Prescription Of Contraceptives Research Articles

Evaluation of Student Pharmacists' Attitudes and Perceptions of Hormonal Contraception Prescribing in Indiana.

Community pharmacists’ scope of practice is expanding to include hormonal contraceptive prescribing. Prior to introducing statewide legislation, it is important to assess the perceptions of future pharmacists. A cross-sectional survey was distributed to 651 third- and fourth-year professional students enrolled at three colleges of pharmacy in Indiana. Data were collected between September and October 2019 to assess students’ attitudes about prescribing hormonal contraceptives, readiness to prescribe, perceived barriers, and desire for additional training. In total, 20.9% (n = 136) students responded. Most (89%, n = 121) believe that pharmacist-prescribed hormonal contraceptives would be beneficial to women in Indiana, and 91% (n = 124) reported interest in providing this service. Liability, personal beliefs, and religious beliefs were the most commonly cited perceived barriers. Most students felt they received adequate teaching on hormonal contraceptive methods (90%, n = 122) and hormonal contraceptive counseling (79%, n = 107); only 5% (n = 7) felt ready to provide the service at the time of survey completion. Student pharmacists in their final two years of pharmacy school are interested in prescribing hormonal contraceptives and believe that this service would be beneficial. This expansion of pharmacy practice would likely be supported by future pharmacists who feel the service could provide benefit to women seeking hormonal contraceptives in Indiana.

Real world outcomes related to providing an annual supply of short-acting hormonal contraceptives

ObjectiveTo compare pregnancy rates among women provided a 12-month supply or less than a 12-month supply of short-acting hormonal contraceptives. Study DesignThis retrospective cohort study examined data from an integrated health plan in California, collected about people aged 10−50 years, who filled at least one contraceptive prescription between January 2017 and September 2018. We examined outcomes following index contraceptive prescriptions for up to 15 months, end of membership, initiation of a long-acting contraceptive, or death, whichever occurred first. We compared rates per 100 person years of observation of: pregnancy, receipt of emergency contraception (EC), and contraceptive refills more than 12 months after the index prescription. We used multivariable logistic regression to control for demographics and baseline clinical variables when comparing provision of a 12-month to a smaller supply. ResultsWe identified 1689 members who received a 12-month supply of short-acting hormonal contraception and 352,624 women who received less than a 12-month supply. Those who received a 12-month supply were less likely to receive EC (1.3 vs 2.1 per 100 person years, p = 0.04) or have documentation of pregnancy (1.7 vs 2.7 per 100 person-years, p = 0.02), and more likely to refill the contraceptive more than 1 year after the index prescription (99.4% vs 63.9%, p < 0.01). Among new starts, the adjusted odds ratio (OR) of pregnancy was 0.50 (95% CI 0.27−0.94) among women who received a 12-month supply vs. those were not. ConclusionMembers of an integrated healthcare system who received a 12-month supply of short-acting hormonal contraceptives are less likely to become pregnant within the following year. ImplicationsOffering a 12-month supply of short-acting hormonal contraceptives may reduce rates of undesired pregnancy.

Patient experiences with pharmacist prescribed hormonal contraception in California independent and chain pharmacies

