Access to Emergency Contraception in the U.S.
Emergency contraception (EC) can prevent pregnancy when taken up to five days following sexual intercourse.
There are two EC pills approved by the U.S. Food and Drug Administration (FDA). They contain a concentrated dose of progestin, a hormone found in many birth control pills, which inhibits or delays ovulation. EC pills will not work if a woman is already pregnant.
Emergency contraception pills are estimated to be 75 to 90 percent effective at preventing pregnancy.
The FDA has approved a new form of prescription-only emergency contraception, ‘ella,’ which can prevent pregnancy if taken up to 120 hours, or five days, after a contraceptive failure or unprotected sexual intercourse.
‘Plan B,’ another alternative, was approved by the FDA in 2011 as an over-the-counter form of emergency contraception for all women over the age of 17. Plan B is available with a prescription to all women of child-bearing age.
State Laws and Access to Emergency Contraception
The following states have taken legislative action related to accessing emergency contraception:
- Twenty-one states—Alaska, Arkansas, California, Colorado, Connecticut, Hawaii, Illinois, Maine,Massachusetts, Minnesota, New Hampshire, New Jersey, New Mexico, New York, Oregon, South Carolina, Texas, Utah, Vermont, Washington and Wisconsin—and the District of Columbia have statutes related to accessing emergency contraception.
- Sixteen of these states—Arkansas, California, Colorado, Connecticut, Illinois, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Oregon, South Carolina, Texas, Utah, Washington, and Wisconsin—and the District of Columbia have enacted legislation requiring hospitals or health care facilities to provide information about and/or initiate emergency contraception therapy to women who have been sexually assaulted.
- Ohio has a law that directs the state’s public health council to establish procedures for gathering evidence for victims of sexual offenses. The council created the Ohio Protocol for Sexual Assault Forensic and Medical Exams, which requires medical personnel to discuss and offer options for emergency contraception with survivors of sexual assault.
- Pennsylvania has established the requirement that health care facilities provide information about emergency contraception and administer it onsite upon the victim’s request through administrative code.
- Nine states—Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Vermont, and Washington—allow pharmacists to initiate emergency contraception drug therapy if they are working in collaboration with a physician, and/or after they have completed a training program in emergency contraception.
For information about state laws related to pharmacist conscience clauses, including states that allow a pharmacist to refuse to dispense emergency contraception, please click here.
Summary of Statutes
|Alaska||Alaska Stat. 12 AAC § 52.240 allows a pharmacist to dispense emergency contraception without a physician’s prescription under collaborative practice agreement.|
|Arkansas||Ark. Stat. Ann. § 20-13-1401 et seq. (2007) require all licensed health care facilities that provide emergency care to sexual assault survivors to amend their evidence-collection protocols for treatment of survivors. The amendment requires the facility to inform the survivor in a timely manner about the availability of emergency contraception. (SB 847)|
|California||Cal. Business and Professions Code § 682 (2003) revises the training requirement that a pharmacist would have to complete prior to being authorized to administer emergency contraception drug therapy. The law also prohibits the pharmacist from requiring a patient to provide identifiable medical information. Additionally, the law authorizes the pharmacist to charge an administrative fee, not to exceed $10, for providing the service. (SB 545)
Cal. Business and Professions Code § 4052 (2001, 2003) authorizes a pharmacist to initiate emergency contraception drug therapy in accordance with standardized protocols developed by the pharmacist and an authorized prescriber acting within his or her scope of practice. The law requires a pharmacist who initiates emergency contraception drug therapy pursuant to these provisions to provide the recipient with a standardized fact sheet (2001 SB 1169). The law was amended in 2003 (SB 490) to require standardized protocols to be established jointly by the State Board of Pharmacy and the Medical Board of California, in consultation with specified entities and to require pharmacists to obtain proper training prior to administering emergency contraception drug therapy.
