Help women achieve success with the Pill
(Editor’s note: This is the first in a two-part series to help providers guide women in achieving proper use of oral contraceptives. This month’s installment addresses some of the clinical challenges and strategies to encourage compliance; the article in January will focus on effective counseling on missed pills.)
A new report shows that more than 2 million women around the globe will become unintentionally pregnant this year due to improper use of oral contraceptives (OCs).1 While the perfect use pregnancy rate for OCs is 0.1%, the typical use pregnancy rate in the United States is 6.9%.2
The Pill may be near perfect when it comes to pregnancy prevention, but its efficacy depends on correct, consistent use. Taken correctly, OCs are among the most effective family planning methods.
If the Pill offers such a high level of efficacy, why do so many women experience unintended pregnancy? Women may not fully understand their role in achieving the Pill’s effectiveness, says Vera Zlidar, MHS candidate, research writer at Baltimore-based Johns Hopkins University School of Public Health’s Population Information Program and author of the new report.
"Women don’t know about typical use effectiveness; they’re told the pill is 99.9% effective," says Zlidar. "What pill users are not told is that it is up to them to make it that effective."
Reinforce the concept that it is up to every woman to make birth control pills an effective method, Zlidar advises. Then explain why use habits are important. Women may miss pills, take "rests" from OCs, make transition errors in beginning new pill packs at the correct time, or take pills out of sequence, she notes. If side effects are not fully explained before initiating pills, many women may skip taking OCs when such effects are encountered.
Many women become frustrated and frightened by side effects, notes Zlidar. Such women stop using the pill without consulting their providers, or they use the pill erratically because they mistakenly think skipping pills will alleviate the problem, she states.
Telling women about the possibility of side effects, what those side effects are, and that they usually subside within a few months of taking the pill helps reduce anxiety, she notes. "Letting women know that a provider can work with them to help manage and alleviate the side effects is a big relief. It is also important to reassure women that side effects are normal and do not indicate danger, harm, or illness."
Let women know you are available should they want to discuss side effects or any other questions they have about the Pill, says Zlidar.
"Remember, there is more to family planning than a written prescription," explains Linda Dominguez, RNC, OGNP, assistant medical director of the Albuquerque-based Planned Parenthood of New Mexico. "We must engage the patient in a full conversation regarding her dreams and plans for herself and her loved ones."
Dominguez suggests that you ask the simplest and most essential questions, such as, "What are your thoughts about someday getting pregnant?" and "When do you imagine that someday will be?" The patient’s responses will help guide contraceptive choices and are at the core of her motivation to use contraception effectively.
"It is surprising how many women and teens may never had the opportunity to say to themselves or to others what their family planning plans are," she observes. "If [the patient] responds Never!’ this will help you to guide her toward the most effective methods of contraception and will force both her and you to face the reality of how demanding her contraceptive choice will be."
If pills are the patient’s choice, providers must discuss the challenges surrounding OC use: a regular pill-taking schedule, the need for timely purchase of new packs, the importance of partner support (both psychological and financial to assist with costs), and what to do when pills are skipped, missed, or delayed. (See article, "Tips on how to take the pill," in this month's issue.)
Providers should cover emergency contraceptive use and how to obtain it, as well as the health benefits of the Pill, says Dominguez. "Helping a woman to see how the Pill and family planning will support her to achieve her life goals is the most essential part of that prescription," she concludes. "We can give her assurance that we can help her to get to those goals by entering into a partnership of care and counseling." (Our January 2001 issue will feature tips on how to manage missed pills, plus the latest update on pill information.)
References
1. Zlidar VM. Helping women use the Pill. Population Reports. Baltimore: Johns Hopkins University School of Public Health, Population Information Program; Series A, No. 10, Summer 2000.
2. Trussell J, Vaughan B. Contraceptive failure, method-related discontinuation and resumption of use: Results from the 1995 National Survey of Family Growth. Fam Plann Perspect 1999; 31:64-72, 93.
Resource
Full text of the report "Helping Women Use the Pill" (A-10) is available at the Johns Hopkins University School of Public Health’s Population Information Program Web site: www.jhuccp.org. Click on "Population Reports," then "Helping Women Use the Pill (A-10)." Printed copies of Populations Reports are free in any quantity to developing countries. In the United States and other developed countries, multiple copies are $2 each, including shipping and handling. To order a copy of "Helping Women Use the Pill" (A-10), contact: Population Information Program, The Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, MD 21202. Fax: (410) 659-2645. E-mail: [email protected].
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