Nonprescription Methods Research Articles

Continuity of Health Insurance Coverage and Choice of Contraception Method.

Objective: To evaluate whether part-year or year-round uninsurance is associated with reduced likelihood of using prescription contraception methods rather than using nonprescription methods or using no contraceptive methods. Methods: We identified nonpregnant and sexually active female respondents participating in the National Longitudinal Survey of Youth, 1997 cohort between 2007 and 2019. At each interview, we classified the contraceptive method used most frequently as prescription, nonprescription, or none, and used mixed-effects multinomial logistic regression to predict contraceptive method based on health insurance coverage over the past year (classified as continuous private, continuous public, part-year uninsured, or year-round uninsured). Results: Our sample included 3,738 respondents and 18,678 observations (person-years). In the most recent interview, 35% of respondents used prescription contraception, 16% used nonprescription methods only, and 49% used no method. On multivariable analysis using all available years of data, respondents with part-year uninsurance were 20% less likely to use prescription rather than nonprescription methods, as compared to respondents with continuous private insurance (95% confidence interval: -31%, -6%; p = 0.007), but did not differ on the likelihood of using prescription methods rather than no method. Conclusions: Part-year uninsurance was associated with lower use of prescription contraceptive methods rather than nonprescription methods when compared with continuous private insurance coverage. Use of prescription contraceptives was lowest among people with year-round uninsurance. Policy efforts ensuring continuous insurance coverage with greater flexibility of eligibility and enrollment periods may promote greater access to prescription contraceptives.

Association of the affordable care act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy

ObjectivesBefore the Affordable Care Act (ACA), 55% of individuals giving birth with Medicaid lost insurance postpartum, potentially affecting their access to postpartum contraception. We evaluate the association of the ACA Medicaid expansions with postpartum contraceptive use and pregnancy at the time of the survey. MethodsWe used 2012–2019 Pregnancy Risk Assessment Monitoring System data to estimate difference-in-difference models for the association of Medicaid expansions with the use of postpartum contraception (mean: 4 months postpartum): any contraception, long-acting reversible contraception, or LARC (contraceptive implant and intrauterine device), short-acting (contraceptive pill, patch, and ring), permanent, or non-prescription methods (condoms, rhythm method, and withdrawal), and pregnancy at the time of the survey. We examine low-income respondents overall and stratified by race and ethnicity. ResultsWe find that Medicaid expansion was associated with a 7.0 percentage point (95% CI: 3.0, 11.0) increase in postpartum LARC, a 3.1 percentage point (95% CI: -6.0, -0.2) decrease in short-acting contraception, and a 3.9 percentage point (95% CI: -6.2, -1.5) decrease in non-prescription contraceptive use overall. In stratified analyses, we find that increases in LARC use were concentrated among non-Hispanic White and Black respondents, with shifts in other postpartum contraceptives towards LARCs. Medicaid expansion was associated with a decrease in early postpartum pregnancy only among non-Hispanic Black respondents. ConclusionsMedicaid expansions led to shifts from methods with a lower upfront out-of-pocket cost for people without insurance towards methods with the higher upfront out-of-pocket cost for people without insurance. These changes suggest that Medicaid expansion improved postpartum contraceptive access. ImplicationsThese findings indicate that postpartum uninsurance was a barrier to postpartum contraceptive access prior to Medicaid expansions under the Affordable Care Act. Medicaid expansions increased access to the full range of contraceptive methods.

Can an online educational video broaden young women’s contraceptive choice? Outcomes of the PREFER pre-post intervention study

IntroductionContraceptive knowledge mediates access and use. We aimed to assess whether an online educational video describing all methods and their benefits, side effects and mode of action increased young women’s...

