It's been two years since the FDA made certain types of emergency contraception available without a prescription to women of all ages, but Indian Health Service has yet to update its policy.

It's been two years since the FDA made certain types of emergency contraception available without a prescription to women of all ages, but Indian Health Service has yet to update its policy.

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When the Food and Drug Administration (FDA) in 2013 approved over-the-counter access to certain emergency contraceptive pills without any age restrictions, Indian Health Service (IHS) promised that it would update its policies to make this pregnancy-prevention method available in the pharmacies it runs.

Two years later, the IHS policy remains the same, and a group of U.S. senators last week sent a letter to the secretary of Health and Human Services, Sylvia Mathews Burwell, urging her to look into the matter.

Emergency contraception (EC) is a high dose of hormones that can prevent pregnancy by preventing ovulation if taken within three to five days of unprotected intercourse. The sooner it is taken, the better it works, which is why immediate access without a prescription is so important.

Efforts to win FDA approval for over-the-counter status, however, took the better part of a decade with opponents falsely suggesting that emergency contraception causes abortions (it will not, in fact, affect an established pregnancy) and arguing that making it readily available—especially to teens and young women—will increase promiscuity.

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One of the available versions of EC—marketed as Plan B One-Step—was approved in July 2009 for over-the-counter sale, but such sales were limited to women 17 and older. Younger women still needed a prescription.

The age restriction was dropped to 15 in April 2013. Finally, in June 2013 the FDA—complying with a district court ruling—declared that Plan B One-Step would be available without a prescription for “all women of reproductive potential,” regardless of age.

At the time, a group of lawmakers led by Sen. Barbara Boxer (D-CA) reached out to then U.S. Secretary of Health and Human Services (HHS) Kathleen Sebelius urging her to create a long-term solution that would ensure EC was available over the counter in pharmacies run by the IHS.

Sebelius and her staff replied, promising that they were already working on updates to IHS pharmacy policy. So far, however, no policy has been released.

Boxer’s staff recently conducted a survey of 20 IHS pharmacies and found that EC was not readily available. Some pharmacies did not offer EC at all, others still required a prescription, and others wouldn’t provide it to certain women based on their age.

A similar survey by the Native American Women’s Health Education Resources found that access to EC varied widely at 69 IHS centers.

This is particularly disturbing because Native American women who rely on these health centers often live in rural areas where access to other health care and even pharmacies is limited. As the American Civil Liberties Union (ACLU) points out, “The nearest commercial pharmacy may be hundreds of miles away.”

The ACLU also notes that access to EC is particularly important to Native American women because they face rates of sexual assault that are more than twice as high as other women in this country. EC is often given to sexual assault survivors to reduce the chance that they will become pregnant from their attack.

Last week, to try to spur action, Sens. Boxer, Patty Murray (D-WA), Jon Tester (D-MT), Richard Blumenthal (D-CT), Tammy Baldwin (D-WI), and Maria Cantwell (D-WA) wrote another letter to HHS.

“We request that you share the steps your Department has taken towards updating its policy and provide a clear timeline for when that process will be completed,” the letter reads. “Further, we ask that you share with us data from surveys of pharmacies the IHS has undertaken in order to assess access to emergency contraception and the steps that the Department and IHS plan to take to monitor patient access moving forward. We appreciate your consideration of this request.”

“Native American women have waited too long for access to emergency contraception, which is now much more easily available to women across the country,” the ACLU wrote. “The federal government is legally and morally obligated to ensure that these women and communities are not left behind.”