Preference for alternative contraceptive sources reported by many patients

Preference for alternative contraceptive sources reported by many patients | Image Credit: © (JLco) Julia Amaral - © (JLco) Julia Amaral - stock.adobe.com.

Most patients using the pill, patch, or ring contraceptive prefer alternative sources to obtain their contraception, according to a recent study published in JAMA Network Open.¹

Method availability and insurance coverage toward contraception have improved in the United States, but barriers to access such as misinformation and legal obstacles remain. Short-acting reversible contraception (SARC) such as the pill, patch, or ring is traditionally obtained through interactions with the health care system.

The ability of patients to have their needs met is influenced by how and where they receive their contraception. However, data has indicated a significant number of female individuals using contraception do not obtain care through their preferred approach.²

Options for obtaining contraception have expanded to include pharmacist prescribing, telehealth, and over-the-counter (OTC) provision.¹ These alternate sources allow individuals to receive care without visiting a clinic, increasing access.

To describe the use of preferred source of contraception among SARC users, investigators conducted a survey study. Data was obtained through a cross-sectional nationally representative survey between January and March 2022. Thirty-three cognitive interviews were held with patients who met eligibility criteria.

Participants were aged 15 to 44 years, assigned female sex at birth, and not sterile. The survey was self-administered online and had a median length of 25 minutes.

Patient preference for contraceptive sources was determined using the question, “If you could choose any way of getting a birth control prescription, how would you prefer to get it?” Response options included in-person at the doctor’s office or clinic, in-person at a hospital, from a telehealth appointment, prescribed by a pharmacist, OTC, from an online service, and another way.

Respondents choosing multiple sources were asked to specify their most preferred method. Participants were also asked how they got their preferred method prescribed the last time it was received and why they preferred their top source of contraception.

Sociodemographic characteristics and sexual and reproductive health factors were also obtained. The survey asked patients to describe their experiences obtaining a contraception, including missing a SARC, encountering delays or challenges, and whether they would change any part of the process.

The initial sample included 3059 patients, 70.3% of whom reported a history of SARC use and 21.7% current SARC use. The final sample included 595 patients, 95.9% of whom were female, 77.8% heterosexual, and 72.1% had commercial health insurance. Pill use was reported in 92.3% and using their preferred contraceptive method in 62.1%

Of participants, 49.7% obtained their contraception from any preferred source and 39.8% through their primary preferred source. The most common method of obtaining contraception was in-person at the doctor’s office, clinic, or hospital with a rate of 73.8%.

Additional methods of obtaining contraception included by an online service in 9% asynchronous telehealth in 7.9%, synchronous telehealth in 5.2%, and prescribed by a pharmacist in 2.2%. SARC was used for pregnancy prevention by 84.2% of participants, menstrual regulation by 71.6%, and period pain alleviation by 46.2%.

Use of a contraception method for over a year was reported by 73.8% of participants and over 5 years by 32.2%. Most recently receiving a 1-month to 3-month supply was reported by 80.9%. Of respondents, 35.4% missed using their method because they could not receive it in time, 25.1% encountered challenged or delays, and 14.5% wanted to change part of the process.

In-person, clinic-based care was preferred by 44.7% of respondents, OTC by 32.4%, online services by 27.4%, pharmacist-prescribed by 26.4%, and telehealth by 25.4%. Preferring an alternate source of contraception was more common in patients with prior issues toward obtaining contraception.

These results indicated that patients face less barriers toward contraceptive access through the availability of non-traditional sources. Investigators concluded policymakers can ensure equitable access through policies promoting the use of alternative sources.

References

1. Gomez AM, Bennett AH, Schulte A, et al. Use of preferred source of contraception among users of the pill, patch, and ring in the US. JAMA Netw Open. 2024;7(10):e2439191. doi:10.1001/jamanetworkopen.2024.39191
2. Frederiksen B, Ranji U, Long M, Diep K. Contraception in the United States: a closer look at experiences, preferences, and coverage. KFF. November 3, 2022. Accessed October 31, 2024. https://www.kff.org/report-section/contraception-in-the-united-states-a-closer-look-at-experiences-preferences-and-coverage-findings/