History of unintended pregnancy and patterns of contraceptive use among racial and ethnic minority women veterans

Nearly half of all pregnancies in the United States each year are unintended, with the highest rates observed among non-Hispanic black and Hispanic women. Little is known about whether variations in unintended pregnancy and contraceptive use across racial and ethnic groups persist among women veteran Veterans Affairs users who have more universal access than other populations to health care and contraceptive services. The objectives of this study were to identify a history of unintended pregnancy and describe patterns of contraceptive use across racial and ethnic groups among women veterans accessing Veterans Affairs primary care. Cross-sectional data from a national random sample of women veterans (n= 2302) aged 18-44 years who had accessed Veterans Affairs primary care in the previous 12 month were used to assess a history of unintended pregnancy (pregnancies reported as either unwanted or having occurred too soon). Any contraceptive use at last sex (both prescription and nonprescription methods) and prescription contraceptive use at last sex were assessed in the subset of women (n= 1341) identified as being at risk for unintended pregnancy. Prescription contraceptive methods include long-acting reversible contraceptive methods (intrauterine devices and subdermal implants), hormonal methods (pill, patch, ring, and injection), and female or male sterilization; nonprescription methods include barrier methods (eg, condoms, diaphragm), fertility-awareness methods, and withdrawal. Multivariable logistic regression models were used to examine the relationship between race/ethnicity with unintended pregnancy and contraceptive use at last sex. Overall, 94.4% of women veterans at risk of unintended pregnancy used any method of contraception at last sex. Intrauterine devices (18.9%), female surgical sterilization (16.9%), and birth control pills (15.9%) were the 3 most frequently used methods across the sample. Intrauterine devices were the most frequently used method for Hispanic, non-Hispanic white, and other non-Hispanic women, while female surgical sterilization was the most frequently used method among non-Hispanic black women. In adjusted models, Hispanic women (adjusted odds ratio, 1.60, 95% confidence interval, 1.15-2.21) and non-Hispanic black women (adjusted odds ratio, 1.84, 95% confidence interval, 1.44-2.36) were significantly more likely than non-Hispanic white women to report any history of unintended pregnancy. In the subcohort of 1341 women at risk of unintended pregnancy, there were no significant racial/ethnic differences in use of any contraception at last sex. However, significant differences were observed in the use of prescription methods at last sex. Hispanic women (adjusted odds ratio, 0.51, 95% confidence interval, 0.35-0.75) and non-Hispanic black women (adjusted odds ratio, 0.69, 95% confidence interval, 0.51-0.95) were significantly less likely than non-Hispanic white women to have used prescription contraception at last sex. Significant racial and ethnic differences exist in unintended pregnancy and contraceptive use among women veterans using Veterans Affairs care, suggesting the need for interventions to address potential disparities. Improving access to and delivery of patient-centered reproductive goals assessment and contraceptive counseling that can address knowledge gaps while respectfully considering individual patient preferences is needed to support women veterans' decision making and ensure equitable reproductive health services across Veterans Affairs.

What Women Want: Factors Impacting Contraceptive Satisfaction in Privately Insured Women.

To identify factors associated with high contraceptive method satisfaction among privately insured, adult women in Pennsylvania. We used cross-sectional survey data collected in 2014 from 874 privately insured women participating in the MyNewOptions study who were currently using contraception. Binomial logistic regression assessed the relationship of contraceptive attributes, attitudes, and sociodemographic variables with contraceptive method satisfaction. More than one-half of the analytic sample (53%) was "very satisfied" with their current contraceptive method. The strongest predictors of high method satisfaction were having a method that was easy to use (adjusted odds ratio [aOR], 2.65; 95% confidence interval [CI], 1.79-3.91), high perceived method effectiveness (aOR, 2.52; 95% CI, 1.68-3.78), cost not being a factor in method selection (aOR, 2.88; 95% CI, 2.08-4.00), and not being troubled by side effects (aOR, 2.27; 95% CI, 1.54-3.34). In contrast with previous studies, long-acting reversible contraception (i.e., intrauterine devices and contraceptive implant) was not independently associated with high method satisfaction, but other hormonal methods were (versus nonprescription methods; aOR, 2.48; 95% CI, 1.65-3.75). The strongest predictors of high method satisfaction were having a method that was easy to use and effective and for which cost was not a factor in method selection.

