Federal and state policies to increase access to birth control have included expanding access to preventive and emergency hormonal contraception at pharmacies for women and girls of all ages without a physician's prescription. We conducted a "mystery shopper" telephone survey to quantify the impact of these policies in Los Angeles County, California. That county consistently has among the highest number of unintended pregnancies and teen births in the US, especially in low-income and minority neighborhoods. Between June and November 2017, three in four pharmacies offered over-the-counter emergency hormonal contraception, but only one in ten offered pharmacist-prescribed preventive hormonal contraception. Many of these pharmacies also imposed age restrictions when dispensing hormonal contraception, including in the neighborhoods at highest risk for unintended pregnancies and teen births, even though the Food and Drug Administration removed age restrictions for over-the-counter emergency hormonal contraception in 2013. In addition, many low-income, minority neighborhoods lacked pharmacies when the survey was performed. Policies aimed solely at expanding pharmacy access to birth control might not be sufficient to address disparities in contraceptive use.
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