Women say yes to direct access to contraception

If women could directly access hormonal contraception in pharmacies without a prescription, would they be interested in doing so, provided that pharmacists screen for the methods? A new survey indicates they would.1

Without convenient access to hormonal contraception, women may risk unintended pregnancy by experiencing gaps in obtaining contraceptive supplies, using less effective nonprescription methods, or using no contraception at all, notes Sharon Cohen, MPH, program administrator of the Oakland, CA-based Pharmacy Access Partnership, which sponsored the survey. The partnership is part of the Oakland-based Public Health Institute, a nonprofit health promotion organization.

"At a time when policy-makers and consumers are looking for ways to deliver and gain access to health services in the most efficient and cost-effective way, pharmacies represent a logical point of service," says Cohen, who presented information on the survey at the 2004 Reproductive Health conference sponsored by the Washington, DC-based Association of Reproductive Health Professionals. "With their easy accessibility and expanded hours of operation, pharmacy access to hormonal contraceptive methods could substantially expand women’s access to, and use of, these methods."

Between 25 million and 35.5 million women in the United States ages 18-44 are at risk for pregnancy.2 The partnership estimates 17-24 million women would fall in the potential market for using pharmacy access to hormonal contraceptives. To get a handle on women’s experiences accessing contraception, as well as their attitudes and interest in getting such methods as pills, patches, and rings directly in pharmacies, the partnership contracted the San Francisco-based Field Research Corp. to perform a national survey, which included responses from 811 women ages 18-44.

Look at the results

Two-thirds (68%) of women surveyed said they would use the pharmacy to access hormonal contraceptives such as the pill, patch, ring, and emergency contraception (EC).

According to survey results, women likely to use pharmacy access include those now using the pill, patch, or ring (66%) and women not using contraception who would begin using hormonal contraceptives (41%).

Pharmacy access would be an important step in increasing the use of EC, survey results indicate. If it were available without prescription, 55% of women say they would be more likely to use EC and 40% say they would buy EC to have at home.

Expanded access OK?

Is it mandatory for women to receive a breast and pelvic examination prior to obtaining hormonal contraception? A 2001 review of existing recommendations for hormonal contraceptives concluded that in most cases, waiting to schedule a pelvic and breast exam prior to prescribing birth control causes an unnecessary and potentially dangerous delay.3 Consensus developed over the last decade supports a change in practice that hormonal contraception can safely be provided based on a careful review of medical history and blood pressure measurement, according to review authors.3

Programs that provide hormonal contraceptives without requiring a pelvic examination can expand low-income women’s access to such methods and improve the chances that they will obtain other reproductive health services, according to an analysis of one such program.4

Collaborative drug therapy agreements have allowed pharmacists to partner with physician prescribers in expanding access to care. Women in Washington state are participating in a study to determine the feasibility of screening and prescribing oral contraceptives (OCs), the patch, and the ring through specially trained pharmacists, rather than through visits to a doctor or clinic. The Seattle-based University of Washington School of Pharmacy and the Department of Obstetrics and Gynecology are conducting the study.

Looking at the new survey results, support for pharmacy access is broad and diverse, crossing age, race/ethnicity, and marital status, says Cohen. Interest in pharmacy access to hormonal methods is even higher among women who face significant barriers, such as uninsured and low-income women, she observes.

The primary take-away point about the partnership survey is the significant untapped demand for this kind of service, says Kirsten Moore, president of the Washington, DC-based Reproductive Health Technologies Project.

"A broad cross-section of women — particularly women with experience using contraception and women who do not have a regular health care provider — are telling us they feel they would be better served with more convenient access to contraceptive supplies," Moore says. "At the same time, I think we’re seeing a number of misperceptions about the level of medical screening that is necessary before selecting a contraceptive method, which means that pharmacists will have an important role to play in educating consumers about the risks and benefits of hormonal contraception."

References

1. Cohen S. Consumer attitudes toward direct access to hormonal contraception in the U.S. Presented at the Reproductive Health 2004 conference of the Association of Reproductive Health Professionals. Washington, DC; September 2004.

2. Abma JC, Chandra A, Mosher WD, et al. Fertility, family planning, and women’s health: New data from the 1995 National Survey of Family Growth. National Center for Health Statistics. Vital Health Stat 1997; 23.

3. Stewart FH, Harper CC, Ellertson CE, et al. Clinical breast and pelvic examination requirements for hormonal contraception: Current practice vs. evidence. JAMA 2001; 285:2,232-2,239.

4. Harper C, Balistreri E, Boggess J, et al. Provision of hormonal contraceptives without a mandatory pelvic examination: The First Stop demonstration project. Fam Plann Perspect 2001; 33:13-18.