Factors Associated with New Uptake of Long-Acting Reversible Contraceptives Since the Affordable Care Act Among Privately Insured Women in Pennsylvania

The Affordable Care Act eliminated out-of-pocket costs for contraceptives, including highly effective long-acting reversible contraception (LARC), for most insured women. Patient characteristics associated with new LARC uptake after the Affordable Care Act have not been well-studied. We hypothesized that awareness of no-cost intrauterine device (IUD) coverage would be associated with new LARC use. Data included were from 883 women not using a LARC at baseline who participated in the MyNewOptions study, a 2-year study of privately insured women in Pennsylvania. Multivariable analysis assessed whether the following baseline characteristics predicted new LARC use over 2years: awareness of no-cost IUD coverage, future pregnancy intention, baseline contraceptive use, contraceptive attitudes, and sociodemographic characteristics. At baseline, 54.4% of participants were using prescription methods; 21.1% nonprescription methods; 12.1% natural family planning, withdrawal, or spermicide alone; and 12.5% no method. A minority (7.2%) was aware of no-cost coverage for IUDs. Over 2years, 7.2% of participants became new LARC users, but awareness of no-cost coverage for IUDs was not associated with new LARC use (adjusted odds ratio, 0.84; 95% confidence interval, 0.27-2.55). New LARC use was associated with already using prescription methods, not intending pregnancy within the next 5years, prior unintended pregnancy, and desire to change method if cost were not a factor. Among privately insured women, wanting to switch methods if cost were not a factor was associated with new LARC uptake, although awareness of no-cost IUD coverage was not. Providing women with information about their contraceptive coverage benefits may help women to seek and obtain the methods better aligned with their personal needs.

Cross cultural workers in maternity and child & family health services

In the United States, 45% of pregnancies continue to be unintended. Although many previous studies have focused on external barriers to contraceptive use such as cost or access, fewer studies have evaluated internal barriers such as individual characteristics. We hypothesize that high self-efficacy for contraception will be associated with use of more effective contraceptive methods.The analytic sample is 861 privately insured Pennsylvania women aged 18 to 40 years not intending pregnancy for 12 months at enrollment. Contraceptive self-efficacy (high vs. low) was measured using an eight-item scale. The association of self-efficacy with prescription contraceptive use was determined using multivariable logistic regression adjusting for future pregnancy intention, history of unintended pregnancy, number of live births, non-White race, frequency of sexual intercourse, marital status, and age group.Prescription contraceptive use was higher among those with high self-efficacy (adjusted odds ratio, 1.75; 95% confidence interval, 1.29–2.37).Women with high self-efficacy for contraception had an increased use of prescription contraceptive methods compared with nonprescription methods. Strategies for encouraging effective contraceptive choices in women with low contraceptive self-efficacy should be further studied.

High Self-Efficacy Is Associated with Prescription Contraceptive Use

In the United States, 45% of pregnancies continue to be unintended. Although many previous studies have focused on external barriers to contraceptive use such as cost or access, fewer studies have evaluated internal barriers such as individual characteristics. We hypothesize that high self-efficacy for contraception will be associated with use of more effective contraceptive methods. The analytic sample is 861 privately insured Pennsylvania women aged 18 to 40years not intending pregnancy for 12months at enrollment. Contraceptive self-efficacy (high vs. low) was measured using an eight-item scale. The association of self-efficacy with prescription contraceptive use was determined using multivariable logistic regression adjusting for future pregnancy intention, history of unintended pregnancy, number of live births, non-White race, frequency of sexual intercourse, marital status, and age group. Prescription contraceptive use was higher among those with high self-efficacy (adjusted odds ratio, 1.75; 95% confidence interval, 1.29-2.37). Women with high self-efficacy for contraception had an increased use of prescription contraceptive methods compared with nonprescription methods. Strategies for encouraging effective contraceptive choices in women with low contraceptive self-efficacy should be further studied.

