Hi, I'm Gretchen Borchelt, Senior Counsel with the National Women's Law Center, and I will be talking to you today about pharmacists refusing to dispense contraception to women at the pharmacy. So there are two problems, one is that pharmacists are refusing to fill valid prescriptions for contraception, and then also pharmacists are refusing to sell women emergency contraception. For those of you who aren't familiar with emergency contraception or EC as we call it, it is a regular form of birth control that works in a more concentrated way to prevent pregnancy, and it is most effective the quicker someone can take it. So in the first twelve to twenty-four hours following unprotected sex, or birth control failure or sexual assault; it can prevent pregnancy from ever happening. It was approved for women and men who are 18 and over to buy it at the pharmacy without a prescription, but the problem is that it's kept behind the pharmacy counter, so that pharmacists still have the ability to refuse to just sell it to those people who are coming in to buy it. So we've seen both these kinds of refusals taking place.
And unfortunately, pharmacists who refuse to dispense or sell emergency contraception also usually take more action to really kind of actively obstruct women's access to contraception. We've heard of pharmacists who refused to refer to pharmacies, we've heard of pharmacists who refused to transfer prescriptions, pharmacists in some cases have actually confiscated prescriptions and not given them back to women so they can't take them somewhere else. We've also heard of pharmacists who actually lie to women bout whether a drug in stock. They say, oh no we don't sell EC here, when in fact they do and the woman could have bought it if she'd had an honest pharmacist. We've also heard of pharmacists who have stalled or delayed access to emergency contraception which is, you know, because of the time sensitivity is a real problem because it only works if you can only take it within a certain time period. And then we've heard of pharmacists who have publicly lectured or harassed women and in some cases that's led to violations to confidentiality when you think about a woman in a crowded pharmacy area who is being yelled by a pharmacist because of the contraception that she is seeking. So it's a real problem across the board, and we've recently heard of this new effort to deny women access to contraception.
So called pro life pharmacies have been popping up around the country. These are pharmacies that actually refuse to stock any contraception at all. And so a woman who goes in not knowing that this pharmacy doesn't have contraception, cant get it there, and not only will they not sell it, they actually wont help women get contraception elsewhere. So they wont' refer her to another pharmacy or call around to help her find contraception.
Now we get a lot of questions about how many refusals are happening, and it's hard to say.
We know that reports of pharmacist refusals are increasing. We have heard either through press reports, or women coming to us directly that refusal have occurred in at least twenty-three states across the nation. And we certainly think that the problem is underreported because it's kind of a sensitive topic. Some women don't want to talk about it happening to them. They're embarrassed, or they don't want it to get out that they were seeking emergency contraception. And it is has occurred in at least twenty-three states across the nation. And I just want to make obvious that the refusals we are talking about here are refusals that are based on personal, moral, or ethical beliefs. These are not refusals that are based on legitimate medical or professional reasons. Certainly there are professional reasons that we would want a pharmacist that we would want a pharmacist to give someone a prescription. For example, contraindications: if you are taking a medication that would interfere with another one you're taking or if there's a fraudulent prescription. But that's not what we're talking about with these refusals.
So let's talk about the effect of refusals. First of all, refusals are bad for all women, and I'll explain why we think that. First of all, they deny women's rights to make their decisions about their personal health care. They also allow pharmacists to impose their religious beliefs on women that are seeking that health care. They humiliate and anger women who are subjected to them, especially if they are accompanied by lectures or moralistic opinions, as I said some pharmacists do. And certainly, when there is a violation of confidentiality, that's a real problem that hurts the health care system. But most importantly, refusals are bad for women's health. Women need contraception in order to prevent unintended pregnancies, and in order to control the timing and spacing of their pregnancies. And that is very important, not only to women's health, but to infant health, as well. Unplanned pregnancies can have consequences on women's and infant's health.
It's also important to note that women use contraception for reasons other than contraceptive purposes. Women might need contraception in order to prevent endometriosis, or to treat endometriosis, or to regulate their cycles. So it's not just contraceptive purposes that women take contraception for, and pharmacists who are refusing don't ever inquire as to why a woman is actually seeking contraception, nor should they, it's not their business, but we don't refusals for any reasons, whether if it's because the woman is seeking it for contraception purposes or health reasons.
And there are three groups in particular that are affected negatively by refusals. Sexual assault survivors, when they have already undergone through a rape, to refuse to provide them with a chance to prevent pregnancy from a rape obviously could add to trauma to an already traumatic situation. For rural women, they may be geographically limited to one pharmacy. They may not be able to travel from one pharmacy to another in search of medication because it's too far or they're not able to because of the timing of when it happens. And especially in the cases of emergency contraception, it may not be possible for them to get to another pharmacy in the time frame in which emergency contraception is effective. And then low income women. They may not have the funds to travel to another pharmacy. And if they are refused in the sense that the pharmacist keeps the prescription and won't give it back to them, they may have to have another doctor's visit, and pay for that visit, which could be just too expensive for them to do. Certainly some low income women have insurance constraints, so they may not be able to go to other pharmacies, their insurance may let them only go to the one pharmacy, so if they face a refusal there, they don't have another option.
