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Otto AK, Klein DA, Lau M, Dhar CP, Hwang LY. Over-the-counter access to hormonal contraception: a global perspective. Curr Opin Pediatr 2024; 36:382-388. [PMID: 38655795 DOI: 10.1097/mop.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Oral contraceptive pills are among the most popular contraceptives worldwide, including among adolescents, and are available over the counter in over 100 countries. However, when a prescription is required, oral contraceptives may be difficult to obtain, particularly for adolescents. Recent approvals of over-the-counter progestin-only pills in the United Kingdom and United States have brought widespread attention to this topic. RECENT FINDINGS Progestin-only pills, including the norgestrel pill recently approved for over-the-counter use in the United States, are highly effective and may be used safely without a prescription or medical monitoring, including by adolescents. These pills are associated with relatively high user satisfaction. Although over-the-counter availability may improve contraceptive access overall, issues related to insurance coverage and out-of-pocket cost may continue to pose practical barriers to access for many individuals. SUMMARY Over-the-counter oral contraceptives are an appropriate and important contraceptive option for many adolescents. Over-the-counter availability has the potential to increase access to safe and effective contraception in the United States, United Kingdom, and other countries where a prescription is currently required. Future research on use patterns among adolescents is needed, as are advocacy efforts and policies to ensure access and affordability.
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Affiliation(s)
- Alana K Otto
- Division of Adolescent Medicine, Department of Pediatrics, University of Michigan
| | - David A Klein
- Departments of Family Medicine and Pediatrics, Uniformed Services University, Bethesda, Maryland
- Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, California
| | - May Lau
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Medical Center Dallas
| | - Cherie P Dhar
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Loris Y Hwang
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, University of California, Los Angeles, California, USA
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Nappi RE, Farris M, Gallina Toschi A, Michieli R, Moccia F, Orthmann N, Arisi E. Overcoming barriers to oral contraception in Italy an expert opinion to empower women. Gynecol Endocrinol 2023; 39:2254400. [PMID: 37666276 DOI: 10.1080/09513590.2023.2254400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023] Open
Abstract
Oral contraceptives are among the most commonly used contraceptive methods. However, Italian women underused reliable hormonal contraceptives as compared with other European women. There is a need to streamline access to oral contraception, with expected benefits on emotional well-being of women and potential savings for health system in Italy. Indeed, women can only access to oral contraceptives through mandatory medical prescription. This is one of the most important barrier experienced by women. We hereby provide an expert opinion on the potential reclassification, extending pharmacy services to include responsible and appropriate use of POP, as an opportunity also in Italy to increase the use of safe and effective contraceptive methods.
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Affiliation(s)
- Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Manuela Farris
- AIED (Italian Association for Demographic Education), Rome, Italy
| | | | | | | | - Nicoletta Orthmann
- Onda Foundation - National Observatory of Women's and Gender Health, Milano, Italy
| | - Emilio Arisi
- SMIC (Italian Medical Society of Contraception), Milano, Italy
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Farris M, Arisi E, Mirjalili N, Nappi RE. Attitudes of women and pharmacists on the opportunity to obtain a progestogen-only pill over the counter - Italian outcomes. Gynecol Endocrinol 2023; 39:2206922. [PMID: 37141915 DOI: 10.1080/09513590.2023.2206922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
PURPOSE Scrutinizing, among potential providers and users, the perceived claim and interest for over the counter (OTC) accessibility of a progestogen-only pill (POP). METHODS Cross-sectional, descriptive study based on an online survey of 1000 women and 100 pharmacists in Italy, part of a larger sample including Germany and Spain. RESULTS Hormonal contraceptive methods are used by 35%; 5% of women reported currently not using contraception, 40% using a barrier method, and 20% a method considered less effective than male condoms (including 16% withdrawal and 4% natural methods and fertility/contraceptive applications). Almost 80% of women felt knowledgeable about the different contraceptive method, but about 1/3 had experienced difficulty accessing their oral contraceptive (OC) in the past two years. Women reacted positively to the proposition of an OTC-POP and 85% agreed that they would discuss the decision to buy it with their doctor; 75% reported they would continue to see their doctor for other reproductive health issues, including screening. The most frequent barrier is cost (reported by 25-33% of women) followed by long waiting times for doctor appointments and lack of personal time to schedule an appointment.Pharmacists (66%) would be likely/fairly likely to recommend the POP after appropriate training, agreeing that the benefits of an OTC-POP included improved access for women, saving them time and giving them more independence. CONCLUSIONS Potential users of contraception in Italy have a positive attitude toward OTC-POP, with doctors continuing to have a relevant role. Following training, pharmacists are also positive.
