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ABSTRACT Combined oral contraceptives (COCs) are a very safe and effective family planning method. While women in many countries can purchase COCs over-the-counter, in the United States a prescription is required, creating a barrier to contraceptive access. Even with clinician screening, it is estimated that 6 percent of COC users in the United States are contraindicated for use. We aimed to determine how well a convenience sample of women from the general population could self-screen for contraindications to COCs using a checklist. 1,271 women 18–49 years old were recruited at shopping malls in El Paso, Texas, and asked to use a checklist to determine the presence of level 3 or 4 contraindications to COCs according to the WHO Medical Eligibility Criteria. Women were then interviewed by a blinded nurse practitioner who also measured blood pressure. The sensitivity of the checklist to detect true contraindications was 84.5 percent (95% CI: 80.9%–87.6%) and specificity 88.4 percent (85.9%–90.5%). Some 6.0 percent (4.6%–7.3%) of women incorrectly thought they were not contraindicated when they truly were, largely due to unrecognized hypertension of > 140/90 mmHg. Using a cut-off of 160/100 mmHg (WHO category 4 contraindication), 1.8 percent (1.1%–2.6%) incorrectly thought they were not contraindicated. In regression analysis, younger women, Spanish speakers, and non-contraceptive users were significantly more likely to correctly self-screen than older women, English-only speakers, and hormonal users (p<0.05). Self-screening with a checklist would not result in more contraindicated women using COCs than the current clinician-screening system. Over-the-counter provision of COCs would be safe, especially for younger women and if independent blood pressure screening were encouraged. Learning objectives
Poster Session 3281.0—Issues in Contraceptive Technology This page updated |