BackgroundPharmacist contraception care is an innovative practice that is rapidly expanding with policy changes. There is limited literature describing patient experiences with this pharmacist service. ObjectiveThe objective of this study is to describe patient experiences using pharmacist-prescribed hormonal contraception in California pharmacies. MethodsAn online survey was conducted among a cross-sectional convenience sample of people of all ages who completed a contraception visit with a pharmacist from December 2017 to January 2019 at a participating independent or chain pharmacy in California. Descriptive statistics were used to analyze data on patient characteristics, experiences and satisfaction with the service, and preventive health screenings. ResultsA total of 160 individuals completed the survey and nearly all were adults (97%) and had started or completed postsecondary education (85%). Most (72%) visited the pharmacy to get a prescription for a contraceptive method they were already using. The most common method prescribed was the pill (90%). The most common reason for seeking a prescription at a pharmacy was because it would be faster than waiting for a doctor’s appointment (74%), followed by the location and hours being more convenient (46% and 41%), saving money (28%), and not having a regular doctor (26%). Respondents reported satisfaction with the services overall (97%), level of comfort they felt with the pharmacist (94%), counseling provided (86%), and level of privacy (74%). Nearly all were likely to return to a pharmacist for contraception (96%) and recommend the service to a friend (95%). ConclusionPharmacist prescribing of contraception in community pharmacies provided a convenient access point that was highly acceptable to patients who used it. One area for attention is in the level of privacy during contraception visits. These findings support the effectiveness of direct pharmacy access to contraception and encourage pharmacist contraception prescribing policies and widespread implementation.

Pharmacist‐prescribed hormonal contraception services: A systematic review of implementation studies

AbstractAs of July 2021, 16 states and Washington DC permit pharmacist prescribing of hormonal contraceptives. The objective of this systematic review is to describe the impact of pharmacist prescribing on hormonal contraceptive access in the United States (U.S.). Using a protocol based on PRISMA guidelines, a librarian performed the literature search for articles published between January 1, 2013 and January 15, 2021. Studies were excluded if they were incomplete (ie, without results) or the full text was not available. Studies that took place outside of the U.S., within the U.S. but in a state that had not implemented pharmacist contraception prescribing at the time the research was initiated, or not written in English, as well as those that were not primary literature (ie, reviews, editorials, opinion papers, etc.) were also excluded from this review. Articles were categorized based on whether the outcomes evaluated (a) uptake of pharmacist‐prescribed hormonal contraceptive services, (b) implementation of pharmacist‐prescribed hormonal contraceptive services, or (c) impact of pharmacist‐prescribed hormonal contraceptive services on patients' access to hormonal contraception. Of 2056 identified articles, 21 articles met the inclusion criteria and were included in the analysis. The majority (n = 16) assessed uptake of the service, whereas eight examined implementation and three evaluated impact of the service on patients' access. More research is warranted on the impact of pharmacist prescribing on patients' access to hormonal contraceptives.

Ectopic pregnancy prevention: Further evidence of benefits of prescription contraceptives

ObjectiveTo estimate the incidence of ectopic pregnancy (EP) associated with prescription contraceptive use. Study DesignWe performed a retrospective cohort study of women aged 15 to 44 years at Kaiser Permanente Northern and Southern California during 2010 to 2019. We identified EPs and prescription contraceptive use from diagnosis, procedural, and medication codes, and natural language processing of clinical notes from electronic health records. Contraceptive use categories included combined hormonal contraceptives, intrauterine devices, depot-medroxyprogesterone acetate (DMPA), progestin-only pills (POPs), implants, no method after recent discontinuation of a prescription contraceptive in the last 12 months, and no method after discontinuation of a prescription contraceptive more than 12 months ago or no use of prescription contraceptives during the study period. Contraceptive use was updated as women started, stopped, or changed methods. An EP was attributed to a contraceptive method if it occurred 14 days after starting and up to 42 days after stopping a method. Age-adjusted EP incidence and 95% confidence intervals (CI) were estimated per 10,000 woman-years overall and by contraceptive category. ResultsThere were 11,436 EPs among 3,204,118 women with 11,909,842 woman-years of follow-up for an overall EP incidence of 9.5 per 10,000 woman-years (95%CI 9.3−9.6). The majority of EPs (9662; 84.5%) occurred during no prescription contraceptive use. EP incidence was lowest during DMPA (1.8 per 10,000 woman-years [95%CI 1.2−2.5]) or implant (2.0 per 10,000 woman-years [95%CI 1.2−3.3]) use, and higher during POP use at 15.2 (95%CI 12.2−19.6); however, incidence was highest after recent discontinuation of a prescription contraceptive (20.6 per 10,000 woman-years [95%CI 19.7-21.4]). ConclusionsEP incidence is lower with prescription contraceptive use than with nonuse. ImplicationsAll prescription contraceptives, including POPs are protective of EP.

