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New study shows that many California pharmacists are willing—but unable—to prescribe medication abortion

Most California pharmacists are willing to prescribe medication abortion if it becomes legal for them to do so, according to a new study by a team of researchers that included two investigators from UC Berkeley School of Public Health. In the U.S., medication abortion typically consists of a regimen of two medications: Mifepristone and Misoprostol, taken within days of each other, during the first ten weeks of pregnancy.

The report, published today in JAMA Network Open, was designed to explore the feasibility of permitting pharmacists to prescribe medication abortion. Researchers—including Berkeley Public Health’s Lauren A. Hunter, a postdoctoral scholar, and Sandra I. McCoy, professor of epidemiology and biostatistics—found that nearly 70% of pharmacists who work in community pharmacies were amenable to prescribing medication abortion if it is allowed by law.

Less than half, however, were confident in their knowledge of medication abortion or their ability to prescribe it, the authors wrote. The investigators found that additional training and attention to pharmacy-level barriers may be needed.

“We wanted to look ahead to pharmacies’ potential to provide medication abortion,” said Hunter. “We know that pharmacists are very highly-trained health care providers, who are often trusted sources of care within their communities. For some people, receiving services at a community pharmacy can feel more accessible, and less stigmatizing, than some other health care settings.”

Currently, nearly half of U.S. states have restricted abortion access, though policymakers are exploring pathways to increase access to abortion and other reproductive health care services. Medication abortion, according to the authors, accounts for 54% of all abortions in the U.S.

“Provision of medication abortion in pharmacies thus represents an opportunity to increase access to abortion care and reduce the burden on the healthcare system,” the authors wrote. “Both the American Medical
Association and the American College of Obstetricians and Gynecologists have expressed support for pharmacists dispensing medication abortion, and pilot programs have shown that pharmacists can safely and effectively do so.”

The investigators also asked survey respondents about their views on other reproductive health services, such as pharmacy-provided hormonal birth control, which has been legal in California for nearly a decade.

They hypothesized that pharmacists who held favorable attitudes and practices toward pharmacist-prescribed hormonal birth control would be more likely to hold favorable attitudes toward medication abortion. Their hypothesis held true.

Ninety-one percent of pharmacists surveyed held favorable attitudes toward pharmacist-provided birth control, including hormonal birth control (91%) and emergency contraception (92.5%). Few participants indicated that prescribing birth control would violate their religious beliefs, the authors wrote.

But many respondents indicated barriers to providing this service.

“There is a big gap between the number of pharmacists who are supportive of providing hormonal birth control compared to the number of pharmacists who are actually doing it,” said Hunter. “There’s very high support from pharmacists for birth control provision— and yet less than half say their pharmacies are providing that service.”

Among the obstacles to providing prescriptions for hormonal birth control without an outside provider’s prescription were lack of time and staff, lack of training, and lack of insurance reimbursement.

McCoy believes that pharmacists have untapped potential in promoting access to safe and effective medication abortion, contraception, and HIV prevention.

“Our study documents high levels of pharmacist interest and enthusiasm for provision of these services, which requires a favorable policy environment and implementation research to make a reality,” she said.

Lead author on the article Cathren Cohen, a staff attorney at UCLA’s Center on Reproductive Health, Law, and Policy, used data from the California Pharmacist Study. Analyses were limited to 316 licensed pharmacists who were currently or most recently working in a community pharmacy.

Additional authors include: Raiza M. Beltran, PhD, formerly at UCLA Luskin School of Public Affairs, now at the University of Minnesota; Jaclyn Serpico, JD, MPH, MA, Center on Reproductive Health, Law and Policy at UCLA School of Law; Laura Packel, PhD, formerly at Berkeley Public Health, now at UCSF; Ayako Miyashita Ochoa, JD, UCLA Luskin School of Public Affairs; and Kerith J. Conron, ScD, Center on Reproductive Health, Law and Policy at UCLA School of Law.

Funding was provided by the California HIV/AIDS Research Program, the University of California Office of the President, and the UCLA Center on Reproductive Health, Law and Policy.