Cal. Health and Safety Code § 13823.11 (2002) provides a female victim of sexual assault with the option of postcoital contraception by a physician or other health care provider. Postcoital contraception shall be dispensed by a physician or other health care provider upon the request of the victim. (AB 1860)
Cal. Insurance Code § 10604.1, Health & Safety Code § 1363.02 and Welfare & Institutions Code § 14016.8 require Medi-Cal and every disability insurer providing coverage for hospital, medical, or surgical benefits, to include a paragraph in the provider directory related to emergency contraception.
|Colorado||Colo. Rev. Stat. § 25-3-110 (2007) defines emergency contraception as a drug approved by the federal food and drug administration that prevents pregnancy after sexual intercourse, including but not limited to oral contraceptive pills. Specifies that emergency contraception does not include RU-486, mifepristone, or any other drug or device that induces a medical abortion. The law requires all licensed health care facilities that provide emergency care to sexual assault survivors to amend their evidence-collection protocols to include informing the survivor in a timely manner about the availability and proper use of emergency contraception. The law also encourages entities offering victim assistance or counseling, rape crisis hotlines and pharmacies to include or distribute information concerning the availability and use of emergency contraception. (SB 60)|
|Connecticut||Conn. Gen. Stat. § 19a-11e (2007) requires licensed health care facilities to provide emergency contraception to victims of sexual assault upon the request of such victims. (Conn. Acts, P.A. 07-24, SB 1343)|
|District of Columbia||D.C. Code Ann. §7-2121 et seq. (2009) require hospital emergency rooms to provide emergency contraception and prophylactic antibiotics for the treatment of sexually transmitted diseases to victims of sexual assault. The law requires emergency room personnel to provide the patient with medically and factually accurate written information regarding emergency contraception and prophylactic antibiotics; to provide an oral explanation of the written information distributed; to orally inform the patient in a language they understand of the option to be provided with these treatments; and to immediately provide treatment upon request in a manner consistent with accepted medical practice and protocols. Also specifies that hospitals must have written policies and procedures to ensure that all personnel who provide care or information to a victim of sexual assault are trained to provide medically and factually accurate and objective information about emergency contraception and prophylactic antibiotics; to actually provide that information to the patient; and to ensure immediate access to treatment. (2009 D.C. Stat., Chap. 17-664, Bill 17-323)|
|Hawaii||Hawaii Rev. Stat. § 461-1 (2003) allows pharmacists working in collaboration with a physician and with the appropriate training to initiate emergency contraception oral drug therapy. (HB 123)|
|Illinois||Ill. Rev. Stat. ch. 410, § 70/1a et seq. (2002, 2008) the Sexual Assault Survivors Emergency Treatment Act defines emergency contraception and requires the dissemination of emergency contraception information to women who are victims of sexual assault. The law requires hospitals to submit a plan for providing services to sexual assault survivors to the Department of Public Health for approval. Hospitals are required to provide sexual assault survivors with medically and factually accurate, oral and written information about emergency contraception, including possible side-effects and risks of using emergency contraception, and information about how to obtain the drug. (2002 Ill. Laws, P.A. 92-156, SB 114; 2008 Ill. Laws, P.A. 95-432, SB 1618)|
|Maine||Me. Rev. Stat. Ann. tit. 32, § 13821 et seq. (2003) allow a pharmacist to initiate emergency contraception drug therapy in collaboration with an authorized prescriber, provided that the pharmacist complete an emergency contraception training program. The pharmacist is also required to provide the recipient of the drug therapy with a standardized fact sheet.|
|Massachusetts||Mass. Gen. Laws Ann. ch. 41, § 97B (2005) requires police standardized rape kits to include medically and factually accurate information about emergency contraception.
Mass. Gen. Laws Ann. ch. 94C, § 19A allows licensed pharmacists to dispense emergency contraception after completing a training program. Pharmacists who dispense emergency contraception must annually provide to the Department of Public Health the number of times emergency contraception was administered.
