Medicine

The Public Perception of Pharmacist Prescribed contraception | by Alec Robitaille | Dec, 2023

Alec C. Robitaille

On June 24, 2022, the Supreme Court overturned the groundbreaking 1973 decision to affirm the constitutional right of abortion.1,2 With about half of the pregnancies in the United States being unintended these drastic changes in laws governing maternal health and access to contraception will have significant effects on unintended pregnancy rates and female reproductive rights.3 Understanding the public perceptions on pharmacist-prescribed birth control will help policymakers inform future decisions on the creation of law and policy.

In a study by Landau et. al. on the United States’ perceptions of pharmacist-prescribed contraception, it was found that 68% of women in the United States would use pharmacy access to oral contraception, path, ring, or emergency contraception.4 Additionally, over half of the women (55%) said they would be more likely to utilize emergency contraception if it were directly available in pharmacies. Out of the group of women interested, the majority were uninsured and of low-income groups per the study.4 Additionally, surveys found that 63% of women believed that oral contraception, the patch, ring, and emergency contraception should be available without prescription if pharmacists screen women.5

Compared to the study from Landau, an older 2011 study from Grindlay et. al., surveyed over 600 women seeking abortions at urban clinics. In this study, 81% supported over-the-counter access to oral contraceptives and 42% planned to use contraception pills after their abortion.3 Additionally, 61% claimed they would use oral contraception pills if they were available over-the-counter. Out of the women in this study who planned to use no contraceptives after their abortion (33%), all of them agreed that they would use over-the-counter contraception if it was pharmacy accessible.6 Further analysis of the survey results found that the groups that claimed they were most likely to use over-the-counter oral contraception were women older than 19 who were uninsured and had difficulty obtaining a prescription refill or planned to use the pill post-abortion.6 The study from Grindlay et. al. demonstrated that over-the-counter contraceptive administration could reduce unintended pregnancy among abortion patients.

A smaller study in select parts of California utilized phone interviews in 2017 and found that out of a random sample of 30 ethnically diverse, high school-educated men and women, nearly all were in strong support of California’s new law which allows pharmacist prescription of contraception.7 Participants in the study believed that increased access would include both personal and societal benefits. The main concerns voiced by individuals in this study were confidentiality, parental involvement, and insurance disclosure.7

Perceptions towards the actual implementation of pharmacist-prescribed contraception is another important aspect of the new policy. In a 2015 study by Gardner et. al., a total of 195 women were provided hormonal contraceptives.8 In this study, pharmacists used a screening tool that each woman took on their own as well as a physical exam measurement of weight and blood pressure to qualify for the safe use of contraceptives. The results found that after 12 months, 70% of women responding to an interview reported continuing use of hormonal contraceptives.3 Both women and pharmacists were satisfied with the experience and nearly all respondents expressed willingness to continue to see pharmacist prescribers and to receive other services from them.8

The online climate towards pharmacist-prescribed contraception has also been researched. In a 2015 study, 348 female teenagers aged 14–17 were recruited through Facebook, a social media platform, to participate in an online survey on contraceptive administration.9 In the study, 73% of the participants supported over-the-counter access to hormonal contraception, and 61% reported that they would likely use oral contraceptives available over-the-counter as opposed to through a traditional primary care provider.10 When examining subgroups, it was found that sexually experienced participants were most likely to support this approach and those who self-reported live in lower-income households.9 The online survey demonstrates that over-the-counter access may be effective at providing oral contraceptives to teenagers.

Gardner et. al showed that community pharmacists can efficiently screen women for the safe use of hormonal contraceptives and select appropriate products. The study from Landau et. al. shows that most women in the United States believe that hormonal contraception should be available without a prescription, and more than half would personally use pharmacy access given the ability to do so. The women in these studies represent approximately 22 million citizens in the United States and their perspectives on reproductive health and access to care should not be overlooked. In the future, policymakers should incorporate study findings when designing services and physical pharmacy spaces to better serve the population. As states like Arizona incorporate more progress laws, further research is warranted to explore this new service to assess utilization and satisfaction as well as outcomes.

Works Cited

1. Roe v. Wade Overturned: Our Latest Resources. Guttmacher Institute. Published August 12, 2021. Accessed July 30, 2022. https://www.guttmacher.org/abortion-rights-supreme-court

2. Jane ROE, et al., Appellants, v. Henry WADE. LII / Legal Information Institute. Accessed July 30, 2022. https://www.law.cornell.edu/supremecourt/text/410/113

3. Unintended Pregnancy in the United States. Guttmacher Institute. Published January 26, 2012. Accessed July 30, 2022. https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states

4. Landau SC, Tapias MP, McGhee BT. Birth control within reach: a national survey on women’s attitudes toward and interest in pharmacy access to hormonal contraception. Contraception. 2006;74(6):463–470. doi:10.1016/j.contraception.2006.07.006

5. Kooner M, Joseph H, Griffin B, et al. Hormonal contraception prescribing by pharmacists: 2019 update. J Am Pharm Assoc. 2020;60(5):e34-e39. doi:10.1016/j.japh.2020.01.015

6. Grossman D, Grindlay K, Li R, Potter JE, Trussell J, Blanchard K. Interest in over-the-counter access to oral contraceptives among women in the United States. Contraception. 2013;88(4):544–552. doi:10.1016/j.contraception.2013.04.005

7. Wilkinson TA, Miller C, Rafie S, Landau SC, Rafie S. Older teen attitudes toward birth control access in pharmacies: a qualitative study. Contraception. 2018;97(3):249–255. doi:10.1016/j.contraception.2017.11.008

8. Gardner JS, Downing DF, Blough D, Miller L, Le S, Shotorbani S. Pharmacist prescribing of hormonal contraceptives: Results of the Direct Access study. J Am Pharm Assoc. 2008;48(2):212–226. doi:10.1331/JAPhA.2008.07138

9. Manski R, Kottke M. A Survey of Teenagers’ Attitudes Toward Moving Oral Contraceptives Over the Counter. Perspect Sex Reprod Health. 2015;47(3):123–129. doi:10.1363/47e3215

10. A Survey of Teenagers’ Attitudes Toward Moving Oral Contraceptives Over the Counter — Manski — 2015 — Perspectives on Sexual and Reproductive Health — Wiley Online Library. Accessed August 2, 2022. https://onlinelibrary.wiley.com/doi/abs/10.1363/47e3215


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