Convenience stores are aptly named. They’re stocked with essentials people need at all hours of the day or night, everything from a quart of milk to a package of condoms. But they haven’t stocked contraception for women.
That’s slowly and steadily changing as an Oakland, California-based company, Cadence, has spent the last year stocking highway gas stations, corner delis and 24-hour convenience stores with its own emergency contraception brand called “Morning After Pill,” which prevents pregnancy by delaying ovulation if taken within 72 hours of unprotected sex or a birth control mishap.
The first morning-after pills, a single dose of levonorgestrel, hit convenience store shelves in Texas in March 2024. Since then, according to company executives, the pills are in some 11,000 locations in 48 states. South Dakota and Hawaii are the last holdouts. A zip code search found the product everywhere from an E-Z Mart in San Antonio to a deli in Walla Walla, Washington.
Kate Voyten, the company’s senior vice president of commercial operations, said that Cadence, which is also seeking Food and Drug Administration approval for its over-the-counter regular birth control pill, is trying to make it easier for women to control their sexual health.
“Our original goal was to transform contraception,” she said. “Get it everywhere there is a condom.”
About one-third of all prophylactics for men are sold at convenience stores, she noted, and yet the stores “have nothing for females” except tampons and pregnancy tests.
Over-the-counter emergency contraception is a safe and effective synthetic hormone that’s meant to be used when a condom breaks, a regular birth control pill is missed, or no birth control is used. It works by inhibiting or delaying ovulation and doesn’t end an existing pregnancy or harm a fertilized egg that is already implanted in the uterus, according to the FDA. And it doesn’t affect future fertility. Some patients may experience a later or earlier menstrual period and short-term spotting, headache, nausea, and fatigue.
Availability in stores such as 7-Eleven and Circle K comes even as legislators in some Republican-led states have indicated they want a new level of scrutiny for contraception. It’s been nearly three years since the Supreme Court overturned the federal right to abortion and that decision — handed down by the court’s conservative majority — led to many Republican states, including Texas and Tennessee, to criminalize abortion.
The fallout from state abortion bans cut off some women’s access to contraception, since many abortion providers that were forced to close also provided birth control.
In particular, hormonal birth control, which includes emergency contraception, has been under increasing attack from the religious right.
A major legal victory by a conservative Christian legal group in Texas restricted minors’ access to birth control in that state, and a Trump administration order freezing $65 million in family planning funds has threatened contraceptive access from Mississippi to California.
While the Catholic Church has long opposed all forms of artificial birth control, leading anti-abortion groups such as Students for Life of America have ramped up their campaigns targeting emergency contraception, intrauterine devices, shots, implants, patches and birth control pills. The groups falsely claim that these methods are “abortifacients” that prevent a fertilized egg from implanting in a woman’s uterus.
In some states, such as South Carolina, Alabama, Texas, abortion is illegal as soon as an egg is fertilized in the fallopian tube, even before the zygote travels to the uterus and implants.
Why 24-hour access matters
At the same time, some birth control products have become more easily available through online purchasing and over the counter, including Opill, which last year became the first non prescription birth control pill available in the United States. New methods of birth control have also come to market, including long-acting implants, patches and Phexxi, a hormone-free vaginal gel.
Emergency contraception is available without a prescription, a fact that many women don’t know, according to a poll conducted by KFF, a health policy research organization. Indeed, half of women who live in states where abortion is banned either incorrectly think emergency contraceptive pills are illegal in their state or say they are unsure, the poll found.
Still, younger women are more likely to report that they’ve used emergency contraception: 44% of women ages 15 to 24 and 40% of women ages 25 to 34. And online data shows that searches for emergency contraception often happen later at night, Voyten said.
“And 7-Eleven is open,” she said.
Megan Kavanaugh, a principal research scientist with the Guttmacher Institute, a reproductive health research group, said 99% of women of childbearing age in the United States have used some form of contraception, including natural family planning, “over the course of their lifetime,” a trend that holds true across all demographics, including religious beliefs. Less than 1 percent of women use fertility awareness based methods.
And the use of emergency contraception has also risen in recent decades. Researchers at KFF found that one-third of women ages 15 to 49 who have ever had sex with a male in the United States have used it.
“People use EC for a lot of reasons,” Kavanaugh said. “The condom fails, they haven’t been using birth control or they may need to use it after sexual assault.”
Cost, however, can be a barrier for some women, she said, noting that over-the-counter products like Plan B One Step — another emergency contraceptive — can cost upwards of $50. “That’s a prohibitive price point,” she said.
Condoms are inexpensive but usually outside the control of women having sex, Kavanaugh said. “It’s all part of the misogyny that we live in that we price products differently,” she said.
Cadence’s emergency contraception is priced around $25 per box for a one-time dose. A study of consumer behavior conducted by the manufacturer, Cadence, found that women questioned the quality and efficacy of a birth control product priced below $15, but products priced more than $30 were prohibitively expensive.
Polling shows that a broad majority of Americans support contraception and oppose efforts to restrict its access.
Stored in lockboxes or behind the counter
Still, getting help in preventing pregnancy can often be a challenge, said Dr. Amanda Bryson, a pediatrician and adolescent medicine specialist at the University of California, San Francisco and an assistant professor of pediatrics.
Bryson, who provides care to adolescents and young adults and is not affiliated with Cadence, said that those barriers can include a need for confidentiality, as well as a lack of transportation, financial means or health insurance. And even though emergency contraception is available without a prescription or age requirement, pharmacists often stock the product in lockboxes or behind the counter, requiring teenagers and young adults to seek out a store clerk.
In convenience stores, the pills are generally stocked next to condoms, not behind the counter.
Finding emergency contraception in rural areas can also be difficult, particularly in towns without a pharmacy or a drugstore.
Bryson recalled one patient who called, after-hours, seeking emergency contraception. After counseling the patient, who had insurance, Bryson called in a prescription to a local pharmacy, but it was out of stock. Another pharmacy, however, had over-the-counter medication — for $50. The patient bought the pills there.
“It shouldn’t be this hard,” Bryson said. “This young adult had information about EC, she had a physician who could counsel her, she knew she could reach me after hours, she had insurance, she was able to drive, and this was still an immense barrier.”
She added: “In situations similar to this one, having a lower cost pill in convenience stores with expanded hours could be really meaningful.”
“Taking care of your sexual health should not be stigmatized,” Bryson said, adding that “availability and visibility” of birth control for women on convenience store shelves can help combat stigma.
Cadence officials say they would like to expand their market on college campuses, and perhaps even to vending machines, noting that it is a “very profitable product.”
And though Plan B, a widely known emergency contraception brand, is not available in convenience stores, the medication is distributed at CVS, Walgreens, Walmart and other retailers and can be delivered by UberEats, Doordash, and Instacart, according the company.
While retailers in some areas “have objections about bringing in the product,” those concerns are often overtaken by demand, Voyten said.
“There are some who say, ‘I don’t believe in this,’” she said. “’But I know my customer needs it.’”
This article was originally published on NBCNews.com
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