Expanding adolescent access to hormonal contraception: an update on over-the-counter, pharmacist prescribing, and web-based telehealth approaches

Abstract

Purpose of review Hormonal contraceptives are largely responsible for recent declines in unintended adolescent pregnancies, with oral contraceptives being the most commonly used. Young people face multiple barriers to accessing effective contraception in clinical settings. This article reviews innovations in contraceptive access. Recent findings The three biggest innovations are over-the-counter oral contraceptives (OTC-OCs), pharmacist-prescribing, and web-based telehealth platforms. In many countries, oral contraceptives are available OTC, and FDA trials for OTC-OCs are underway in the United States. Many states have passed legislation allowing pharmacists to prescribe contraceptives after a brief health screening. Web-based telehealth platforms also provide prescription contraceptive access. There is a small but growing body of literature that demonstrates young people's interest in, and capacity to consent to, hormonal contraceptives in nontraditional settings. State-to-state variability in minor consent, pharmacist prescribing, and telehealth laws act as barriers to young people's access to these newer options. Summary Access to hormonal contraception is expanding outside of clinical settings, reducing barriers. Adolescents’ unique needs should be considered in the design, implementation, and evaluation of these new approaches. More data is needed to ensure that adolescents are not excluded from expanded contraceptive access options, as they are disproportionately affected by unintended pregnancy.

Clinician Perspectives on Ethics and COVID‐19: Minding the Gap in Sexual and Reproductive Health

“…[7][8][9] Moreover, telehealth requires access to adequate and reliable Internet service, which is not available in some rural areas, 10 and many individuals who do not have Internet service at home (because of cost or geography) and had relied on public access points such as libraries or coffee shops no longer have these options available because of pandemic closures and social distancing. 11 Although newer approaches for improving access to contraceptives, such as provision of hormonal methods through pharmacies, apps or telehealth, 12 have the potential to maintain access to contraceptives, these approaches are frequently not available to all, and may worsen disparities in SRH access among specific groups. For example, laws that regulate telehealth, authorize pharmacists to prescribe contraceptives, or permit minors to provide consent and obtain confidential services vary from state to state.…”

“…In many states, these laws do not specifically allow adolescents to access contraceptives through telehealth, apps or pharmacies. 12,13 For women in rural areas, pharmacy access can be limited even in states with supportive laws. 14 Further gaps in access to SRH services have resulted from the postponement or cancellation of well-woman and wellchild visits; in the absence of such visits, many women are not being screened for asymptomatic STIs, abuse, genderbased violence and contraceptive needs.…”

“…Currently, only 11 states and the District of Columbia allow pharmacists to prescribe contraceptives, and even in those states, many pharmacies (especially in rural areas) do not offer the service; telehealth is more widely available, but many states do not allow minors to consent to these services. 12,[38][39][40] Broad geographic expansion of pharmacy, telehealth and app-based contraceptive services could provide necessary access for adolescents and for individuals who lack transportation, have low incomes or live in rural areas. Nontraditional approaches may also be possible for other SRH services; for example, data from home-based STI screening programs, such as "IWanttheKit," suggest that such screening is feasible and acceptable, including for marginalized populations.…”

Providing Contraception for Young People During a Pandemic Is Essential Health Care

“…Further, some private companies provide telehealth options for home delivery of contraceptives. 6,7 However, we believe it is possible and imperative for HCPs to prioritize contraception access for young people throughout this pandemic and beyond as essential health care. Pregnancy exclusion questions All methods can be started immediately if HCP is reasonably certain person is not pregnant if patient has no signs or symptoms of pregnancy and answers yes to any of the following questions:…”

Preserving the Reproductive Rights of Girls and Women in the Era of COVID-19: The Need for a Least Restrictive Solution

“…In all cases, ensuring the least restrictive approach means identifying the barriers to access created by COVID policies and creating ways to improve access, while maintaining important public health policies, like shelter-in-place restrictions. For contraception, a least restrictive solution might involve expanding over-the-counter, pharmacy, and telemedicine options, with particular attention to access for adolescents (Williams et al 2018). Abortion procedures are time-sensitive and have been identified as an essential service in a pandemic setting, given their ability to prevent far worse pregnancy outcomes (Robinson et al 2020).…”