Medical barriers to contraceptive use

Abstract

Various practices keep women from receiving and using contraception. These medical barriers include those pertaining to eligibility process and regulatory and provider bias. Eligibility barriers place too strict criteria on what women may use a particular contraceptive. For example severe migraine headaches are a relative contraindication for oral contraceptives (OCs) but some community-based distribution programs include headaches without being specific on their checklist resulting in denying OCs to women who have had a recent headache. Blood tests to rule out liver and cardiovascular diseases as a prerequisite for a prescription of combined OCs in some West African countries represent a process hurdle. Yet just a brief medical history can identify women at risk of these diseases. Restricting IUD insertion to physicians in some countries is another example of a medical barrier. Family planning providers or program managers sometimes determine themselves what methods are best suited for various women. This provider bias essentially eliminates womens choice of methods. Until 1992 the US Food and Drug Administration (FDA) had not approved the 3-month injectable contraceptive method Depo-Provera despite many studies confirming its safety. The lack of FDA approval prevented other countries from approving it. Despite 30 years of OC use worldwide Japan still does not allow OC use. According to a WHO survey of 50 collaborating centers the most common medical barrier to contraceptive use is requiring women who use OCs and IUDs to return for follow-up examinations more often than is necessary. This recent survey concludes that no overall standardized information about contraceptives their side effects and who can and cannot use them safely exists. WHO and other groups are developing internationally accepted guidelines to counteract conflicting information and outdated criteria for contraceptive delivery.