Medical contraindications to estrogen and contraceptive use among women veterans

Women veterans have high rates of medical comorbidities and may be particularly vulnerable to adverse health outcomes associated with unintended pregnancy. The objective of the study was to estimate the prevalence of medical contraindications to estrogen-containing combined hormonal contraception among women veterans of reproductive age and to evaluate the relationship between contraindications and contraceptive use. This was a secondary analysis of data from a cross-sectional, telephone-based survey with a national sample of 2302 female veterans, aged 18-45 years, who use the Veterans Administration Healthcare System for primary care. This analysis included women at risk of unintended pregnancy, defined as heterosexually active and not pregnant or trying to conceive and with no history of hysterectomy or infertility. Seven contraindications to combined hormonal contraception were identified using survey data or medical diagnosis codes: hypertension; coronary artery disease; active migraine in women older than 35 years or migraine with aura; smoking in women older than 35 years; and a history of thromboembolism, stroke, or breast cancer. Outcomes were current use of combined hormonal contraception and contraceptive method type (combined hormonal contraception, and other prescription methods, nonprescription methods or no method). Multivariable logistic and multinomial regression were used to assess the relationship between contraindications and combined hormonal contraception use and method type, respectively. Among 1169 women veterans at risk of unintended pregnancy, 339 (29%) had at least 1 contraindication to combined hormonal contraception. The most prevalent conditions were hypertension (14.9%) and migraine (8.7%). In adjusted analyses, women with contraindications were less likely than women without contraindications to report use of combined hormonal contraception (adjusted odds ratio, 0.54, 95% confidence interval, 0.37-0.79). Relative to use of combined hormonal contraception, women with contraindications were more likely than women without contraindications to use other prescription methods (adjusted odds ratio, 1.74, 95% confidence interval, 1.17-2.60), nonprescription methods (adjusted odds ratio, 1.96, 95% confidence interval, 1.19-3.22), and no method (adjusted odds ratio, 2.29, 95% confidence interval, 1.35-3.89). Women veterans at risk of unintended pregnancy have a high burden of medical contraindications to estrogen. Women with contraindications were less likely to use combined hormonal contraceptive methods but were more likely to use no method, suggesting an unmet need for contraception in this medically vulnerable population.

Trends in contraceptive use according to HIV status among privately insured women in the United States

There is limited information on the patterns and trends of contraceptive use among women living with HIV, compared with noninfected women in the United States. Further, little is known about whether antiretroviral therapy correlates with contraceptive use. Such information is needed to help identify potential gaps in care and to enhance unintended pregnancy prevention efforts. We sought to compare contraceptive method use among HIV-infected and noninfected privately insured women in the United States, and to evaluate the association between antiretroviral therapy use and contraceptive method use. We used a large US nationwide health care claims database to identify girls and women ages 15-44 years with prescription drug coverage. We used diagnosis, procedure, and National Drug Codes to assess female sterilization and reversible prescription contraception use in 2008 and 2014 among women continuously enrolled in the database during 2003 through 2008 or 2009 through 2014, respectively. Women with no codes were classified as using no method; these may have included women using nonprescription methods, such as condoms. We calculated prevalence of contraceptive use by HIV infection status, and by use of antiretroviral therapy among those with HIV. We used multivariable polytomous logistic regression to calculate unadjusted and adjusted odds ratios and 95% confidence intervals for female sterilization, long-acting reversible contraception, and short-acting hormonal contraception compared to no method. While contraceptive use increased among HIV-infected and noninfected women from 2008 through 2014, in both years, a lower proportion of HIV-infected women used prescription contraceptive methods (2008: 17.5%; 2014: 28.9%, compared with noninfected women (2008: 28.8%; 2014: 39.8%, P < .001 for both). Controlling for demographics, chronic medical conditions, pregnancy history, and cohort year, HIV-infected women compared to HIV-noninfected women had lower odds of using long-acting reversible contraception (adjusted odds ratio, 0.67; 95% confidence interval, 0.52-0.86 compared to no method) or short-acting hormonal contraception method (adjusted odds ratio, 0.59; 95% confidence interval, 0.50-0.70 compared to no method). In 2014, HIV-infected women using antiretroviral therapy were significantly more likely to use no method (76.8% vs 64.1%), and significantly less likely to use short-acting hormonal contraception (11.0% vs 22.7%) compared to HIV-infected women not using antiretroviral therapy. Those receiving antiretroviral therapy had lower odds of using short-acting hormonal contraception compared to no method (adjusted odds ratio, 0.45; 95% confidence interval, 0.32-0.63). There was no significant difference in female sterilization by HIV status or antiretroviral therapy use. Despite the safety of reversible contraceptives for women with HIV, use of prescription contraception continues to be lower among privately insured HIV-infected women compared to noninfected women, particularly among those receiving antiretroviral therapy.