POSTER ABSTRACTS: P65 RAPID INNOVATION AND IMPLEMENTATION OF TELEMEDICINE FOR CONTRACEPTION: PROVIDERS’ PERSPECTIVES

Objectives: Many family planning providers faced disruptions to service delivery from the COVID-19 pandemic and needed to quickly implement telemedicine for contraceptive care. This study describes how Illinois providers responded to the uptake of telemedicine. Methods: We interviewed clinicians (n=20) from non-Planned Parenthood clinics (July – September 2020) and clinicians and staff (n=17) from Planned Parenthood of Illinois sites (December 2020 – March 2021) across the state. Interviews were conducted by phone or video, audio-recorded, transcribed, and coded in Dedoose. Analysis revealed themes focusing on telemedicine's effects on patient care and access to comprehensive contraceptive services, and on steps needed to improve telemedicine and sustain its benefits post-pandemic. Results: Interviewees expressed mostly positive attitudes towards telemedicine, highlighting its utility for counseling and prescription contraceptive methods, with additional benefits for rural patients and patients facing transportation, childcare, or other barriers to in-person visits. Challenges included rapid telemedicine rollout, patient barriers to accessing technology platforms, and reduced access to long-acting reversible contraception (LARC). Providers implemented changes to mitigate barriers, such as prioritizing same-day LARC insertion and removals, and eliminating required post-LARC follow-up visits. Providers noted virtual visits enhanced privacy for some and compromised privacy for others. All participants observed that continuation of telemedicine contraceptive services would depend on equitable reimbursement for telehealth services. Conclusions: Telemedicine contraception services can enhance access for patients who face barriers to care beyond those created by the pandemic. However, reimbursement parity for providers, patient-centered flexibility regarding telemedicine options, and measures to ensure access to all methods are important for long-term success.

The association between depression and contraceptive behaviors in a diverse sample of new prescription contraception users

ObjectiveAmong women initiating new prescription contraception, we investigated the relationship between recent depression and a range of contraceptive behaviors. Study DesignWe used medical and pharmacy records of 52,325 women ages 19 to 29 who initiated prescription contraception (pills, patches or rings, injectables, and long-acting reversible contraceptives) in 2014−2016 at a large integrated healthcare system in Northern California. Women had continuous enrollment for a year before and after initiating, and no records of prescription contraceptive use in the year before initiating. Depression in the year prior to initiation was dichotomized into (1) no depression indicator (reference group) or (2) depression diagnosis or redeemed antidepressant. Multinomial logistic regression models examined the associations between depression and method type initiated, and contraceptive patterns, timing of discontinuation, inconsistent use, and switching methods over a year after initiating, adjusting for sociodemographics and testing for interactions between depression and having a recent birth or abortion. ResultsWomen with recent depression were more likely to initiate methods other than the pill, and the association was stronger for patches or rings vs pills among those with a recent birth compared to those without. Among women initiating all methods and the pill, those with depression were more likely to discontinue their method, use it inconsistently, and switch from it than use it continuously for a year. ConclusionWomen with recent depression were less likely to initiate the pill; and when the pill was initiated, those with depression were more likely to discontinue use, use it inconsistently, and switch from it. ImplicationsWomen with recent depression indicators should be followed closely to ensure they have the support they need to meet their reproductive goals. Those who wish to avoid pregnancy may benefit from methods that do not require daily use.

