Women support getting hormonal contraceptives without a prescription.

More than two-thirds of U.S. women aged 18-44 and at risk for unintended pregnancy say they would obtain hormonal contraceptives from pharmacies if these methods were available without prescription, and more than half would be more likely to use emergency contraceptives if the method were available in this manner, according to findings from a national telephone survey. (1) Notably, 41% of women who do not use any birth control say they would begin using a hormonal method if such access were available. Furthermore, women who have had problems obtaining prescription contraceptives, uninsured women and those with low income have elevated odds of saying they would use pharmacy access to get hormonal methods (odds ratios, 2.6, 2.3 and 1.5, respectively).

Because many women who are at risk of unintended pregnancy lack convenient and affordable access to contraceptives, some states are establishing pharmacy access programs, by which women can obtain hormonal contraceptives without first getting a doctor's prescription or visiting a clinic. Researchers collected data on respondents' experiences in obtaining hormonal contraceptives, support for pharmacy access and likelihood of getting contraceptives in this manner, and asked them what services they wanted from pharmacists. A random digit dial telephone survey conducted between March and May 2004 yielded a nationally representative sample of English-speaking women aged 18-44 who were at risk for unintended pregnancy. Women were considered at risk if they had had sexual intercourse in the past year, were not pregnant or trying to get pregnant, and had not given birth in the last two months; women were excluded if they or their partner were sterile for contraceptive or noncontraceptive reasons. Multivariate logistic regression analyses assessed characteristics associated with awareness of contraceptive methods, problems in obtaining them, and support for and likely use of pharmacy access.

The sample included 811 women; about seven in 10 were white, three in 10 had incomes below 200% of the federal poverty level and 15% were uninsured. Nearly four in 10 were using the pill, patch or ring, and a third were using no birth control. Nearly all respondents had heard of birth control pills, the contraceptive patch and emergency contraceptives, whereas fewer than six in 10 had heard of the contraceptive ring. More than half of all current and past contraceptive users had chosen their method because it did not require a prescription; among women who had used or wanted to use a prescription contraceptive, two in 10 said the cost of a doctor's visit was an obstacle to obtaining it. In addition, nearly three in 10 of those who had used prescription contraceptives reported having had a problem in obtaining or filling a prescription, or in having access to their supplies when away from home.

Respondents saw a number of advantages to pharmacy access: Three-fourths identified the benefit of avoiding the cost of a clinician visit, and more than eight in 10 said that pharmacies' convenient hours and locations, as well as the time saved in using them, were important. More than seven in 10 believed that such access would reduce the number of unintended pregnancies, and would allow more low-income women to gain access to hormonal contraceptives. Uninsured women were significantly more likely than insured women to support pharmacy access for the pill, patch and ring (odds ratio, 1.7), and women aged 18-25 were more likely than those 36 or older to do so (1.8). Likewise, women who had had an unintended pregnancy or pregnancy scare, or problems getting prescription methods, had elevated odds of supporting pharmacy access (1.5 and 1.8, respectively). Those who reported problems in obtaining prescription contraceptives were also more likely than others to support pharmacy access to emergency contraceptives (1.5).

Sixty-eight percent of respondents said they would use pharmacy access to obtain hormonal contraceptives if it were available, and 41% of those who were not using any birth control said they would begin use of hormonal methods under such a program. Women who had had problems obtaining prescription contraceptives were more likely than others to say they would use pharmacy access (odds ratio, 2.6). Uninsured women were more likely than insured women to be potential users (2.3), and low-income women were more likely than those with an income at or above two times the federal poverty level to give this response (1.5). Black and Latina women were more likely than white women to be potential users (1.6 and 1.8, respectively). Furthermore, respondents who had had an unintended pregnancy or pregnancy scare had higher odds of saying they would use pharmacy access than those who had not (1.8). Fifty-five percent of women said they would be more likely to use emergency contraceptives if the method were available without a prescription. This group included nearly two-thirds of uninsured and low-income women.

When respondents were asked about the role of pharmacists under a pharmacy access program, 75% said that they should provide method instruction, 46% wanted them to offer screening and counseling, and 24% just wanted pharmacists to answer their questions. The issue of screening was important: Sixty-three percent agreed that the pill, patch and ring should be available without prescription if pharmacists first screened women, but support dropped to 43% when screening was not mentioned.

Women also reported a number of concerns about pharmacy access. For example, 83% said the medical safety of a method was a "big" concern for them, and 72% believed that pharmacy access would expose more women to potential health risks. Other concerns were that contraceptives obtained through pharmacy access might be of lower quality and that fewer women would get Pap smears and STD testing.

The researchers believe that pharmacy access has the potential to attract many women who currently do not use any method of birth control, and that this represents an important opportunity to reduce the prevalence of unintended pregnancy. Furthermore, "women who would benefit the most (poor women and women of color) report an even stronger interest, which presents important policy and program opportunities for improving access to health services for underserved populations."

REFERENCE

(1.) Landau SC, Tapias MP and McGhee BT, Birth control within reach: a national survey on women's attitudes toward and interest in pharmacy access to hormonal contraception, Contraception, 2006, 74(6): 463-470.