Does body mass index or weight perception affect contraceptive use?

ObjectiveOverweight and obese women may avoid contraceptive methods they believe are associated with weight gain. The objective of this study was to examine the role of weight and weight perception on contraceptive use. Study designUsing cross-sectional data from the MyNewOptions study, we analyzed contraceptive use among 987 privately insured, sexually active women aged 18–40 years. Contraception was categorized into three groups: (1) long-acting reversible contraceptives (LARCs), (2) non-LARC prescription methods and (3) nonprescription methods/no method. Multinomial logistic regression was used to model the effect of body mass index category and weight perception on contraceptive use while controlling for pregnancy intentions, sexual behavior and sociodemographic characteristics. ResultsEighty-three (8.4%) women were using LARCs, 490 (49.6%) women were using non-LARC prescription methods and 414 (42.0%) were using nonprescription methods or no method. In the adjusted multinomial model, overweight [adjusted odds ratio (aOR) 3.84, 95% confidence interval (CI) 1.85–7.98) and obese women (aOR 2.82, 95% CI 1.18–6.72) were significantly more likely to use LARCs compared to normal-weight women. There were greater adjusted odds of overweight and obese women using nonprescription methods/no method compared with non-LARC prescription methods, but this finding did not reach statistical significance. Weight perception was not associated with contraceptive use. ConclusionIn this study sample, overweight and obese women were more likely to use LARCs than normal-weight women. It will be important to further understand how weight influences women and providers' views on contraception in order to better assist women with individualized, patient-centered contraceptive decision making. ImplicationsOverweight and obese women may be reluctant to use contraceptive methods they believe are associated with weight gain (i.e., pills, shot), but how that affects contraceptive use is unclear. Compared with normal-weight women, overweight and obese women in this study were more likely to use LARCs than non-LARC prescription methods.

How do pregnancy intentions affect contraceptive choices when cost is not a factor? A study of privately insured women

ObjectiveThe objective was to test the hypothesis that among privately insured women who have contraceptive coverage without cost-sharing, using prescription contraception is predicted primarily by pregnancy intentions. Study designParticipants are 987 women ages 18–40 who wish to avoid pregnancy for at least the next 12 months and are enrolled in Highmark Health plans in Pennsylvania. Data are from the baseline survey of MyNewOptions, an ongoing randomized controlled trial testing an intervention to help insured women make optimum contraceptive choices. Primary type of contraception used [categorized as long-acting reversible contraception (LARCs), other prescription methods, nonprescription methods or no method] is modeled using multinomial logistic regression, with predictors representing the timing and strength of pregnancy intentions, pregnancy history, pregnancy risk exposure and sociodemographics. ResultsLARCs were used by 8.4% of the sample; other prescription methods (primarily oral contraceptives), 49.6%; nonprescription methods (primarily condoms), 30.4%; and no method, 11.5%. Pregnancy intentions predicted use of LARCs and other prescription methods compared with no method. The most consistent predictors of using all categories of contraception were pregnancy risk exposure measures (partnership type and frequency of sexual intercourse). ConclusionsIn the absence of cost-sharing for contraception, women’s choice of prescription contraception was a function primarily of pregnancy risk exposure rather than pregnancy intentions. ImplicationsThis study is among the first to examine privately insured women’s contraception choices in the context of contraceptive coverage without cost-sharing; it shows that use of prescription contraception is predicted by pregnancy risk exposure and pregnancy intentions.