Mass. Gen. Laws Ann. ch. 111, 70E (2005) requires hospitals to provide women of childbearing age, who are victims of rape, with medically and factually accurate information on emergency contraception, to offer these women emergency contraception, and to provide them with emergency contraception upon request.
|Minnesota||Minn. Stat. § 145.4711 et seq. (2007) requires emergency rooms to provide emergency contraception, prophylactic antibiotics, and information to sexual assault victims following an assault. (2007 Minn. Laws, Chap. 42, SB 1266)|
|New Hampshire||N.H. Rev. Stat. Ann. § 318:47-e (2005) establishes the Collaborative Practice for Emergency Contraception Act. Under this bill, a pharmacist may initiate emergency contraception drug therapy in accordance with procedures developed by the New Hampshire pharmacy board and a physician or other authorized prescriber who is acting within his or her scope of practice (SB 30)|
|New Jersey||N.J. Stat. Ann. § 26:2H-12.6b et seq. (2004) require certain health care facilities providing care to sexual assault victims to provide information about emergency contraception and to provide emergency contraception upon request. The law also requires these facilities to have written policies and procedures to ensure that all personnel who provide care or information to sexual assault victims be trained to provide information about emergency contraception. (SB 1668)
2011 N.J. Laws, Chap. 106 clarifies that victims of sexual assault may not be charged any fees for services associated with a forensic sexual assault exam, including the cost of emergency contraception. (SB 972)
|New Mexico||N.M. Stat. Ann. § 184.108.40.206 authorizes a pharmacist to administer emergency contraception drug therapy in accordance with protocols established by the Board of Pharmacy. The law also requires the pharmacist to complete a course in emergency contraception drug therapy.
N.M. Stat. Ann. § 24-10 D-1 et seq. require hospitals that treat victims of sexual assault to provide written and oral information about emergency contraception and to provide the contraception to patients who request it.
|New York||N.Y. Public Health Law § 2805-p requires hospitals providing treatment for survivors of rape to provide survivors with written and oral information on emergency contraception, including its efficacy and availability. Hospitals are required to provide survivors with emergency contraception unless the individual requests otherwise.|
|Ohio Rev. Code Ann. §2907.29 requires every hospital that offers emergency services to provide survivors of sexual assault with information on available venereal disease, pregnancy, medical and psychiatric services. The law directs the state’s public health council to establish procedures for gathering evidence for victims of sexual offenses. The council created the Ohio Protocol for Sexual Assault Forensic and Medical Exams, which requires medical personnel to discuss and offer options for emergency contraception with survivors of sexual assault.|
|Oregon||Or. Rev. Stat § 147.225 et seq. and 147.395 et seq. authorize the Sexual Assault Victims Emergency Medical Response Fund within the Department of Justice to pay for emergency contraception as part of a “complete medical assessment”.
Or. Rev. Stat. § 435.250, § 435.252, § 435.254 and § 435.456 (2007) require hospitals to provide unbiased, medically and factually accurate written and oral information about emergency contraception to female victims of sexual assault. The Oregon Health Authority will develop and approve informational materials, and may impose civil penalties against any hospital that does not comply with the rules detailed in these laws. (HB 2700)
|Pennsylvania||Pa. Code tit. 28 § 117.53, § 117.55 and § 117.57 (Administrative Code) require hospitals providing emergency medical care to victims of sexual assault to supply written information about emergency contraception, orally inform victims of the availability of emergency contraception and administer emergency contraception onsite upon the victim’s request. A hospital may choose not to provide emergency contraception onsite if doing so may be contrary to the stated religious or moral beliefs of the hospital. If a hospital claims a religious or moral exemption, that hospital must still provide written information about emergency contraception, and arrange for a victim who requests it to be transported to a facility which provides emergency contraception. Hospitals must also ensure each member of the hospital personnel providing sexual assault emergency services is provided with written informational materials about emergency contraception. (The Pennsylvania Bulletin, January 26, 2008)|
|South Carolina||S.C. Code Ann. § 16-3-1350 (1997) requires the South Carolina Crime Victims Compensation Fund to pay for medical treatment for sexual assault victims, including “medication for pregnancy prevention, if indicated and if desired.”|
