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Rural pharmacist-prescribed hormonal contraception

Community perspectives on pharmacist-prescribed hormonal contraception in rural California reveal that awareness among potential users is low, despite people being supportive and interested in the service.

The study in the journal Contraception implies that increasing the availability of pharmacist-prescribed contraception could bolster an individual’s reproductive self-determination and alleviate gaps in access.

A community survey was conducted in the largely rural California farming community of Tulare County, in the Central Valley, between November 2019 and May 2020.

Overall, 66% of Tulare County residents are Latinx, 28% White, 4% Asian, 3% Native American and 2% Black.

In addition, 50% of households speak a language other than English at home, with 22% of residents born outside the United States.

The researchers recruited participants, aged 15 to 44, who were assigned female sex at birth, through passive community-based approaches, social media advertisements and social networks.

In total, 215 eligible respondents completed the survey, of whom 38 respondents were excluded because they did not desire or need to use contraception, leaving a sample size of 177 respondents.

Half of the sample was younger than age 25, with 18% of respondents between the ages of 15 to 17, and 36% between the ages of 18 to 24.

Moreover, 64% of respondents identified as Latinx and 98% identified as women.

Other characteristics of the sample were that 46% had government-sponsored insurance coverage for contraception and 24% reported short-acting hormonal methods as the most effective contraceptive method used in the last month, followed by 20% for barrier methods and 15% for no method.

A third of the sample preferred to use a different contraceptive method, with half desiring to use short-acting hormonal methods.

A full 33% of the sample had encountered a barrier in obtaining contraception in the past 12 months. But only 2% of respondents reported obtaining contraception from a pharmacist, without first seeing a physician or nurse.

Overall, 31% of the 177 respondents were aware that pharmacists could prescribe hormonal contraception in California, yet older respondents had more accurate knowledge.

After receiving brief educational information about pharmacist-prescribed contraception, respondents were highly supportive and accepting of the service. They perceived pharmacist prescribing as safe, time-saving and convenient.

Nonetheless, respondents were much more comfortable discussing contraception with traditional contraceptive care providers than with pharmacists.

When respondents were asked what service delivery factors were important to them when accessing contraception from pharmacies, 69% cited being able to secure contraception quickly, 60% said being able to visit the pharmacy at any time of day, and 58% mentioned affordability.

Overall, 57% of respondents were somewhat or very interested in accessing contraception from a pharmacist, but there was more interest among those who preferred to use a different method.

Increased availability of pharmacist-prescribed contraception might address barriers, especially for people whose contraceptive needs are not currently being met, according to the authors.

“As pharmacists have noted that uncertainty about demand for pharmacist-prescribed contraception has factored into their hesitance to implement this service, these data provide important evidence of community interest in and need for pharmacist-prescribed contraception,” they wrote.

Reference

Manchikanti Gomez A, Rafie S, Garner-Ford E, er al. Community perspectives on pharmacist-prescribed hormonal contraception in rural California. Contraception. 2022 Oct;114:10-17.

doi:10.1016/j.contraception.2022.05.013