Contraception needs and pregnancy termination in sub-Saharan Africa: a multilevel analysis of demographic and health survey data

BackgroundWomen in sub-Saharan Africa (SSA) have a higher risk of unintended pregnancies that are more likely to be terminated, most of which are unsafe with associated complications. Unmet need for contraception is highest in SSA and exceeds the global average. This study investigates the association between unmet/met need for contraception and pregnancy termination SSA.MethodsWe used pooled data from Demographic and Health Surveys conducted from January 2010 to December 2018 in 32 countries in SSA. Our study involved 265,505 women with diverse contraception needs and with complete data on all variables of interest. Multilevel logistic regression at 95% CI was used to investigate the association between individual and community level factors and pregnancy termination.ResultsWe found an overall pregnancy termination rate of 16.27% ranging from 9.13% in Namibia to 38.68% in Gabon. Intriguingly, women with a met need for contraception were more likely to terminate a pregnancy [aOR = 1.11; 95% CI 1.07–1.96] than women with unmet needs. Women with secondary education were more likely to terminate a pregnancy as compared to those without education [aOR = 1.23; 95% CI 1.19–1.27]. With regards to age, we observed that every additional age increases the likelihood of terminating a pregnancy. At the contextual level, the women with female household heads were less likely to terminate a pregnancy [aOR = 0.95; 95% CI 0.92–0.97]. The least socio-economically disadvantaged women were less likely to terminate a pregnancy compared to the moderately and most socio-economically disadvantaged women.ConclusionsOur study contributes towards the discussion on unmet/met need for contraception and pregnancy termination across SSA. Women with met need for contraception have higher odds of terminating a pregnancy. The underlying cause of this we argued could be poor adherence to the protocols of contraceptives or the reluctance of women to utilise contraceptives after experiencing a failure. Governments of SSA and non-governmental organisations need to take pragmatic steps to increase met needs for contraception and also utilise mass media to encourage women to adhere to the prescription of contraceptives in order to reduce the incidence of unplanned pregnancies and unsafe abortions.

Access to contraception in pharmacies during the COVID-19 pandemic

BackgroundAs a result of the coronavirus disease 2019 (COVID-19) pandemic, shifts in traditional contraception access points have presented new challenges, leading people to seek alternative sources of contraception care, including pharmacies. Pharmacists in one-fourth of U.S. states are able to prescribe hormonal contraception, a model known as pharmacy access. Pharmacy access became available in California in 2016 and in Colorado in 2017. ObjectiveTo characterize how access to contraception products and services in pharmacies changed during the COVID-19 pandemic, including pharmacist prescribing practices and innovations in service delivery. MethodsWe conducted a cross-sectional survey among California and Colorado pharmacists from September to October 2020. Survey questions included pharmacist and pharmacy practice site characteristics, prescribing practices, pharmacist perspectives, and pharmacy services in the context of the COVID-19 pandemic. ResultsA total of 128 pharmacists participated in the study, with 38% (n = 49) from California and 62% (n = 79) from Colorado. Among participants, 41% (n = 53) prescribed contraception, of which 94% (n = 50) continued, 4% (n = 2) started, and 2% (n = 1) suspended during the pandemic. Most participants reported interest (79%) and effort (75%) in prescribing contraception to be about the same during the pandemic. Community need for contraceptive services was perceived to be slightly or much higher (45%) or about the same (47%). Patient interest in pharmacy access was perceived to be slightly or much higher by 26% and about the same by 57% of the participants. When distributing contraception prescriptions, pharmacies increased curbside (from 12% to 52%), home delivery (from 40% to 60%), and mailing options (from 41% to 71%) during the pandemic. ConclusionsPharmacists prescribing hormonal contraception who participated in this study remained committed to providing this service during the pandemic. Some perceived increased community need for contraception and patient interest in direct pharmacy access. There was an increase in options for patients to receive contraception prescriptions with minimal contact.

