There are more than three million unintended pregnancies each year in the United States, a widely recognized public health problem that entails adverse personal, health, economic, and social consequences. Simplifying women's access to hormonal contraceptives such as the pill would improve women's health, according to a UCSF study that appears in today's issue of the Journal of the American Medical Association (JAMA).
Traditionally, women choosing to start use of hormonal contraceptives have been required to wait until after they have received a clinical breast and pelvic exam. Researchers at the UCSF Center for Reproductive Health Research and Policy and colleagues reviewed the existing recommendations for use of hormonal contraceptives and concluded that, in most cases, waiting to schedule a pelvic and breast exam may cause an unnecessary - and potentially dangerous - delay.
A sexually active woman of reproductive age has an annual risk of pregnancy of 85 to 90 percent without contraception, and "unintended pregnancy has significant health risks," said Felicia H. Stewart, MD. Stewart is co-director of the UCSF Center for Reproductive Health Research and Policy and is the lead author of the study. "Exam requirements often cause delay for women who need effective contraceptive protection, and in some cases constitute a serious obstacle because of costs, scheduling difficulties, or fear," she said.
The study examined oral contraceptives and injectable and implantable contraceptives currently used in the United States. More than 16 million U.S. women use the birth control pill as their form of contraception, and more information is available about birth control pills than any other medication in history, the researchers said.
"The study's conclusions are especially important for young women, who often wait several months between initiating sexual activity and seeking health care to obtain contraception," said Stewart, who is a UCSF adjunct professor of obstetrics, gynecology and reproductive sciences. Having to get a pelvic exam is one of the reasons young women cite for their delay in seeking care, she added.
Although hormonal contraceptives are not recommended for women with some serious medical conditions, the problems that make their use unwise are effectively identified through medical history and a simple blood pressure measurement. "Hormonal contraceptives can safely be started based on medical history review and a blood pressure check. For most women no further evaluation is needed before making a decision to use them," said George F. Sawaya, MD, UCSF assistant professor of obstetrics, gynecology and reproductive sciences and research coordinator for the UCSF-Stanford Evidence-based Practice Center.
The JAMA article summarizes medical criteria recommended by a World Health Organization international review panel in 2000 for safe provision of hormonal contraceptives. "In short," said Sawaya, "40 years of data and practice tell us that hormonal contraceptives are safe for most women, and have very important health benefits."
Additional researchers on the study are Cynthia C. Harper, PhD, UCSF statistician, Center for Reproductive Health Research and Policy, department of obstetrics, gynecology, and reproductive sciences, UCSF; Charlotte E. Ellertson, PhD, The Population Council; and James Trussell, PhD, Woodrow Wilson School of Public and International Affairs, Office of Population Research, Princeton University, New Jersey. The Center for Reproductive Health Research and Policy works to promote reproductive health worldwide, through research, training and policy analysis in reproductive health, family planning, and the prevention of sexually transmitted infections including HIV. The Center is part of the UCSF department of obstetrics, gynecology and reproductive sciences.
The study was funded by The California Endowment, the state's largest health foundation. The Endowment was established to expand access to affordable, quality health care for underserved individuals and communities. The Endowment provides grants to organizations and institutions that directly benefit the health and well being of Californians.