Over-the-Counter Access to Hormonal Contraception

Knowledge on Adherence and Continuation

Over-the-counter entry seems to have comparable charges of adherence and continuation when put next with prescription-only entry. One third of girls who begin utilizing an oral contraceptive can have stopped utilizing the tactic by the tip of the primary yr 19. Causes for discontinuation embody hostile results and problem with a every day technique in addition to entry points, together with price and lack of time for a medical go to to acquire a prescription 5 6. Notably, causes for discontinuation of contraception are complicated and embody the need for being pregnant, though discount of boundaries to entry is vital for these people who want to proceed their most popular technique of contraception. A research of practically 1,000 OCP customers (half of whom obtained their capsules from an over-the-counter pharmacy in Mexico and half of whom obtained capsules by prescription from a household planning clinic in El Paso, Texas) reported that at 9 months, 79.2% of the over-the-counter group and 74.9% of the prescription group had continued their capsule use (P=.12) 20. Moreover, when adjusting for variations (age, nation of delivery, nation the place schooling was accomplished, U.S. medical health insurance standing, receipt of presidency help, border-crossing frequency, period of use of OCPs, expertise of hostile results attributable to OCPs, and the way lengthy the girl reported she deliberate to make use of OCPs), a better price of discontinuation for ladies who obtained capsules in El Paso clinics (25.1%) in contrast with those that obtained their capsules with no prescription in Mexico was reported (20.8%; hazard ratio, 1.6; 95% CI, 1.1-2.3).

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Entry to a number of OCP packs at one time (which can be understood as a proxy for elevated entry) ends in increased charges of continuation. In a 2011 randomized trial, investigators in contrast 6-month contraceptive continuation charges amongst ladies who have been allotted a 3-month provide of capsules and people who acquired a 7-month provide of capsules 21. Members who acquired seven capsule packs had a better 6-month continuation price than members who acquired three capsule packs and have been required to return for additional refills (51% in contrast with 35%; P<.001), and the impact was better amongst members youthful than 18 years (49% in contrast with 12;%; P<.001) 21. These findings are reassuring and assist the view that adolescents and girls who get hold of their contraception over-the-counter are as prone to adhere to a routine and to proceed the tactic as those that get hold of contraception by prescription.

The 1-year continuation price for DMPA injection is roughly 56% 19. The requirement to return to a clinic each 3 months for an injection can result in missed appointments and undesired discontinuation 22. A number of research have demonstrated curiosity in and the feasibility and steady use of self-administered subcutaneous DMPA, though it isn’t at present labeled within the U.S. for self-administration 23 24 25 26. Self-administration would make DMPA an choice for over-the-counter entry. A 2014 randomized managed trial of girls presenting to a New York Metropolis household planning clinic to provoke, restart, or proceed DMPA discovered that when evaluating self-administration of subcutaneous DMPA with well being care supplier administration, 71% of the self-administration group versus 63% of the well being care supplier administration group continued utilizing DMPA at 1 yr 27. A 2018 research of 401 females aged 15-44 years requesting DMPA at clinics in Texas and New Jersey randomized members to self-administration or clinic-administration of subcutaneous DMPA and reported that 1-year steady use of DMPA was 69% within the self-administration group and 54% within the clinic group (P=.005) 25. Equally, a research in Malawi discovered that continuation charges have been increased within the 364 ladies randomly assigned to self-administer subcutaneous DMPA in contrast with the 367 ladies assigned to the well being care provider-administered group (73% versus 45%; RR, 0.40; 95% CI, 0.31-0.51) 24.

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Source: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/over-the-counter-access-to-hormonal-contraception

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