Aim toward success in OC compliance, better communication improves use
More than 33% have sex when OC reliability may be compromised
The next woman in your examination room has been using oral contraceptives (OCs) as her chosen method of birth control for the past three months. During her checkup, she tells you that she often misses a pill in her pack, but doesn’t take further precautions for protection.
This woman is not alone in her dilemma. According to a new international study, more than one-third of women continue to have unprotected sexual intercourse when they know the Pill’s reliability may be compromised.1 What can providers do to help women achieve success with daily pill-taking?
About 60% of the 62 million women ages 15-44 in the United States are using a contraceptive method; about 30% of those women are using the Pill for birth control.2 The Pill represents a very effective form of contraception. When used correctly, for every 1,000 women who take pills for one year, just three will become pregnant in the first year of use.3 But in a typical use setting, the Pill’s failure rate rises to 8% in the first year.3
What can you do to help women achieve success with oral contraceptives? Know that the office/clinic visit is just the start of the patient’s/ client’s process of effective contraceptive use, says Deborah Oakley, PhD, professor emeritus in the University of Michigan School of Nursing in Ann Arbor. "The provider can help with this future behavioral process by asking about whether the woman has a plan for how she is going to use her method effectively, what that plan is, and how she is going to overcome barriers and solve problems," says Oakley, who has studied Pill use.4-7
Many women experience difficulty in taking the Pill correctly, according to results from the new survey.1 To perform the analysis, researchers questioned 8,531 heterosexual men and women ages 16-40 years in 14 countries about their contraceptive use and experience. A previous survey shows that more than two-thirds of women regularly miss pills, and one in five pill users miss a pill every month.8
Problems with pill-taking can lead to fears. More than half of pill users and 40% of men whose partner used the Pill had thought they/their partner might be pregnant while on the Pill, according to results from the new survey.1 Overall, 67% of women and 59% of men reported that pregnancy scares had a negative impact on their emotional life, rising to 72% and 67% respectively if their career was important to them. About 25% of women and men reported a negative impact on their work or studies, with figures rising to 34% and 42% respectively among respondents who said their career or studies were important to them.1
Who can take OCs daily?
What are some ways to assess a woman’s ability to take a pill every day? Findings from research performed by Oakley and family planning colleagues suggest that two of the most powerful predictors of those who especially need to be asked about future plans for effective use are:
- women who have had an abortion;
- women who are not especially strong in their resolve to avoid pregnancy for the next six months.
Contrary to many clinicians’ beliefs, risky OC use is not necessarily related to socioeconomic status or age, says Oakley. Recent research confirms that compliance problems are common among all age groups, with 47% of women missing one or more pills per cycle and almost a quarter (22%) missing two or more pills per cycle.9
Help women to formulate a game plan for success with oral contraceptives, says Oakley. Help them to identify potential barriers and discuss how to solve such problems use the following "problem areas" as discussion triggers:
- staying overnight at a friend or relative’s house and forgetting to take her pill pack;
- forgetting to take a pill during a stressful time at work or school;
- drinking too much or getting sick so that no protection is used or severe vomiting occurs;
- not having money to refill a prescription.
"Listening is such a powerful tool, and more of the provider-client/patient interaction needs to be focused on asking questions about how the future will unfold for the contraceptive user," says Oakley.
Educate on side effects
Aside from providing basic information about OCs, provide anticipatory guidance as part of the counseling process, says Mimi Zieman, MD, adjunct associate professor at Emory University in Atlanta. Although many women never experience adverse events related to Pill use, others may have episodes of breakthrough bleeding or may skip an entire period.10
"It is very important when a women is starting oral contraceptives to know in advance what side effects she may have and the usual time course of those side effects, because many improve with time," says Zieman. "The most important message is that if she is experiencing anything that she is worried about, or she doesn’t like, that she needs to call [the provider’s office] before just stopping using the method."
Many teen OC users tend to skip pills, so anticipatory counseling also should include emergency contraception methods, use of backup contraceptives, and alternatives to sexual intercourse.10
Help patients to establish a regular pill-taking regimen, which may be cued to daily activities such as putting on earrings, brushing teeth, or showering. Another way women are reminding themselves to take their pill is by setting their cell phones to beep at a certain time each day. Research has looked at using daily e-mail reminders for pill-taking; 64% of women participating in the study said they found such reminders helpful.11
By gearing oral contraceptive counseling to a woman’s individual needs, clinicians can increase the likelihood that patients will adhere to the prescribed regimen, says Zieman.
"Today, there are so many formulations and so many delivery systems that we can really work to make people as satisfied as possible with their chosen method," she states. (Editor’s note: What is your guidance regarding missed pills? See upcoming issues of Contraceptive Technology Update for a review of current evidence.)
References
- TNS NIPO for Organon International. Contraceptive Confidence and Consequences Survey. March/April 2005.
- Alan Guttmacher Institute. Contraceptive Use. Accessed at: www.guttmacher.org/pubs/fb_contr_use.pdf.
- Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology: 18th revised edition. New York City: Ardent Media; 2004.
- Smith JD, Oakley D. Why do women miss oral contraceptive pills? An analysis of women’s self-described reasons for missed pills. J Midwifery Womens Health 2005; 50:380-385.
- Oakley D, Potter L, Leon-Wong E, et al. Oral contraceptive use and protective behavior after missed pills. Fam Plann Perspect 1997; 29:277-279, 287.
- Potter L, Oakley D, Leon-Wong E, et al. Measuring compliance among oral contraceptive users. Fam Plann Perspect 1996; 28:154-158.
- Peterson LS, Oakley D, Potter LS, et al. Women’s efforts to prevent pregnancy: Consistency of oral contraceptive use. Fam Plann Perspect 1998; 30:19-23.
- TNS NIPO for Organon International. European Women on Contraception Survey. November 2003.
- Rosenberg M, Waugh MS. Causes and consequences of oral contraceptive noncompliance. Am J Obstet Gynecol 1999; 180(2 Pt 2):276-279.
- Zieman M. Making OCs more user-friendly. Fem Patient 2000; November:42-46.
- Fox MC, Creinin MD, Murthy AS, et al. Feasibility study of the use of a daily electronic mail reminder to improve oral contraceptive compliance. Contraception 2003; 68:365-371.
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