P–047 Knowledge, professional attitudes and training of health professionals on male contraceptive methods

Abstract Study question Among health professionals involved in contraceptive prescribing, what are the knowledge, professional attitudes and training on male contraceptive methods? Summary answer The health professionals involved in prescribing contraception are not sufficiently trained in male contraception and almost all of them want more. What is known already The most recent large-scale studies show that 70% of couple contraception is provided by women and that the majority of men and women would be willing to adopt male contraception as couple contraception. The medicalization of contraception places the medical profession at the forefront of the acceptability of and information regarding a contraceptive method. However, only one study have evaluated health professionals’ knowledge of the various methods of male contraception (MC), including male hormonal contraception (MHC) and male thermal contraception (MTC). Study design, size, duration Between April 2020 and June 2020, we carried out a descriptive prospective multicentre study in a medical population of 2243 prescribers of couple contraception in France. Participants/materials, setting, methods The participants were obstetrician-gynaecologists, medical gynaecologists, general practitioners or midwives. They completed a three-part numerical questionnaire, including i) sociodemographic characteristics and personal experiences with contraception, ii) knowledge and professional attitudes about male contraception and iii) training on male contraception. Main results and the role of chance The overall participation rate was 19% (340/2243). Condoms and withdrawal were known by 98% and 89% of the population, respectively. Vasectomy was known by 75% of the population and significantly better known by obstetrician-gynaecologists than by medical gynaecologists and general practitioners (p = 0.026). Male hormonal contraception (MHC) and male thermal contraception (MTC) were known by 10% and 23% of the population, respectively, and were significantly better known by medical gynaecologists and general practitioners than by other specialties (p &amp;lt; 0.001). More than half (55%) of the population never or infrequently offered MC during a couple’s contraceptive request consultation. Female practitioners offered MC significantly more often than male practitioners (48% vs. 26%; p = 0.033). Only 14% of the population had ever participated in training on MC, 96% wished to be better trained on MC, and 86% expressed a willingness to participate in such a training. Limitations, reasons for caution The population was mainly representative of medical health practitioners of southeastern France. There was an over-representation of women in all medical specialties, except for midwives. Wider implications of the findings: Our study shows that health professionals involved in contraception have limited knowledge about MC and are eager to have more information about it. To advance the acceptability and dissemination of such contraceptive methods, it seems imperative to provide health professionals with an adapted training program on male contraception. Trial registration number 2020–01–23–03

Contraceptive Provision and Quality Care Measures for Insured Individuals in Massachusetts Who Are Deaf or Hard of Hearing.

To evaluate contraceptive provision and contraceptive care quality measures for individuals who are deaf or hard of hearing and compare these outcomes to those individuals who are not. We conducted a claims analysis with data from the 2014 Massachusetts All-Payer Claims Database. Among premenopausal enrollees aged 15-44, we determined provision of any contraception (yes or no) and provision by contraception type: prescription contraception (pills, patch, ring, injectables, or diaphragm), long-acting reversible contraceptive (LARC) devices, and permanent contraception (tubal sterilization). We compared these outcomes by deaf or hard-of-hearing status (yes or no). The odds of contraceptive provision were calculated with regression models adjusted for age, Medicaid insurance, a preventive health visit, and deaf or hard-of-hearing status. We calculated contraceptive care quality measures, per the U.S. Office of Population Health, as the percentage of enrollees who used: 1) LARC methods or 2) most effective or moderately effective methods (tubal sterilization, pills, patch, ring, injectables, or diaphragm). We identified 1,171,838 enrollees at risk for pregnancy; 13,400 (1.1%) were deaf or hard of hearing. Among individuals who were deaf or hard of hearing, 31.4% were provided contraception (23.5% prescription contraception, 5.4% LARC, 0.7% tubal sterilization). Individuals who were deaf or hard of hearing were less likely to receive prescription contraception (adjusted odds ratio 0.92, 95% CI 0.88-0.96) than individuals who were not deaf or hard of hearing. The percentage of individuals who were deaf or hard of hearing who received most effective or moderately effective methods was less than that for individuals who were not (24.2% vs 26.3%, P<.001). There were no differences in provision of LARC or permanent contraception by deaf and hard-of-hearing status. Individuals who were deaf or hard of hearing were less likely to receive prescription contraception than individuals who were not; factors underlying this pattern need to be examined. Provision of LARC or permanent contraception did not differ by deaf or hard-of-hearing status. These findings should be monitored and compared with data from states with different requirements for contraceptive coverage.

