Objective To estimate how well a convenience sample of women from the general population could self-screen for contraindications to combined oral contraceptives using a medical checklist. Methods Women 18-49 years old (N=1,271) were recruited at two shopping malls and a flea market in El Paso, Texas, and asked first whether they thought pills were medically safe for them. They then used a checklist to determine the presence of level 3 or 4 contraindications to combined oral contraceptives according to the World Health Organization Medical Eligibility Criteria. Women were then interviewed by a blinded nurse practitioner who also measured blood pressure. Results The sensitivity of the unaided self-screen to detect true contraindications was 56.2% (95% CI: 51.7%-60.6%) and specificity 57.6% (54.0%-61.1%). The sensitivity of the checklist to detect true contraindications was 83.2% (79.5%-86.3%) and specificity 88.8% (86.3%- 90.9%). Using the checklist, 6.6% (5.2%-8.0%) of women incorrectly thought they were eligible for use when, in fact, they were contraindicated, largely due to unrecognized hypertension. Seven percent (5.4%-8.2%) of women incorrectly thought they were contraindicated when they truly were not, primarily due to misclassification of migraine headaches. In regression analysis, younger women, more educated women and Spanish-speakers were significantly more likely to correctly self-screen (p<0.05). Conclusion Self-screening for contraindications to oral contraceptives using a medical checklist is relatively accurate. Unaided screening is inaccurate and reflects common misperceptions about the safety of oral contraceptives. Over-the-counter provision of this method would likely be safe, especially for younger women and if independent blood pressure screening were encouraged.
Objective To compare the estimated proportion of contraindications to combined oral contraceptives between women who obtained combined oral contraceptives in U.S. public clinics, compared with women who obtained combined oral contraceptives over the counter (OTC) in Mexican pharmacies. Methods We recruited a cohort of 501 women who were residents of El Paso, Texas who obtained combined oral contraceptives over the counter (OTC) in Mexico and 514 women who obtained combined oral contraceptives from family planning clinics in El Paso. Based on self-report of WHO category 3 and 4 contraindications and interviewer-measured blood pressure, we estimated the proportion of contraindications and, using multivariable-adjusted logistic regression, identified possible predictors of contraindications. Results The estimated proportion of any category 3 or 4 contraindication was 18%. Relative contraindications (category 3) were more common among OTC users (13% vs 9% among clinic users, p=0.006). Absolute contraindications (category 4) were not different between the groups (5% for clinic users vs 7% for OTC users, p=0.162). Hypertension was the most prevalent contraindication (5.6% of clinic users and 9.8% of OTC users). After multivariable adjustment, OTC users had higher odds of being contraindicated compared to clinic users (OR 1.59, 95% CI: 1.11–2.29). Women aged 35 years or older (OR 5.30, 95% CI: 3.59–7.81) and those with body mass index 30.0 kg/m2 or greater (OR 2.24, 95% CI: 1.40–3.56) also had higher odds of being contraindicated. Conclusions Relative combined oral contraceptive contraindications are more common among OTC users in this setting. Progestin-only pills might be a better candidate for the first OTC product given their fewer contraindications.
CONTEXT Sterilization is the most commonly used contraceptive in the United States, yet access to this method is limited for some. METHODS A 2006–2008 prospective study of low‐income pill users in El Paso, Texas, assessed unmet demand for sterilization among 801 women with at least one child. Multivariable logistic regression analysis identified characteristics associated with wanting sterilization. In 2010, at an 18‐month follow‐up, women who had wanted sterilization were recontacted; 120 semistructured and seven in‐depth interviews were conducted to assess motivations for undergoing the procedure and the barriers faced in trying to obtain it. RESULTS At baseline, 56% of women wanted no more children; at nine months, 65% wanted no more children, and of these, 72% wanted sterilization. Only five of the women interviewed at 18 months had undergone sterilization; two said their partners had obtained a vasectomy. Women who had not undergone sterilization were still strongly motivated to do so, mainly because they wanted no more children and were concerned about long‐term pill use. Among women's reasons for not having undergone sterilization after their last pregnancy were not having signed the Medicaid consent form in time and having been told that they were too young or there was no funding for the procedure. CONCLUSIONS Because access to a full range of contraceptive methods is limited for low‐income women, researchers and providers should not assume a woman's current method is her method of choice.
Objectives As part of the Border Contraceptive Access Study, we interviewed oral contraceptive (OC) users living in El Paso, Texas, to assess motivations for patronizing a US clinic or a Mexican pharmacy with over-the-counter (OTC) pills and to determine which women were likely to use the OTC option. Methods We surveyed 532 clinic users and 514 pharmacy users about background characteristics, motivations for choosing their OC source, and satisfaction with this source. Results Older women and women born and educated in Mexico were more likely to patronize pharmacies. Cost of pills was the main motivation for choosing their source for 40% of pharmacy users and 23% of clinic users. The main advantage cited by 49% of clinic users was availability of other health services. Bypassing the requirement to obtain a doctor’s prescription was most important for 27% of pharmacy users. Both groups were very satisfied with their pill source. Conclusions Women of different ages, parities, and educational levels would likely take advantage of an OTC option were OCs available at low cost. Improving clinic provision of OCs should be considered.
Objective To estimate differences in continuation of oral contraceptive pills (OCPs) between U.S.-resident women obtaining pills in U.S. family planning clinics compared with over-the-counter in Mexican pharmacies. Methods In El Paso, Texas, we recruited 514 OCP users who obtained pills over-the-counter from a Mexican pharmacy and 532 who obtained OCPs by prescription from a family planning clinic in El Paso. A baseline interview was followed by three consecutive surveys over 9 months. We asked about date of last supply, number of pill packs obtained, how long they planned to continue use, and experience of side effects. Retention was 90%, with only 105 women lost to follow-up. Results In a multivariable Cox proportional hazards model, discontinuation was higher for women who obtained pills in El Paso clinics (25.1%) compared with those who obtained their pills without a prescription in Mexico (20.8% [hazard ratio 1.6, 95% CI: 1.1--2.3]). Considering the number of pill packs dispensed to clinic users, discontinuation rates were higher (hazard ratio 1.8, 95% CI: 1.2 -- 2.7) for clinic users who received 1-5 pill packs. However, there was no difference in discontinuation between clinic users receiving 6 or more pill packs and users obtaining pills without a prescription. Conclusion Results suggest providing OCP users with more pill packs and removing the prescription requirement would both lead to increased continuation.
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