Jane Hutchings

Using pharmacies in Washington state to expand access to emergency contraception

The authors describe preliminary results from a 2-year demonstration project launched in July 1997 in Washington State to expand access to emergency contraceptive pills by promoting collaboration between pharmacists and independent prescribers in providing emergency contraception (EC). The project was undertaken to improve womens awareness and use of emergency contraception by using pharmacists to increase the availability of such contraceptive products. The authors also discuss the impact that the pills is having upon access to emergency contraception, and therefore the potential impact of the program upon rates of unintended pregnancy. Key components of the project include teaching pharmacists about emergency contraception, helping them link up with prescribers, informing women about the availability of emergency contraception, and evaluating the impact of the project. In the 4 months following the projects launch, the national emergency contraception hotline received 4934 calls from Washington State. Before the launch, the hotline averaged 100 calls per month from the state. Over the same period, area pharmacists at 111 participating pharmacies wrote and filled 2765 prescriptions for emergency contraception. The preliminary response to the project has been extremely positive.

An assessment of burst strength distribution data for monitoring quality of condom stocks in developing countries

Laboratory tests were conducted on condoms to examine the changes that occur over time in indicators of condom burst strength, and to determine the relationship between laboratory-assessed condom burst strength and breakage during use in a developing country setting. Three groups of unaged condoms purchased directly from the manufacturer were used: one group exposed to UV light for 10 hours; one group exposed for five hours; and one group unexposed. A sample of each of these groups was tested according to ISO condom air burst test protocols. The remaining condoms were individually packaged in coded polyethylene bags for shipment to the developing country study site. Also used in the study was a group of condoms that had been aged for over 40 months under field conditions in a tropical climate; a sample from this group was tested by the ISO air burst test protocol and the remainder distributed to the study site. One-hundred-thirty Indonesian urban males participated in the double-blind study. Volunteers were not relying on the condom for contraceptive purposes. Each volunteer was given one individually packaged untreated condom, one condom from each treatment group, and four condoms aged in the field. Study participants were instructed to return all used condoms. Each condom that was returned after use was examined for breakage, and the unbroken condoms were subjected to an air inflation test to determine volume and pressure at burst. A comparison of the air burst volume data for a sample of unused and used condoms from the same treatment group indicates that most of the condoms that broke during use had air burst volumes below 11 liters. Therefore, a significant downward shift in the burst strength distribution as measured in the laboratory is likely to result in an increased breakage rate during use. A Condom Deterioration Index calculated from regular periodic testing of stored condom stocks is a convenient and sensitive means of monitoring trends in the distribution and deterioration of condom strength.

Reducing unintended pregnancy by increasing access to emergency contraceptive pills.

Objectives: National and state data on the health, social, and economic consequences of unintended pregnancy prompted Washington policy makers to identify strategies to reduce such pregnancies. Though not well known, emergency contraceptive pills (ECPs) are a safe and effective contraceptive method that can prevent pregnancy if taken within 72 hr after unprotected intercourse. A coalition conceived the idea of enabling pharmacists to prescribe ECPs directly to women through collaborative drug therapy agreements (CDTAs) with physicians. Methods: Following a feasibility study, five agencies initiated a novel pilot project in western Washington. Key components included informing pharmacists about ECPs and CDTAs; developing tools, providing training, and developing systems to establish pharmacist/prescriber collaborative agreements; conducting a public awareness campaign; evaluating the impact of the project; and disseminating the results. Results: More than 1000 pharmacists received training in all aspects of providing ECPs and 140 pharmacies participated in the project, with more than 145 CDTA on file. In the 16 months of pharmacy service provision, 11,969 ECP prescriptions were provided, possibly preventing 700 or more unintended pregnancies. The media launch led to 200 broadcast stories and increased calls to the ECP Hotline from 116 to an average of 1160 per month. Conclusion: Enabling pharmacists to provide ECPs directly to women is a convenient delivery system for a time-limited therapy. It increases the chances that women will use the therapy effectively and connects women without a provider to a source of care. By increasing access to an effective contraceptive, this projects supports the Washington State goal of reducing unintended pregnancy.