Understanding Acceptance of Contraception Method Preference Among African American Mothers Receiving Medicaid in Los Angeles County [247

INTRODUCTION: LA Mommy and Baby data show that 50% of pregnancies in African American women in Los Angeles County are unintended; 14% are mistimed. Of these women, more than 40% were not using contraceptives and more than 30% were sometimes using contraception. Of the contraception methods used, the least effective often were preferred. Consequences of unintended or mistimed pregnancies include inadequate initiation of prenatal care, smoking or drinking during pregnancy, prematurity, low birth weight, and reduced likelihood of breastfeeding. METHODS: Three 1-hour focus groups were conducted with African American Medicaid recipients in south–central Los Angeles. Participants reviewed prescription and nonprescription methods along with their efficacy. Qualitative data were collected on participant attitudes, understanding, and preferred contraception methods. RESULTS: Thirty African American women participated. Seventy-three percent (22/30) of participants expressed a preference for nonhormonal contraceptive methods. Eighty percent (24/30) of women expressed no desire for more children, yet were unwilling to use contraceptive methods including birth control pills, Depo-Provera shots, intrauterine devices (IUDs), and condoms, among others. Sixty-six percent (20/30) of women preferred fertility awareness–based methods for temporary contraception and sterilization as a permanent method. When asked why they had those preferences, responses include: “God will decide how many children I have,” “don't trust doctor,” “don't like to put things in my body” (referring to IUDs), “partner doesn't like condoms,” and “won't put chemicals/hormones in my body” (referring to birth control pills). CONCLUSION: This serves as baseline information in understanding the importance of collecting further data to understand how to overcome barriers to contraception use in this population. Focusing on education and gaining trust is vital to this population's increasing their use of contraception and consequently preventing mothers and neonates from suffering the negative perinatal and health outcomes related to unintended pregnancies.

Factors associated with lack of effective contraception among obese women in the United States

ObjectiveTo identify factors associated with contraceptive nonuse and use of less effective methods among obese women in the US. Study DesignWe analyzed data from sexually active obese women (body mass index >30 kg/m2) age 20–44 using the 2006–2010 National Survey of Family Growth. We conducted multinomial logistic regression to assess associations between current contraceptive use and demographic, reproductive and health services factors. Specifically, we compared contraceptive nonusers, behavioral method users (withdrawal and fertility awareness) and barrier method users (condoms) to prescription method users (pill, patch, ring, injection, implant and intrauterine device). ResultsOf 1345 obese respondents, 21.5% used no method, 10.3% behavioral methods, 20.8% barrier methods and 47.4% prescription methods. Only 42.4% of respondents overall and 20.4% of nonprescription method users reported discussing contraception with a provider in the past year. Similar to findings in the general population, behavioral method users were more likely to have previously discontinued a contraceptive method due to dissatisfaction [adjusted RR (aRR), 1.93; 95% confidence interval (CI), 1.09–3.44], and nonusers were more likely to perceive difficulty becoming pregnant (aRR, 3.86; 95% CI, 2.04–7.29), compared to prescription method users. Respondents using nonprescription methods were significantly less likely to have discussed contraception with a healthcare provider (nonusers: aRR, 0.16; 95% CI, 0.10–0.27; behavioral methods: aRR, 0.13; 95% CI, 0.06–0.25, barrier methods: aRR, 0.15; 95% CI, 0.09–0.25) than prescription method users. ConclusionsObese women who discuss contraception with a provider are more likely to use effective contraception and may be less likely to experience unintended pregnancy; however, over half report no recent discussion of contraception with a provider. ImplicationsEfforts are needed to increase contraceptive counseling for obese women, who face increased risks of morbidity from unintended pregnancy.

