摘要：With access to reproductive health care eroding, examination of prescribing of contraception, including emergency contraception (EC), is important. We examined whether working in a family practice affiliated with a religious institution changes the likelihood of a provider prescribing EC. Our survey asked about EC prescribing practices in a range of situations. As predicted, practitioners in non–religiously affiliated practices reported higher rates of prescribing EC than those in religiously affiliated practices. In both cases, however, the practitioners’ prescribing patterns were inadequate. At a time when federal conscience clauses, 1 state legislative initiatives, 2 and fundamentalist religious opposition are challenging women’s access to abortion, it is important to examine physician prescribing practices with regard to contraception. Physicians continue to be the gatekeepers for all non–over-the-counter contraceptive methods, and access to contraception has a significant impact on women’s need for abortion services. In recent years, physician and public health organizations have advocated for greater availability and use of levonorgestrel-based emergency contraception (EC) to prevent unintended pregnancy after a woman has had unprotected intercourse. This US Food and Drug Administration (FDA)–approved treatment is safe, and 75% to 95% effective (efficacy decreases over time), but must be initiated within 120 hours, or 5 days, after unprotected intercourse. 3 – 5 Because of this short time frame, during which women must obtain a prescription, have it filled, and take the medication, many medical organizations, including the American Academy of Family Physicians, 6 the Society of Adolescent Medicine, 7 and the American Public Health Association, 8 have evaluated the relevant data and taken a public position that EC should be available over the counter, without a prescription. According to the World Health Organization, the only contraindication to levonorgestrel-based EC is that it not be given to women with an already established pregnancy. 9 This is not because it works as an abortifacient, but rather because it is completely ineffective in this setting, and so its use is inappropriate. It is not harmful to a fetus if taken mistakenly. Unfortunately, the FDA chose not to make it available over the counter, and Plan B (two 0.75-mg tablets of levonorgestrel) is currently available in the United States primarily by prescription, and directly from pharmacists, in only 7 states. Because of this restriction, many organizations, including the American Public Health Association, have recommended that it be prescribed in advance, wherever possible, to women of reproductive age. 8 We sought to examine how family practitioners in residency training programs are prescribing EC. Family physicians provide the only available health care in large areas of the United States, including many medically underserved rural and inner-city communities. 10 We compared practitioners from family medicine residencies associated with religiously affiliated institutions with those from non–religiously affiliated institutions in 6 demographically similar settings. Four practices are in New York City proper (2 religiously affiliated and 2 non–religiously affiliated), and the other 2, 1 religiously affiliated and 1 non–religiously affiliated, are located in New Jersey, near New York City. Like most family medicine training clinics, all serve a predominantly medically underserved urban patient population. Because of the consolidation of many medical institutions, a growing number of hospitals and health care facilities are now affiliated with religious institutions. 11 , 12 In fact, Catholic-affiliated institutions are now among the largest nongovernmental owners of hospitals. 13 These religious institutions place restrictions on the practice of medicine and limit women’s choices for reproductive health care. 13 – 16 Many of these hospitals have family medicine and gynecology residency programs where new generations of practitioners are being trained. We report on a survey of clinical scenarios comparing the prescribing of EC by family practitioners from religiously affiliated and non–religiously affiliated institutions.
