraceptive failure) to prevent pregnancy. Like regular birth control pills, emergency contraception pills primarily work by delaying or inhibiting ovulation. If a woman is already pregnant when she uses emergency contraception, the pills will not disrupt or harm her pregnancy. No medical clearance, physical exam or laboratory test is required prior to use.

Although combined hormonal contraceptive pills may be used as emergency contraception and have been prescribed as such for three decades, the newer, progesterone-only form of emergency contraception is more effective and causes fewer side effects. Plan B consists of two doses of 0.75 mg of levonorgestrel, taken as soon as possible after unprotected intercourse. Plan B is more effective the sooner it is taken, but evidence shows that it reduces the risk of pregnancy when ingested up to 120 hours after sex.

What Role Do Physicians Play?
1) Educate patients about emergency contraception.
Many women, especially those most vulnerable to unintended pregnancy, are not aware that emergency contraception can prevent pregnancy after intercourse. Many patients are also confused about the contraception mechanism, incorrectly believing it causes abortion. Explain to your patients that, in actuality, emergency contraception may reduce the need for abortion.

2) Write prescriptions for insurance coverage.
The cost of emergency contraception may present a significant barrier for some, especially low-income women and adolescents. The current cost of pharmacy access emergency contraception (and the expected cost of over-the-counter doses) is $40-$50. Medi-Cal and Family PACT are expected to continue to cover Plan B, but by prescription only. Even though Plan B is available through pharmacists in California, writing prescriptions for your patients will mitigate the economic barrier.

3) Write prescriptions in advance of need.
Routine gynecologic and primary care visits provide an excellent opportunity for patient education about emergency contraception. You should offer all sexually active women at risk of unwanted pregnancy a prescription for Plan B in advance of need. Emergency contraception prescriptions may prove especially important for immigrant women who lack the government-issued ID required for over-the-counter access in many pharmacies.

By implementing these three practices, Southern California physicians can greatly enhance women's access to emergency contraception and help decrease unintended pregnancy in our region. For more information, go to www.go2planb.com.

The authors work for the Los Angeles County Department of Public Health. Susie Baldwin, MD, MPH, is the chief of the Health Assessment Unit in the Office of Health Assessment and Epidemiology. Sarah Guerry, MD, is the medical director of the STD Program. Rita Singhal, MD, MPH, is the medical director of the Office of Women's Health.