Hormonal Contraception -- February 2003

When used correctly and consistently, oral contraceptives (OCs) are among the most effective reversible methods of contraception. But reported pregnancy rates during the first year of OC use are as high as 32 percent, and a major contributing factor to these OC "failures" is thought to be missed pills.

With the goal of increasing correct and consistent use of OCs, researchers are trying to determine how OC use is influenced by women's daily routines, their knowledge about OCs, and their interpretations of how OCs should be taken. The current issue of Network, the quarterly reproductive health journal published by Family Health International (FHI), highlights such research in the developed world, as well as in developing countries such as China and Bangladesh.

Recommendations for family planning providers to help clients adhere to pill-taking regimens include:

1. Stressing the importance of a daily routine for pill taking.
2. Emphasizing that most OC side effects — especially spotting and bleeding — are transient.
3. Dispelling OC misinformation and discussing noncontraceptive health benefits of OCs.
4. Demonstrating correct use of the specific OC prescribed.
5. Providing easy-to-understand oral and written instructions about proper OC use and what to do if pills are missed.
6. Suggesting a backup contraceptive method (and providing a few condoms).
7. Telling clients how to obtain more information about OCs and their use, in case problems or questions arise later.

Meanwhile, an OC initiation method called Quick Start — starting OCs while being supervised by a health care provider during the first clinic visit, regardless of the time in a woman's menstrual cycle — may also improve OC continuation rates.

The current issue of Network, which addresses hormonal contraception in general, describes ways in which researchers have been altering formulations of — and delivery systems for — hormonal contraceptives to develop new versions that are safer, more acceptable, and easier to use.

"New methods are coming to the market, and that translates into more choices," says Dr. Miriam Zieman, a family planning expert at Emory University School of Medicine in Atlanta, Georgia, USA, who has extensively studied one of the new delivery systems. "We hope more choices will result in greater method acceptability, client satisfaction, consistent use, continuation, and ultimately fewer unplanned pregnancies."

A major change in hormonal contraception since OCs were introduced in the early 1960s has been the development of low-dose hormonal formulations to decrease side effects. Meanwhile, two novel systems for providing the same hormones as those found in combined OCs (estrogen and progestin) are now available in the United States. Both systems — a weekly transdermal contraceptive patch and a three-week vaginal ring -- have characteristics that may make them easier for women to use correctly and consistently.

The current Network issue also discusses the training of health workers and volunteers in developing world settings to provide injectable contraceptives in their communities, which may improve access to this popular, highly effective method and attract new contraceptive users. While community-based distribution (CBD) of injectables has been limited, in part because of concerns about safety, experience suggests that well-trained CBD workers can administer injectables safely.

Finally, the current issue of Network addresses the possible impact of hormonal contraceptive use on the acquisition or transmission of sexually transmitted infections, including HIV. This is an important research question, which FHI is studying in the United States, Uganda, Thailand, and Zimbabwe. But knowledge to date of a potential relationship is insufficient to change family planning practices.

Network is provided free to family planning providers and other health professionals worldwide.

For more information, please contact:

Kim Best, Managing Editor, 919-544-7040