Journal of the American Pharmacists Association www.japha.org 604 • JAPhA • 50:5 • S EP /OCT 2010 REVIEWS Abstract Objectives: To review the literature regarding pharmacists’ roles in preventing unintended pregnancy, review the relevant laws and policies in the United States to describe pharmacists’ and/or pharmacy’s role in policy development related to unin- tended pregnancy, and identify partners who pharmacists can work with in this public health area. Data sources: A systematic review was conducted focusing on the role of phar- macists in unintended pregnancy. For practice, articles were identifed in Medline through July 1, 2009, using MeSH and keywords. For policy, two authors examined the current status of access issues related to over-the-counter (OTC) status and col- laborative practice agreements. Partners were identifed in the reviews and authors’ experiences. Data extraction: English-language, U.S.-based articles that contained either qualitative or quantitative data or were review articles addressing pharmacist inter- ventions, pharmacists’ knowledge and attitudes regarding contraception, and phar- macists’ comfort and ability to counsel on preventing unintended pregnancy were included. Data synthesis: Some improvements to emergency contraception (EC) access in pharmacies have occurred during the previous decade. Studies focused on counsel- ing, pharmacist provision of depot reinjection, and pharmacist initiation of oral con- traceptives were positive. No studies linked increased contraceptive access in phar- macies to lower pregnancy rates. In terms of policy, the literature described three access-related areas, including (1) EC and conscience clauses, (2) collaborative practice agreements, and (3) changes in prescription to OTC status. Pharmacists’ partnerships may include physicians/clinicians, local health departments, family- planning organizations, nongovernmental organizations, and colleges of pharmacy. Conclusion: Currently, pharmacists may increase access to contraceptives pri- marily via EC and use of collaborative practice agreements to initiate and/or continue hormonal contraceptives. New practice models should be implemented in community or clinic practices as allowed by collaborative practice regulations in each state. We encourage researchers and practitioners to consider a community approach in their endeavors by working with numerous types of primary care providers and organiza- tions to explore ways to increase contraceptive access. Keywords: Pregnancy, pharmacists, contraceptives, emergency contraception. J Am Pharm Assoc. 2010;50:604–612. doi: 10.1331/JAPhA.2010.09195 Preventing unintended pregnancy: Pharmacists’ roles in practice and policy via partnerships Karen B. Farris, Daniel Ashwood, Jennifer McIntosh, Natalie A. DiPietro, Nicole Monastersky Maderas, Sharon Cohen Landau, John Swegle, and Orod Solemani Received October 30, 2009, and in revised form April 9, 2010. Accepted for publication May 1, 2010. Karen B. Farris, PhD, BPharm, is Professor, Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa, Iowa City. Daniel Ashwood, BS, MS, was a graduate research assistant, Program in Phar- maceutical Socioeconomics, Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa, Iowa City, at the time this study was conducted; he is cur- rently a consultant, Elyria, OH. Jennifer McIn- tosh, PharmD, MHS, is Assistant Clinical Pro- fessor, School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston. Natalie A. DiPietro, PharmD, MPH, BPharm, is Assistant Professor of Pharmacy Practice, Department of Pharmacy Practice, Raabe College of Pharmacy, Ohio Northern University, Ada. Nicole Monastersky Mad- eras, MPH, was Associate Program Director, Pharmacy Access Partnership, Los Angeles, at the time this study was conducted; she is currently an independent reproductive health program and policy consultant, Richmond, CA. Sharon Cohen Landau, MPH, was Direc- tor, Pharmacy Access Partnership, Los An- geles, at the time this study was conducted; she is currently a consultant, Los Angeles. John Swegle, PharmD, BCPS, is Associate Professor (Clinical), Department of Pharmacy Practice & Science, College of Pharmacy, Uni- versity of Iowa, Iowa City. Orod Solemani, PharmD, was a student pharmacist, School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, at the time this study was conducted; he is currently Se- nior Pharmacist, Brigham and Women’s Hos- pital, Boston. Correspondence: Karen B. Farris, PhD, BPharm, Professor, S525 Pharmacy, Depart- ment of Pharmacy Practice & Science, Uni- versity of Iowa College of Pharmacy, 115 S. Grand Ave., Iowa City, IA 52242-1112. Fax: 319-353-5646. E-mail: karen-farris@uiowa. edu Disclosure: Dr. Farris and Mr. Ashwood re- ceived grant support from the University of Northern Iowa for a subcontract titled Com- munity Pharmacist’s Role in Improving Re- productive Health in Iowa. Ms. Monastersky Maderas and Ms. Landau were employed by Pharmacy Access Partnership. The other au- thors declare no conficts of interest or fnan- cial interests in any product or service men- tioned in this article, including grants, em- ployment, gifts, stock holdings, or honoraria. 604 9/7/10 12:17 PM