Last fall, Indian Health Service, the federal agency charged with administering healthcare on tribal lands, announced that it would finally make Plan B available over the counter.

Plan B has been available without a prescription since 2006, and available for anyone of any age to buy since March of this year. But that wasn't the case for tribal people, who could get Plan B free of charge but were still being required to get a prescription for the drug. And getting a prescription, in many places, meant going to an emergency room or urgent care clinic and waiting, sometimes for a very long time. Even people who wanted to buy Plan B at a commercial pharmacy sometimes didn't have that choice, as some tribal lands and reservations are extremely geographically remote (in parts of Alaska, for example, getting medical supplies can mean taking a boat, ferry or a small plane to a larger town.)

After years of pressure from Native American women's health activists, IHS promised they would finally change their practices. They provided "verbal directive" to all their facilities requiring that Plan B be made available over the counter. But a new study from the Native American Women's Health Education Resource Center (NAWHERC) has found that in some places it's still impossible for Native women to get Plan B, either because their healthcare facility doesn't carry it, or because the facility refuses to give it to women under 18.

I contacted Charon Asetoyer, the CEO of NAWHERC. "It's over a year later and here we are," she said, sounding tired and fed up. "Indian Health Services is still out of compliance." While there's been some progress, she said, some places still don't provide emergency contraception at all, and some only provide it with an age restriction. "Which means there are a lot of young women who aren't able to access it with autonomy."

NAWHERC surveyed 69 Indian Health Service facilities across the sections of tribal land with the highest populations: Albuquerque, Oklahoma, South Dakota, Minnesota and the Navajo nation, which takes up parts of Utah, New Mexico and Arizona. They found that 80 percent of the facilities now carry Plan B over the counter. But 72 percent of them still impose age restrictions, even though that's now illegal.

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Additionally, the coverage is wildly uneven: NAWHERC awarded 16 healthcare facilities an "A" grade, meaning they provide Plan B over the counter and don't impose an illegal age restriction. But almost as many—14—got a D or an F grade, meaning they either don't carry EC at all, require a prescription, or make it impossible to get for teenagers.

Image via NAWHERC

That unevenness, Asetoyer says, is because the vague "verbal directive" is still in place, rather than a clearly defined —and written down— set of policies on how to administer Plan B.

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"They keep telling us they're working on the procedures," she says. "Since February of 2013 or so."

The "verbal directive" also means that there are no clear policies in place for what should happen when a healthcare provider opposes emergency contraception on moral grounds.

"There's a lot of [medical] staff within IHS that are not pro-choice and see this is as a threat to their beliefs," Asetoyer said. "Like in any facility. But they're not supposed to impose their own values. If there were policies in place, they would stipulate that if you have a moral issue, you'd have to pass it on to another staff person to handle," which is (generally) what happens at non-IHS health facilities. "But without a policy in place stipulating that, they can just get by without providing it, even in a facility where it's being provided over the counter. If you get the wrong pharmacist, there's no policy in place that says you have to step aside to somebody who can handle the situation. That's a very dangerous situation." IHS has instructed consumers who can't find Plan B at their local clinic to call their headquaters, a suggestionAsetoyer also finds absurd. "A lot of the consumers, they're young 15 or 16 year olds. They wouldn't begin to know who to call." And if you email IHS — as Jezebel did earlier today — an auto-reply tells you that someone will be in touch within two weeks, not a helpful timeframe when you're waiting for emergency contraception.

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Asetoyer added that NAWHERC is growing impatient. "We're trying to do everything we can before we take legal action. And it's getting down to the wire. It really is. Denying women access to emergency contraceptives, even after the World Health Organization has come out with these recommendations on how important it is, is a breach of our human rights."

We've contacted Indian Health Services for comment, who say they're looking into the report. We'll update if we hear back.

Image via Shutterstock