The Role of Sexual Self-Concept in the Use of Contraceptives

Sexual self-concept--defined as an individual's evaluation of his or her own sexual feelings and actions--is proposed as an important predictor of contraceptive behavior among teenagers, and a scale measuring the concept is described. In exploratory analyses among university students, sexual self-concept is found to be associated with frequency of contraceptive use and use at most recent intercourse. It is also associated with their choice of contraceptive--students who had used prescription methods at last coitus had significantly higher scores on the sexual self-concept scale than did those who had used nonprescription methods or no method. These findings, together with the finding from analysis among high school students that sexual self-concept appears to improve with age, suggest that younger teenagers may be poorer users of contraceptives because of a lower sexual self-concept. Counseling and sex education that address social and psychological issues may help improve adolescent contraceptive practice by addressing teenagers' views of their own sexuality.

Counseling on Contraceptives: An Unfilled Need

The dictum that pharmacists have a fundamental responsibility to provide health care information for their patients includes the need to furnish complete and accurate information on all of the contraceptive products that currently are on the market. To help accomplish this, many different resources are available that provide guidance for comprehensive patient education on all the different products and devices. If one agrees to the principle that an individual's sexuality is an accepted element of his or her life, then promoting sexual well-being should be an important part of health care. Yet, it seems that pharmacists and other health care professionals in general have not been particularly liberated about talking about and making objective assessments on sexual matters. Health care professionals seem to need more education to enable them to provide accurate information, to augment their own knowledge bases, and to reduce their inhibitions and possible misconceptions about sexual matters. Pharmacists do not want to appear as if they are encouraging or promoting sexual activity, but, given the consequences of nonuse of contraception, socially responsible pharmacists need to disseminate basic information about the use of contraceptive products. At some level, too, objective guidelines should be established to help pharmacists in handling contraceptive information. Pharmacists can play a key role in counseling on both prescription and nonprescription methods. In fact, pharmacists may be the only health care professionals with whom a sexually active person can speak about nonprescription contraceptive methods. Some pharmacists have been reluctant to provide patient information because of the risk of possible liability. But this attitude seems to be changing. The recent emphasis on clinical functions in pharmacy practice has led to speculation that, as pharmacists come to assume new roles, they may become liable for not providing some of this information. At present, at least 22 states already have guidelines or regulations requiring pharmacists to counsel patients. To provide the most effective learning experience, active participation is the key ingredient. It is necessary to elicit active participation in the counseling process. It is not possible to give complete guidance on the subject of contraceptives to every patient that comes in the store. Nor is every person going to be receptive, at least initially, to the idea of talking about contraception with a pharmacist. Yet, the role of the pharmacist takes on greater significance now because of the controversy that continues to surround some of the safety and efficacy issues of oral contraceptives and IUDs. Brochures and other materials are available to help pharmacists counsel patients on all of the different contraceptive methods.