Now, refusals are not just harmful to women, and not just harmful to those groups of women, but they really are harmful to the profession of pharmacy. So again what we're talking about are refusals that are grounded in personal beliefs, not in professional training. The public has come to expect high standards from the profession of pharmacy. So any kind of refusal that is based not on those medical and scientific considerations, but on other reasons, actually undermines what the public expects from the profession of pharmacy. And refusals also represent a breach on the health care system. We depend on pharmacists to help patients comply with doctor orders, and refusals interrupt that system hats in place and should work appropriately.
So what does the public think about pharmacist refusals? Public opinion is actually squarely opposed to allowing pharmacists to refuse to give women contraception. We've done two studies that show this clearly. In July of 2007 as you'll see, we found that 71% of voters said that pharmacists should not be allowed to refuse, and that includes majorities of every voter demographic. And you'll see there are Republicans, Christians, Evangelical Christians, and Catholics and the high percentages of those groups that agree with that statement. And then just recently in September/ October of 2008, we did a survey of Republican and Independent voters and found that they also strongly favor legislation that would require pharmacies to ensure that patients get their contraception. So the public really is behind this issue and understands the problems of what happens when a pharmacist refuses to give women access to the contraception that she needs.
So the question that we get a lot at the Law Center is whether pharmacists have the right to refuse to dispense drugs base don their personal beliefs, and what the law says on this issue. There are fourteen states so far that have taken clear explicit steps to ensure women's access to contraception in the pharmacy. And you see here that are seven states that are listed on the slide that require pharmacists or pharmacies to fill valid prescriptions. So the woman does not leave the pharmacy without contraction in hand. And then there are an additional seven states, and they are listed there, as well, that permit the individual pharmacist to refuse, but say that the pharmacist has to help the patient find the contraception somewhere else. So the pharmacist can't refuse to refer, can't refuse to transfer, can't make moralistic judgments or yell at the patients or anything like that. So those fourteen good stats have taken those positive steps.
On the other side of the issue, there are four states that are listed here that allow pharmacists to refuse based on their personal beliefs, and don't offer any patient protections at all. So a woman can go into a pharmacy, be refused in one of these states, and has no remedy. She could be yelled at, the pharmacist could confiscate the prescription, and all of that is allowed in these four state laws. Now that's only eighteen states and what about the rest of the states? They are actually silent on this issue. They have not taken an explicit position, but there are existing laws under pharmacy law and under other laws that can protect women in the case of a pharmacist refusal.
So what can you do as someone who is interested in this topic? Well, certainly you can learn more, and our project website, we have one specifically dedicated to this issue can give you lots of information. We have fact sheets, we have legal guides, we have maps of the states that lay out all of those laws that I just discussed. So please visit our website for more information. Then, I have listed two other guides put out by organizations: MergerWatch and the ACLU that delve into this problem, and what can be done. And so I recommend that you look into those, as well.
You can also become an advocate. Think about asking your state pharmacy board or state legislature to put into place good policies. State legislatures are grappling this issue every day. And we can help you figure out if your state is one that is dealing this issue, and if so, how you can get involved. You can also talk to your members of Congress to try to get policies in place at the national level, so that women across the country have the benefit of getting access to contraception at the pharmacy. And certainly fight against any bad policies that are being considered either at the state level or at the federal level, and again, we are here to help you figure out when those policies exist, and what can be done to stop them. And then work on educating others, make sure that your friends, your families know about these issues, make sure that they can become advocates themselves to try and make sure that these policies can be put into place. And make sure that you and they know what to do when you face a refusal.
What happens if you actually face a refusal, what can you do? You could file a complaint with the state pharmacy board. The pharmacy boards are the entities that licenses pharmacists and pharmacies, and you can actually bring a complaint against them when they refuse to give you your medication, or if a pharmacist acts unprofessionally, and we have worked with women successfully to file complaints when they have been refused contraception. You should also think about contacting the pharmacy headquarters to complain. Almost every major pharmacy chain at this point has a good policy in place that protects patient access to medication at the pharmacy. We have worked with pharmacy headquarters, and they have been very quick to act when there has been a violation of that store policy, and will discipline the pharmacist in those cases.
You can also exercise your consumer power. Think about hitting pharmacies where it really hurts, which is their business, their bottom line. So if you know of a refusal, or you know a pharmacist that refuses, or a pharmacy that does not have a good policy, don't shop there anymore. Tell your friends and family not to shop there anymore, and make sure that you let them know why you're not shopping there any more so that they can hopefully change policy because of it.
Certainly think about talking to the press. The press loves refusal stories; it's always a good thing to get reporters interested in this. And if it goes in the press, that can spur action in the state legislature or the state pharmacy board, and could lead to a good outcome. So we encourage people to try and talk to the press when they are comfortable doing that. And finally let us know if you have a problem. We have a toll free number that you can call, you can also call us through e-mail, and we are happy to help you with any of these options-to figure out what your state law is, whether you can file a complaint, how to file a complaint, and we are also willing to tell your story publicly in a way that keeps you anonymous if you don't want your name used in any way. So please contact us, we are here to help you at the National Women's Law Center. So I will stop there. Thank you all for listening; this has been Gretchen Borchelt with the National Women's Law Center.
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For more information, Visit the National Women's Law Center's website to download free copies of :
ASK! Will the moral or religious beliefs of your health care providers limit your access to health care?
Don't Take "NO" for an Answer: A Guide to Pharmacy Refusal Laws, Policies, and Practices