Keeping OC users on track: What works?
The next patient in your office is a 25-year-old mother of two. She's using oral contraceptives (OCs) for birth control, but when you ask her about her method use, she admits she's having problems remembering to take her daily pill.
According to a just-published study, among a nationally representative sample of women ages 18-44, of the 38% who said they used OCs, almost all of the pill users (98%) said they used a reminder or routine to help them remember to take their pill every day. Yet, 38% of those using the Pill reported having missed at least one active pill in the prior three months.1
According to the study, which included telephone interviews with 1,978 women, 8% of pill users reported they had missed one pill in the prior three months, 11% had missed two, and 19% had missed three pills. About 70% of those who missed a pill said they had forgotten to take it; 10% reported access problems (they did not have their pills with them), and 8% said variations in schedule interfered with their pill regimen.1
Half of all unintended pregnancies occur among contraceptive users2; nine in 10 pregnancies result from inconsistent or incorrect method use, and only one in 10 result from method failure.3 What can family planning providers do to enhance OC use?
R U Taking Yr OC?
Traditional reminders to help women to take their daily pill include placing the pills beside the toothbrush and toothpaste or the multivitamin bottle. How about a fresh approach?
Researchers at Columbia University Medical Center in New York City are using text messages to help today's cell phone-connected young women to remember to take their pills, reports Katharine O'Connell, MD, MPH, assistant clinical professor of obstetrics and gynecology at the facility.
The research team has designed a randomized trial of adolescents and young women up to age 24, randomizing the participants to receive/not receive daily text messages to remind them to take their pill. The text message not only serves as a reminder for OCs, but also includes a health message as well, she says.
"We want to see if this generation who seems to have their cell phone surgically implanted into their hand, if this will help increase adherence to the method," notes O'Connell.
Researchers have just begun to enroll women in the study. A total of 1,000 women are scheduled to be included in the trial, says O'Connell. The scientists will look at six-month continuation rates to see how many women continue with method use, she notes.
Will 'Six Pack' help?
What is your clinic's policy when it comes to providing multiple packs of pills? Providing multiple packs of pills reduces patient costs and supports method continuation. Women who receive three to 12 pill packages in advance require fewer clinic visits, thus decreasing the likelihood of method discontinuation due to failure to obtain more pills on time.3 Research published in 2006 bears this out: Women who were provided an advance 13 cycle-supply of pills had fewer gaps in usage and longer-term contraceptive use.4
Columbia University Medical Center researchers have initiated the "Six-Pack" study to see if provision of multiple packs aids in method success. The genesis for the current study springs from earlier research that indicated that the more packs of pills a woman received upon method initiation, the longer she stayed on the Pill, says O'Connell.
The research team is enrolling 750 women who are being randomized to receive three packs of pills or seven, with researchers looking at six-month continuation rates. It's important to look at six-month continuation rates, notes O'Connell. Reported six-month OC discontinuation rates vary from 18% to 50%.5-7
Providing six packs of pills is a step in the right direction, says Robert Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta. "When will we permit pills to play the role they could be by providing a full year's supply at time?" he asks.
References
- Frost JJ, Darroch JE. Factors associated with contraceptive choice and inconsistent method use, United States, 2004. Perspect Sex Reprod Health 2008; 40:94-104,
- Finer LB, Henshaw SK, Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006; 38:90-96.
- Callahan R. Five Simple Ways to Improve Oral Contraceptive Provision and Use. Accessed at www.maqweb.org.
- Foster DG, Parvataneni R, de Bocanegra HT, et al. Number of oral contraceptive pill packages dispensed, method continuation, and costs. Obstet Gynecol 2006; 108:1,107-1,114.
- Berenson AB, Wiemann CM. Contraceptive use among adolescent mothers at six months postpartum. Obstet Gynecol 1997; 89:999-1,000.
- Emans SJ, Grace E, Woods ER, et al. Adolescents' compliance with the use of oral contraceptives. JAMA 1987; 257:3,377-3,381.
- Oakley D, Sereika S, Bogue E. Oral contraceptive pill use after an initial visit to a family planning clinic. Fam Plann Persp1991; 23:150-154.
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