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Affiliation(s)
- Manuela Farris
- Demographic Education, Sapienza, University of Rome and Italian Association for Demographic Education, Rome, Italy
| | - Emilio Arisi
- Department of Obstetrics and Gynecology, 'S. Chiara' Regional Hospital, Trento, Italy
| | | | - Rossella E Nappi
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, IRCCS Policlinico San Matteo, Pavia, Italy
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Otte R, Thissen V, Mulder B. (Dis)continuation of the oral contraceptive pill: A focus group approach in the Netherlands. Heliyon 2023; 9:e19405. [PMID: 37810124 PMCID: PMC10558495 DOI: 10.1016/j.heliyon.2023.e19405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives The oral contraceptive pill (OCP) is the most used contraceptive worldwide; nevertheless, discontinuation rates are relatively high. While advantages of the OCP, like pregnancy prevention and planned parenthood, result in autonomy and independence, side effects and other aspects play a role in the decision to (dis)continue usage. Informed and deliberate decision-making is of importance to prevent adverse effects in health and quality of life. Therefore, the present study aimed to explore how women in the Netherlands decide to (dis)continue the OCP. Study design This paper reports a qualitative study using four focus groups, conducted online or face-to-face, with 20 women of different educational background aged between 18 and 23. The topic guide was based on relevant theory and literature, and focused on personal beliefs, experiences and social interactions about the OCP. The study is reported according to SRQR guidelines. Results The main themes that were found the influence decision-making were effects, side effects, towards alternatives, interpersonal communication with peers, interpersonal communication with the general practitioner, and online information seeking. Feeling responsible emerged as a relevant additional theme, embedded in the decision-making process, and influencing other themes. Some educational differences emerged. Conclusions The decision to start the OCP is a highly normalized process in the Netherlands. However, women who feel a strong sense of responsibility for pregnancy prevention may be less open to considering alternative contraception methods. Results imply that women can be better supported in the decision-making process by providing balanced information on effects and side effects of a wide range of contraceptives, as well as restoring the balance in both sexual partner's responsibility for contraception. Implications for practice and suggestions for further research on the concept of responsibility, its influence, and underlying mechanisms are provided.
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Affiliation(s)
- R.S. Otte
- Strategic Communication Group, Wageningen University & Research, P.O. BOX 8130, 6700, EW Wageningen, the Netherlands
| | - V.T.M. Thissen
- Strategic Communication Group, Wageningen University & Research, P.O. BOX 8130, 6700, EW Wageningen, the Netherlands
| | - B.C. Mulder
- Strategic Communication Group, Wageningen University & Research, P.O. BOX 8130, 6700, EW Wageningen, the Netherlands
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Arisi E, Bauer C, Farris M, Giulini-Limbach C, Glasier A, Lete I, May U, Mirjalili N, Nappi RE, Sanchez-Borrego R, Serrano I. The views of women and pharmacists on the desirability of a progestogen-only pill over the counter. Results of a survey in Germany, Italy and Spain. EUR J CONTRACEP REPR 2022; 27:494-503. [PMID: 36256517 DOI: 10.1080/13625187.2022.2128643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To explore the perceived need and enthusiasm for over the counter (OTC) progestogen-only pills (POP). MATERIALS AND METHODS A web-based survey of 1000 sexually active women (16-45) and 100 pharmacists in Germany, Italy and Spain. RESULTS Despite not wanting to conceive, 5-6% of women in each country were not using contraception and 8-20% were using methods less effective than condoms. At least 74% of respondents felt knowledgeable about the different contraceptives available but at least 1/3 had experienced difficulty accessing oral contraceptive (OCs) in the past two years. The cost of contraceptives, the need to see a doctor and long waits for appointments were cited as barriers for not using OCs. The majority agreed they would discuss with their doctor the decision to buy the POP, consult about side effects and other reproductive health issues. Over 2/3 of pharmacists in each country would be very, or fairly, likely to recommend the POP, agreeing that the benefits included improved access for women, and offered them more independence. CONCLUSIONS Asked directly, women in Germany, Spain and Italy currently using contraception are positive about a POP OTC. Pharmacists are also positive, with the overwhelming majority in favour of providing POPs.
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Affiliation(s)
- Emilio Arisi
- Department of Obstetrics and Gynecology, 'S. Chiara' Regional Hospital, Trento, Italy
| | - Cosima Bauer
- May and Bauer, Lecturer at the Fresenius University of Applied Sciences, Rheinbreitbach, Germany
| | - Manuela Farris
- Demographic Education, Sapienza, University of Rome and Italian Association, Rome, Italy
| | - Chiara Giulini-Limbach
- May and Bauer, Academic Director at Fresenius University of Applied Sciences, Rheinbreitbach, Germany
| | - Anna Glasier
- Department of Obstetrics and Gynecology, University of Edinburgh, Queen's Medical Research Institute, Midlothian, UK
| | - Inaki Lete
- Department of Obstetrics and Gynecology, University Hospital of Araba, Vitoria-Gasteiz, Spain
| | - Uwe May
- May and Bauer, Dean of Studies at the Fresenius University of Applied Sciences, Rheinbreitbach, Germany
| | | | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | | | - Isabel Serrano
- Centro Madrid Salud Joven, Programa de Salud Sexual y Reproductiva, Madrid, Spain
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Glasier A, Cameron ST. Improving access to sexual and reproductive health care. Lancet Public Health 2022; 7:e4-e5. [DOI: 10.1016/s2468-2667(21)00283-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
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