Nonprescription Contraceptives: Increasing in Popularity

The nonprescription forms of birth control now receive much attention due to the ongoing controversy about the prescription contraceptive methods. Condoms, 1 of these nonprescription methods, are the most effective nonprescription contraceptives available and among the most widely used. They are simple to use, inexpensive, and not associated with any major adverse effects. Condoms are unique in that they are a reliable contraceptive for males. It is estimated that 1 of 3 people who use contraception worldwide will rely on a male method. In the US this figure is somewhat lower, 18%. In other countries, such as Japan, condoms are the chief contraceptive method. If properly used, the failure rate for condoms is quite low; the lowest observed failure rate is 2%. In contrast, with typical users, the failure rate approaches 10%. The industry has taken several quality control measures to produce a safe and reliable condom. The principal material tested is usually either of the 2 ingredients used to make them, latex or collagenous tissue taken from the lamb cecum. Condoms definitely can protect against sexually transmitted diseases, simply because they prevent the infecting organisms from being transferred across the condom wall. The contraceptive efficacy of the condom is greatly enhanced when a spermicide is used at the same time. In terms of effectiveness, of 100 users that start the year using foams, creams, jellies, or vaginal suppositories containing nonoxynol 9 and used them consistently, the lowest observed rate of failure has been 3-5%. In actual use, the pregnancy rate is probably closer to 18%. Few side effects have been reported with spermicides. The most common of these is a burning sensation. The foaming suppository has been widely promoted as an effective vaginal contraceptive. It does not really offer any advantage over any of the other dosage forms except for convenience. It is the combination of foam and condom that pharmacists need to pay particular attention to because it is these 2 nonprescription methods that, used concurrently and correctly, can rival the efficacy of oral contraceptives. 1 of the newest dosage forms for a vaginal spermicide is a disposable polyurethane foam sponge which is impregnated with nonoxynol 9, but vaginal irritation has been reported frequently as an adverse effect.

The Costs of Contraception

The cost of contraception is one factor that affects the choice of a birth control method. An analysis of the first-year costs for the various methods, based on fees charged by private physicians and supplies purchased at drugstores, shows that the cost can be considerable and that there are large differences in cost between methods. Prescription contraceptives--the pill, IUD and diaphragm--are by far the most expensive of the reversible methods because they require medical supervision, but supplies alone are also more expensive for prescription methods than for nonprescription methods. First-year cost is highest for the pill-$172, compared with $160 for the diaphragm and $131 for the IUD. The mean of $154 for these three prescription methods is almost four times the mean first-year cost of $40 for condoms and foam. Sterilization necessitates the largest initial expenditure, and the cost of tubal ligation-$1,180-is almost five times the cost of vasectomy-$241. However, sterilization represents a one-time cost, while the other methods involve recurring expenses that may add up to more than the cost of sterilization over time. The methods that are associated with the lowest failure rates-sterilization, the pill and the IUD-are among the most expensive. To offset the costs of contraception, 4.6 million American women obtained low-cost care from subsidized family planning clinics in 1980.

Trends in contraceptive method of use by California family planning clinic clients aged 10-55, 1976-1979.

The types of primary contraceptive method chosen by women seeking services in California family planning clinics are reviewed for the years 1976-1979. Of most significance was the decline in the use of oral contraceptives (OC) and the concurrent rise in nonprescription methods at all ages. A striking difference in OC use between the earlier and latter time periods was noted for women age 40 and older.

Why They Delay: A Study of Teenage Family Planning Clinic Patients

Teenagers wait an average of about 1 year before seeking birth control help at a family planning clinic. Nearly 4 in 10 teens come to the clinic only because they fear they are pregnant; only 1 in 7 come for help in anticipation of their 1st sexual encounter. While 3/4 use a nonprescription method at some time before they arrive at the clinic, most use methods of doubtful effectiveness and 1/2 of these used no method at last intercouse. Blacks are more likely than whites to come to the clinic as virgins or soon after beginning intercourse. Fear of pregnancy is the main reason given for finally going to the clinic, and fear that the family would find out was often mentioned. Shorter delays found among users of nonmedical methods suggest that initiative to expand and improve such usage may help teenagers prevent pregnancies during the early part of their sexual careers and also accelerate their adoption of more effective methods. If clinics become known as a source of free supplies of nonprescription methods as well as of general contraceptive advice, they might be more utilized by teenagers earlier. Thorough counseling about these methods as a backup to prescription methods is also needed. The importance of emphasizing confidentiality is noted, although it is also noted that teenagers who are able to talk to their parents about such matters are more likely to come to the clinic before or soon after they begin having intercourse. Data came from a 1980 survey of a wide range of family planning services in 8 cities, representing over 1200 adolescents.