The effects of contraception on female poverty

Poverty rates are particularly high among households headed by single women, and childbirth is often the event preceding these households' poverty spells. This paper examines the relationship between legal access to the birth control pill and female poverty. We rely on exogenous cross-state variation in the year in which oral contraception became legally available to young, single women. Using census data from 1960 to 1990, we find that having legal access to the birth control pill by age 20 significantly reduces the probability that a woman is subsequently in poverty. We estimate that early legal access to oral contraception reduces female poverty by 0.5 percentage points, even when controlling for completed education, employment status, and household composition.

Canadian access to hormonal contraceptive drug choices

On October 29, 2002, Health Canada issued Guidance for Industry: Clinical Development of Steroidal Contraceptives Used by Women. The original draft of this guideline, published July 4, 2001, included recommendations for clinical trials in excess of those required in Europe and the United States. The proposed requirements, which reflected Health Canada's views, had the potential to discourage contraceptive research in Canada and to block registration of new products. To evaluate the impact of Canada's hormonal contraceptive regulation, a comparative analysis of the availability of products in various countries was performed, along with an evaluation of the time required from submission to approval of a new drug. Women in Canada have access to 35% of the contraceptive products available worldwide and to 37% of the hormonal contraceptives available worldwide, compared with 58% and 59% respectively, in the United States; 52% and 54% respectively, in the United Kingdom; 44% and 54%, respectively, in France; and 44% and 50% respectively, in Sweden. Regarding the more recent contraceptive products available worldwide, women in Denmark have the most choices (67% of available products), whereas women in Canada have the least (only 22% of available products). Eleven of 12 oral contraceptive products recently approved in other countries have either not been submitted for approval in Canada or remain in the Canadian regulatory process. Although the time-to-approval period in Canada, for drugs in general, is 6 months longer than in the United States, the mean lag time for 6 contraceptive products is 29.6 months as of January 1, 2004, and no oral contraceptives have been approved in Canada since 1997.

Provider resistance to advance provision of oral contraceptives in Africa

CONTEXT

In Africa, many new family planning clients are not menstruating at the time they present for services. Where pregnancy tests are unavailable, clients are often denied their method of choice and sent home to await menses. For pill clients, one obvious solution is 'advance provision' of oral contraceptives for later use. However, this practice is rare in Africa.

OBJECTIVE

To assess the level of provider resistance to advance provision of oral contraceptives.

DESIGN

We added questions about advance provision of pills to five provider surveys in three African countries. We also used simulated clients in Ghana to assess provider resistance to the practice.

RESULTS

In Kenya, only 16% of providers thought it safe to give women oral contraceptives to be started at a later date. In Ghana and Senegal, fewer than 5% of providers mentioned advance provision as a way to manage non-menstruating pill clients.

CONCLUSION

Training programmes and service delivery guidelines in developing countries should provide for advance provision of pills to appropriate clients

A qualitative study of the views of women aged 18-29 on over-the-counter availability of hormonal emergency contraception

OBJECTIVE

To explore women's views on the deregulation of hormonal emergency contraception (EC) prior to it becoming deregulated on 1 January 2001.

DESIGN

Qualitative study using face to face, semi-structured interviews.

SETTING

A NHS family planning clinic, a voluntary sector family planning clinic and a general practice in the South West region.

SUBJECTS

Twenty-seven women aged 18-29 years.

RESULTS

Most women were in favour of deregulation with over-the-counter provision perceived as quick, convenient and anonymous. Reservations regarding overuse and over-reliance upon EC mirror those of health professionals, although it was not felt that the increased accessibility of EC would lead to changes in sexual activity. Concerns that deregulation would promote an irresponsible attitude towards contraception were largely focused on younger women. Cost was generally regarded as a positive barrier to overuse. However, it was felt that the price should not be prohibitively high. A figure corresponding to the current prescription charge was most often cited. The pharmacy was the preferred choice of provider for most women.

CONCLUSION

Although most women in this study would prefer to obtain EC over-the-counter, the current charge of pound 20 is likely to prove a barrier.

Provision of hormonal contraceptives without a mandatory pelvic examination: the first stop demonstration project

CONTEXT

First Stop, an 18-month demonstration project that operated in 1996-1997, was designed to offer low-income adult women in California hormonal contraceptives without requiring a pelvic examination.

METHODS

An evaluation was undertaken to assess the contraceptives adopted by First Stop clients, compare health risks of these women with risks among women using traditional family planning clinics and assess clients'satisfaction. Data on 2,065 First Stop clients and 1,507 women attending traditional clinics were collected through several self- and clinician-administered instruments, including questionnaires, a telephone survey and medical chart abstractions.

RESULTS

After the initial First Stop visit, 38% of women adopted a more effective method than they had used at last sex, 4 7% remained with the same method, 12% switched to a less-effective method and 3% accepted no method. Of clients who were referred for additional medical care, 73% followed through on their referrals. Compared with clients at traditional clinics, First Stop clients were less likely to have a regular source of health care, but more likely to have made a health care visit in the past year. Most First Stop clients valued the project's services; 76% said it was important to be able to receive pills or injections without a pelvic examination.

CONCLUSIONS

Programs that provide hormonal contraceptives without requiring a pelvic examination can expand low-income women's access to these methods and improve the chances that they will obtain other reproductive health services.

[The P-pill for men--when will it be available?]

Although the development of a hormonal contraceptive for men has proved to be more of a challenge than oral contraception for women, several experimental prototypes already satisfy many of the criteria that must be met. Steroid regimes are more effective in Asians than in men of other ethnic backgrounds. They are inexpensive, and the effect is reversible.GnRH analogues are promising, but further research is needed and is being carried out. Androgens must be used as a supplement to all hormonal strategies in order to maintain normal sexual function. The impact of androgens on lipid metabolism and prostate physiology must be clarified. Lack of funding is the greatest barrier to further research and the development of a hormonal contraceptive for men.