|Texas||Tex. Health and Safety Code Ann. § 323.005 directs the Department of Health Services to develop a standard information form for sexual assault survivors. The form must include information regarding treatment of sexually transmitted infections and pregnancy, including generally accepted medical procedures, appropriate medications and any contraindications of the medications prescribed for treating sexually transmitted infections and preventing pregnancy.|
|U.S. Virgin Islands|
|Utah||Utah Code Ann. § 26-21b-101 et seq. define emergency contraception as the use of a substance, approved by the Food and Drug Administration, to prevent pregnancy after sexual intercourse. The law requires specified health care facilities and practitioners to provide victims of sexual assault with written and oral medical information regarding emergency contraception that is unbiased, accurate and generally accepted by the medical community as being scientifically valid; orally inform the victim that they may obtain emergency contraception at the facility; offer a complete regimen of emergency contraception; and provide emergency contraception to the victim upon her request. The facility must also develop and implement a policy to ensure that a person is present at the facility, or on-call, who has the authority to dispense or prescribe emergency contraception. (2009 Utah Laws, Chap. 266)
2010 Utah Laws, Chap. 140 (HB 340) amended § 26-21b-201 to exempt freestanding urgent care centers that are within 30 miles of general acute hospitals and critical access hospitals from the requirements of this law. An employee of the free standing urgent care center must provide victims with written and oral information about emergency contraception and the name and address of the health facility within 30 miles that is required to provide emergency contraception.
|Vermont||Vt. Stat. Ann. tit. 26, § 36.2077-2079 (2006) authorize a pharmacist to dispense emergency contraception under a collaborative agreement with a physician or prescriber. Establish protocol and procedures for collaboration. The law also requires pharmacists to participate in an education and training program prior to dispensing emergency contraception. (HB 237)|
|Washington||Wash. Rev. Code Ann. § 70.41.020 and § 70.41.350 (2002) relate to emergency care for victims of sexual assault. The law declares it essential for all hospital emergency rooms to provide emergency contraception as a treatment option to any woman who seeks treatment as a result of a sexual assault. The law requires hospitals providing emergency care to victims of sexual assault to: provide medically and factually accurate information about emergency contraception, orally inform victims they may receive emergency contraception at the hospital upon request, and provide emergency contraception immediately to each victim who requests it. The law directs the secretary of health to develop, prepare, and produce informational materials relating to emergency contraception for the prevention of pregnancy in rape victims for distribution to and use in all emergency rooms. (2002 Wash. Laws, Chap. 116, SB 6537)
Wash. Rev Code Ann. § 18.64.011 under a very broad collaborative practice agreement, pharmacists may dispense emergency contraception if specially trained and part of a collaborative practice. (Please note that this agreement does not specifically include emergency contraception, but it is included in practice.)
|Wisconsin||Wis. Stat. § 50.375 (2007) requires hospitals providing emergency services to victims of sexual assault to provide individuals with written and oral information about emergency contraception, orally inform her of the option to receive emergency contraception and the option to report the sexual assault, and immediately provide emergency contraception to her upon her request. The act also requires a hospital that provides emergency care to ensure that each hospital employee who provides care to a victim of sexual assault has available information about emergency contraception. (AB 377)|
Note: List may not be comprehensive, but is representative of state laws that exist. NCSL appreciates additions and corrections.
Sources: National Conference of State Legislatures, StateNet, Guttmacher Institute.
- Unintended Pregnancy Prevention: Contraception
Centers for Disease Control and Prevention
- Emergency Contraception Frequently Asked Questions
The National Women’s Health Information Center, Office on Women’s Health, U.S. Department of Health and Human Services
- Emergency Contraception Fact Sheet
Office of Population Affairs, U.S. Department of Health and Human Services
- Emergency Contraception
Kaiser Family Foundation, August 2010
- Plan B Tablets Information
United States Food and Drug Administration, Office of Women’s Health
- FDA approves ella tablets for prescription emergency contraception
United States Food and Drug Federal Administration, Press Release, August 13, 2010
- ella Drug Details
Drugs @ FDA: FDA Approved Drug Products