“They really hear you out”: Lessons on providing contraceptive care from a community-based sexual health clinic

Individuals in Canada may obtain prescription contraception from a family doctor, a walk-in clinic, or sexual health clinic. While there are guidelines for best practice in contraceptive care, the quality of this care varies widely. Access to any contraceptive care is also a concern, partly due to increasing pressures on physicians’ time. These issues have led to calls to expand contraceptive care into the purview of nurses and other qualified health professionals, a ‘task-sharing’ approach. Here, we use data from semi-structured interviews with providers and patients at a sexual health clinic in British Columbia to examine the benefits of such an approach as implemented in this particular clinic. We conducted semi-structured interviews with physicians, nurses, volunteer peer contraceptive educators, and patients about their experience providing or obtaining care at the clinic, and thematically analyzed the resulting data. Interviewees identified four key benefits in the clinic’s approach: the value of a specialized sexual health clinic where providers had a wealth of experience providing sexual health care; the time and attention given by providers relative to practitioners at other types of clinics; the increased efficiency facilitated by a task-sharing approach; and the inclusive and supportive environment. Although some aspects of this clinic’s strategy are not transferrable to all settings, implementing elements of this model in other settings could increase access to quality contraceptive care.

Sexual and reproductive health services provided by community pharmacists: a scoping review

ObjectivesPharmacists are increasingly providing patient-focused services in community pharmacies, including in the area of sexual and reproductive health (SRH). Specific SRH areas have been the focus of research, but a...

Association of pharmacist prescription and 12-month contraceptive continuation rates

States have passed legislation to expand the scope of pharmacists to directly prescribe contraception. It is thought that pharmacist prescription of contraception may promote correct and consistent use of contraception by reducing barriers to access. However, it is not known how this may impact ongoing contraceptive use. This study aimed to determine whether 12-month rates of continuation of an effective form of contraception or perfect use of contraception differ by prescribing provider (pharmacist or clinician). We conducted a 1-year prospective cohort study of 388 women seeking contraception in 139 pharmacies across 4 states (California, Colorado, Hawaii, and Oregon). Our study was powered to detect a 10% difference in 12-month continuation of an effective form of contraception. We clarified women's pregnancy intention at baseline and subsequent follow-ups. Women received a prescription directly from a pharmacist (n=149) or were filling a prescription from a clinician, our comparison group (n=239). We used multivariable logistic regression to measure the association between pharmacist prescriber and use of any effective contraceptive method or perfect use at 12 months. Model covariates included age, race, education, side effects experienced, payor, and contraceptive supply dispensed at baseline. Of the study cohort, 88% (n=340) completed 12 months of follow-up. Among women not planning to become pregnant, 7 women in the clinic-prescribed group vs 1 woman in the pharmacy-prescribed group (3.4% vs 0.8%; P>.05) reported a positive pregnancy test during the study period. The majority of the cohort was continuing to use an effective method of contraception at 12 months (clinician 89.3% vs pharmacist 90.4%; P=.86). Among women receiving a prescription from a clinician, 53.9% reported perfect use (no missed days) at 12 months, compared with 47% of the pharmacist-prescribed group (P=.69). Pharmacist prescriber type was not associated with continuation of an effective contraceptive method at 12 months (adjusted odds ratio, 0.70; confidence interval, 0.28-1.71) or with perfect use of contraception (adjusted odds ratio, 0.87; confidence interval, 0.51-1.48), controlling for other woman-level characteristics. We found no difference in use of any effective contraception, perfect use, or switching at 12 months among those who received their baseline prescription from a pharmacist vs a clinician. This study is limited by not examining information on safety outcomes.

