Women's access to birth control should be streamlined, UCSF study finds

By Maureen McInaney

There are more than three million unintended pregnancies each year in the
United States, a widely recognized public health problem that entails adverse
personal, health, economic, and social consequences.  Simplifying women’s
access to hormonal contraceptives such as the pill would improve women’s
health, according to a UCSF study that appears in today’s issue of the Journal
of the American Medical Association (JAMA).
Traditionally, women choosing to start use of hormonal contraceptives have
been required to wait until after they have received a full physical exam.
Researchers at the UCSF Center for Reproductive Health Research and Policy and
colleagues reviewed the existing recommendations for use of hormonal
contraceptives and concluded that, in most cases, waiting to schedule a pelvic
and breast exam causes an unnecessary - and potentially dangerous - delay.

A sexually active woman of reproductive age has an annual risk of pregnancy of
85 to 90 percent without contraception, and “unintended pregnancy has
significant health risks,” said Felicia H. Stewart, MD. Stewart is co-director
of the UCSF Center for Reproductive Health Research and Policy and is the lead
author of the study. “Exam requirements often cause delay for women who need
effective contraceptive protection, and in some cases constitute a serious
obstacle because of costs, scheduling difficulties, or fear,” she said.

The study examined oral contraceptives and injectable and implantable
contraceptives currently used in the United States. More than 16 million U.S.
women use the birth control pill as their form of contraception, and more
information is available about birth control pills than any other medication in
history, the researchers said.
“The study’s conclusions are especially important for young women, who often
wait several months between initiating sexual activity and seeking health care
to obtain contraception,” said Stewart, who is a UCSF adjunct professor of
obstetrics, gynecology and reproductive sciences.  Having to get a pelvic exam
is one of the reasons young women cite for their delay in seeking care, she

Although hormonal contraceptives are not recommended for women with some
serious medical conditions, the problems that make their use unwise are
effectively identified through medical history. “Hormonal contraceptives can
safely be started based on medical history review and a blood pressure check. 
For most women no further evaluation is needed before making a decision to use
them,” said George F. Sawaya, MD, UCSF assistant adjunct professor of
obstetrics, gynecology and reproductive sciences, and Research Director for the
UCSF-Stanford Evidence-based Practice Center.

The JAMA article summarizes medical criteria recommended by a World Health
Organization international review panel in 2000 for safe provision of hormonal
contraceptives.  “In short,” said Sawaya, “40 years of data and practice tell
us that hormonal contraceptives are safe for most women, and have very
important health benefits.”

Additional researchers on the study are Cynthia C. Harper, PhD, UCSF
statistician, Center for Reproductive Health Research and Policy, department of
obstetrics, gynecology, and reproductive sciences, UCSF; Charlotte E.
Ellertson, PhD, The Population Council; and James Trussell, PhD, Woodrow Wilson
School of Public and International Affairs, Office of Population Research,
Princeton University, New Jersey. The Center for Reproductive Health Research
and Policy works to promote reproductive health worldwide, through research,
training and policy analysis in reproductive health, family planning, and the
prevention of sexually transmitted infections including HIV.  The Center is
part of the UCSF department of obstetrics, gynecology and reproductive

The study was funded by The California Endowment, the state’s largest health
foundation. The Endowment was established to expand access to affordable,
quality health care for underserved individuals and communities. The Endowment
provides grants to organizations and institutions that directly benefit the
health and well being of Californians.