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The Morning After Pill, made by Cadence OTC of Oakland, Calif., is shown on a convenience store shelf. Women’s health advocates claim that as retail pharmacies close across the country they leave behind emergency contraception deserts. Photo courtesy of Cadence OTC
St. PAUL, Minn., May 27 (UPI) — Women’s health advocates say they want to expand the availability of morning-after pills to convenience stores as new state abortion laws sow confusion about their legality and pharmacies are closing nationwide.
Emergency contraception deserts are arising in many areas of the United States where morning-after pills, although still legal everywhere, have become almost impossible to find due to a combination of misconceptions about their function and the ongoing drug store closures, healthcare experts told UPI.
Some suggest that wider availability of morning-after pills for women at convenience stores and other non-traditional outlets, such as gas stations, grocery stores, corner delis, travel retailers and hotels, could ease the problem.
Levonorgestrel, also known as “Plan B,” or the morning-after pill, is a first-line oral emergency contraceptive pill approved from the U.S. Food and Drug Administration and the World Health Organization to prevent pregnancy. It is to be used within 72 hours of unprotected sexual intercourse or when a presumed contraceptive failure has occurred.
It has an average cost about $40 to $50, with generics generally costing less at about $11 to $45.
Approved in 2007
Levonorgestrel earned FDA approval to be sold over the counter without a prescription in 2007 after the agency deemed it to be safe following years of debate. Since then, it has been available without a prescription at drug stores alongside male contraceptives, such as condoms.
But while condoms are widely available in many different settings, women’s health advocates are warning that the lack of similar availability for Plan B pills outside traditional pharmacies has created emergency contraception deserts in many areas.
Adding to the problem is confusion about how Plan B pills function and whether they’re still legal in the wake of the Supreme Court’s landmark 2022 Dobbs vs. Jackson Women’s Health Organization decision that allowed states to enact local abortion bans.
Uncertainty has arisen in states with the toughest abortion restrictions about whether the pills even remain legal as people confuse levonorgestrel, which prevents pregnancy, with mifepristone and misoprostol, which induce medical abortions, according to the women’s health advocates.
Polls indicate that as many as 73% of people incorrectly think morning-after pills can end a pregnancy in its early stages. In fact, the right to such contraception is currently protected by two other landmark Supreme Court decisions, Griswold vs. Connecticut (1965) and Eisenstadt vs. Baird (1972), but this confusion is believed to have led to declines in their use since Dobbs, they argue.
Challenging economics
They also point to the challenging economics of the retail pharmacy industry. Walgreens, for instance, announced in October that it will close roughly 1,200 of its stores through 2027 and seeks to close at least 500 stores by the end of 2025 alone. It says one-quarter of its roughly 8,700 U.S. store locations are unprofitable.
About one-third of all U.S. pharmacies have closed since 2010 due to mergers of large pharmacy chains and the closure of stores deemed not profitable enough, according to a study published last year.
As these factors accelerate, some 7,000 U.S. ZIP codes in both urban and rural areas now qualify as emergency contraception deserts in which “healthcare services are lacking and there are few or no drug stores to fulfill the needs of the approximately 23 million women of childbearing age who live there,” according to Cadence OTC, an Oakland, Calif.-based public benefit company that makes and markets a brand of levonorgestrel called “Morning After Pill.”
Cadence officials say they have spent the last few years working hard to convince convenience retailers that stocking Morning After Pill benefits both their bottom lines and the health of their communities.
They have so far succeeded in getting the product into 11,000 locations in 48 states after forging a partnership with Lil’ Drug Store Products, the nation’s top supplier of health and beauty care products to convenience stores.
Sales in remote areas
“A lot of college campuses and military bases are in remote areas and are filled with young people, so these are priorities for contraceptive access,” the company said in a statement issued to UPI. “C-stores are in every neighborhood and they are open long hours.”
Stocking emergency contraceptives makes sense for convenience stores as a way to replace revenue lost as cigarette purchases decline, Cadence said, adding, “Urgent healthcare products are a logical expansion space for C-stores, and the profit margins are generally higher than food and soft drinks.
“Ninety percent of C-stores already carry condoms, so it makes sense to offer female contraceptives. as well.”
The challenge “is to increase awareness among consumers to think of C-stores for these healthcare items,” company officials said in a statement. “Many C-stores are excited about playing a more important role in serving young women, leaning into urgent OTC healthcare is a smart business strategy.”
Health benefit
One gynecologist who has studied the availability of emergency contraception in the aftermath of the Dobbs decision said the push to get morning-after pills into convenience stores would provide a public health benefit.
Dr. Frank “Will” Williams III, who specializes in treating complicated pregnancies for Ochsner Health in New Orleans, co-authored a 2023 study that found only 35% of locally owned, independent pharmacies in the city had emergency contraception in stock. They were also much more likely than chain stores to keep the product behind the counter, require identification and carry no brand that cost under $50.
“The independent pharmacies are the ones who are not likely to have a gaggle of lawyers on retainer who can tell them, ‘Yes, emergency contraception is fine, they’re not discussed at all in any of the abortion legislation, you guys can keep going with this,'” Williams told UPI.
“They didn’t have that luxury, so when Dobbs came through, that’s where we really saw an absence of access to contraception.”
Now with many chain-owned pharmacies closing as well, the push to expand emergency contraception into non-traditional retail venues is needed, he said.
Greater accessibility
“If I’m traveling and need ibuprofen, I can find it a grocery store or convenience store, so there’s no reason why that can’t also be true for emergency contraception,” Williams said. “Whatever we can do to make sure that people have accessible options regarding their health seems like a win to me.”
Agreeing is Dima Mazen Qato, an associate professor at the University of Southern California’s Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences and a senior scholar at the USC Schaeffer Center for Health Policy & Economics.
Qato has researched the causes behind the wave of pharmacy closures and their effects on socioeconomic and racial health disparities across the country.
Getting emergency contraception into non-traditional venues “makes sense, although I don’t know what the price point is for it to be affordable and to actually be used by those who need it,” she told UPI.
“It’s important to make sure it’s affordable at these different access points, and also that there’s no ID required — that’s just available like anything else.”
She added it’s “definitely a great way to distribute emergency contraception, especially in states that, since Dobbs, have banned or partially banned abortion care. I think any effort to expand access to emergency contraception is needed across the country.”
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