Emergency Contraceptives: Knowledge, Attitude and Prescription Practice of Primary Healthcare workers in Sokoto Metropolis, Northwest Nigeria.

Background: Emergency contraception refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. About thirty percent of all pregnancies, and 61% of all unintended pregnancies, ended in an induced abortion in Nigeria, and many women with unwanted pregnancies decide to end them by abortion. Healthcare providers' knowledge and attitude towards emergency contraception is very important for dissemination of awareness, consumer acceptance and use of contraceptives, as health care workers interact with large numbers of women and are reliable sources of information. This study aimed to assess healthcare workers' emergency contraception knowledge, attitude and prescription practice. Materials and Methods: The study was a cross-sectional study. Healthcare workers providing services in Primary Health care facilities of Sokoto metropolis were studied. Using formula for sample size estimation for crosssectional study, a total of 419 respondents were recruited into the study using systematic sampling technique. The instrument of data collection was a structured interviewer administered questionnaire and data was collected by means of Open Data Kit for android App and analysed using IBM SPSS statistical software package version 23. Univariate and bivariate analysis were conducted; level of significance was set at 5%. Results: Few (39.9%) respondents knew that Intra uterine contraceptive devices can be used for emergency contraception, only 15.4% knew how emergency contraceptives work. Most (75.4%) believed that emergency contraceptives should be available only on prescription; and 30.5% felt that emergency contraceptive pills promote irresponsible behaviour. More than half of the respondents (56.5%) had prescribed within the last one month, 48.7% of them prescribed less than 5 times within the month. Only 27(8.0%) have ever prescribed emergency contraceptive pills in advance of need. Conclusion: The study respondents had good knowledge of emergency contraceptives, albeit, with some misconceptions, they also demonstrated good attitude, however, the prescription practice was fair.

Minnesota Policy on Pharmacist-Prescribed Contraceptives: Benefits, Limitations, and Opportunities for Improvement.

In August 2020, pharmacists were authorized to prescribe contraceptives in Minnesota outside of a collaborative practice agreement. To practice under this new authorization, pharmacists must complete formal contraceptive prescribing training and follow guidelines which include restrictions on patient's age and appropriate screening and assessment requirements. Allowing pharmacists to prescribe contraceptives has the potential to extend contraceptive access, decrease overall health care costs, and improve outcomes. However, barriers to the expansion of contraceptive prescribing by pharmacists may prevent widespread adoption of this practice in Minnesota. A key concern among pharmacists is a lack of reimbursement for providing this service. Other states adopting contraceptive prescribing by pharmacists which have not paid for this service have reported limited implementation and discontinuation of this service. To improve contraceptive access to Minnesotans, policymakers should consider expanding provider status to pharmacists and providing reimbursement to pharmacists for contraceptive services.

Contraceptive Care Disparities Among Sexual Orientation Identity and Racial/Ethnic Subgroups of U.S. Women: A National Probability Sample Study.

Background: Sexual minority women may use contraception for various reasons but face notable barriers to contraceptive care, including stigma and discrimination. However, studies examining sexual orientation disparities in contraceptive care have largely relied on nonprobability samples of predominately White women and may thus not be generalizable to U.S. women overall or Black and Latina women in particular. Materials and Methods: Using data from the 2006 to 2017 National Survey of Family Growth, a large national probability sample of U.S. women 15-44 years of age (N = 25,473), we used multivariable logistic regression to estimate adjusted odds ratios for receiving a contraceptive method or prescription and contraceptive counseling from a health care provider in the past year among sexual orientation identity and racial/ethnic subgroups of heterosexual, bisexual, and lesbian White, Black, and Latina women relative to White heterosexual women. Results: Among women overall, 33.9% had received contraception and 18.3% had obtained contraceptive counseling. Black (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.65-0.82) and Latina (OR = 0.73, 95% CI: 0.64-0.82) heterosexual women, White (OR = 0.80, 95% CI: 0.65-0.99) and Black (OR = 0.43, 95% CI: 0.32-0.58) bisexual women, and White (OR = 0.23, 95% CI: 0.13-0.43), Black (OR = 0.19, 95% CI: 0.09-0.40), and Latina (OR = 0.08, 95% CI: 0.03-0.22) lesbian women had significantly lower adjusted odds of receiving contraception compared with White heterosexual women. White (OR = 0.36, 95% CI: 0.15-0.85), Black (OR = 0.42, 95% CI: 0.18-0.98), and Latina (OR = 0.22, 95% CI: 0.09-0.53) lesbian women also had significantly lower adjusted odds of obtaining contraceptive counseling relative to White heterosexual women. Conclusions: Policies, programs, and practices that facilitate access to person-centered contraceptive care among marginalized sexual orientation identity and racial/ethnic subgroups of U.S. women are needed to promote reproductive health equity.

Does anticipatory prescribing of emergency contraception reduce the rate of unintended pregnancy?

Evidence-Based Practice: December 2021 - Volume 24 - Issue 12 - p 12-13 doi: 10.1097/EBP.0000000000001321

Medical contraindications to combined hormonal contraceptive use among women using methods prescribed by a pharmacist

ObjectiveTo determine whether pharmacist prescription of combined hormonal contraception is associated with inappropriate prescription to women with medical contraindications. Study designWe conducted a retrosopective cohort study of all short-acting, hormonal contraceptive users (pill, patch, ring, injectable) in Oregon's All Payer All Claims database from January 1, 2016 to December 31, 2018. Our primary outcome was the proportion of women receiving a combined hormonal method who had a Medical Eligibility Category (MEC) 3 or 4 condition. We identified potential contraindications using International Classification of Disease codes. We conducted descriptive analyses of contraindication prevalence and prescription error rate by prescriber type. We used a multivariable logistic regression model to test the association between pharmacist prescriber and population characteristics. ResultsOur study sample consisted of 439,240 contraceptive users, of which 3782 (0.86%) received their prescriptions from a pharmacist. Women aged 25 to 29 were more likely than women over age 35 to receive contraception from a pharmacist (adjusted odds ratio (aOR) 2.74, 95% confidence interval [CI] 2.44–3.08). Pharmacist prescriptions were slightly less likely in rural areas (aOR 0.78, 95% CI 0.69–0.89) and among women on Medicaid, relative to those with commercial insurance (aOR 0.21, 95% CI 0.19–0.24). Among women given contraception in a clinical setting, 4.25% had evidence of an MEC 3 or 4 contraindication, compared to 0.9% for women seen by a pharmacist. Rates of prescribing a combined method to women with a potential contraindication were not meaningfully different by prescriber type (2.16% for clinicians vs 0.74% for pharmacists). ConclusionRates of contraceptive prescribing with a contraindication were relatively low and did not differ between clinicians and pharmacists. ImplicationsPharmacists can safely screen for medical contraindications to combined hormonal contraception.

Sociology of contraception in France

In France, research on contraception is a dynamic field that has been expanding since the publication of early socio-demographic work in the 1980s. This article offers a synthesis of these publications, by classifying them in four main sociological approaches: a sociology of contraceptive demand (1); a sociology of contraceptive offer, with an attention drawn to the prescription, production, and promotion of contraceptives (2); an institutional approach, focusing on how contraceptive systems are shaped at a national level (3); finally, research on social inequalities in the access to contraceptives (4). The article highlights that the centrality of the pill in the French contraceptive system has been stable for the past 40 years, though oral contraceptives have been the object of growing criticism, particularly in the aftermath of the 2012-13 French pill scare. The article also evidences how access to contraceptives is shaped by power relations (gender, class, age and "ethnicity").