Home-based administration of Sayana® Press: review and assessment of needs in low-resource settings ☆

A new presentation of the subcutaneous (SC) injectable contraceptive depot medroxyprogesterone acetate (DMPA) increases the possibilities for home and self-administration of this popular contraceptive method. Sayana® Press is DMPA-SC in the prefilled Uniject™ injection system and consists of one dose that provides 3 months of contraceptive protection. Studies indicate that lay caregiver and self-injection of various medications, including other injectable presentations of DMPA-SC, are acceptable and effective. Introduction of Sayana® Press in developing countries could extend injectable contraceptive delivery safely and effectively beyond the clinic and, eventually, into the home, allowing lay caregiver or self-administration. Research needs for low-resource settings include assessing the acceptability and feasibility of self-injection with Sayana® Press. Feasibility studies necessary for implementing a sustainable home-based delivery program include assessment of training, health systems, policies, infrastructure needs and programmatic considerations to optimize womens ability to manage their self-injection schedule.

The IUD after 20 years: a review.

5 types of IUDs are currently available in the US: Lippes Loop Cu-7 Tcu 200 Progestasert and TCu 380A. Most prominent side effects to IUD use include bleeding and heavy menstrual blood loss expulsion of the device pain perforation and pelvic inflammatory disease. Although copper and hormone releasing devices have shown some improvement in effectiveness many of the same problems with side effects and complications persist. Experience in the past 2 decades has shown that IUDs appeal to some women and not to others and that it can be a safe and appropriate method for some women and not for others. It is particularly useful for women over the age of 30. The IUD has major benefits when compared with other methods of contraception. Successful IUD use demands active cooperation on the part of the user and provider.

The IUD after 20 years: a review of worldwide experience.

Unrealistic expectations that the IUD would be a contraceptive panacea have not been met in spite of the emergence in the 1970s of a 2nd generation of safer more effective IUDs containing slowly released bioactive copper or progesterone. This article reviews recent IUD research to present findings that will assist family planning practitioners and their clients in making informed decisions about the use of this method. The theoretical effectiveness of the IUD ranges from 97% to 99%; in developed countries IUDs are the 2nd most effective method of reversible contraception in use after oral contraceptives. However in developing countries the use effectiveness of IUDs frequently exceeds that of oral contraceptives. Researchers probably agree that IUD development must be directed toward ways to reduce side effects and complications such as 1) bleeding and heavy menstrual blood loss; 2) pain during insertion for a few days thereafter and during menstruation; 3) expulsion 4) uterine perforation; 5) pelvic inflammatory disease (PID); and 6) ectopic pregnancy. Women who want to use an IUD should receive careful screening services--including counseling a medical history and a physical examination--to enhance the advantages and minimize the disadvantages associated with this method. Clinical evidence has consistently shown that nulliparous women particularly those who have just begun to menstruate encounter more problems with IUD use than do older women. The insertion procedure can affect all major events that determine IUD effectiveness and continued use--pregnancy perforation expulsion pain bleeding and infection. Despite the trouble the Dalkon Shield has created for women using it overall of all the available methods of contraception IUDs are among the most effective with an average pregnancy rate after 1 year of 3-5 per 100 typical users.

Expanding access to emergency contraception through state systems: the Washington State experience.

Access to family planning and reduction of unintended pregnancy are long-standing priorities for Washington States Department of Health (DOH) and Department of Social and Health Services (DSHS). Working together to ensure that all pregnancies are intended (consciously and clearly desired at the time of conception) the two agencies provide family planning counseling and a broad choice of contraceptive methods through a range of health and social service programs. When a dedicated product for emergency contraception became available in 1998 widespread integration of relevant information and services became one more strategy the agencies used to realize the goal of reducing unintended pregnancy in the state. Since 1997 the Program for Appropriate Technology in Health (PATH) has collaborated with state colleagues to increase access to emergency contraception. In a series of interviews conducted in December 2003 PATH asked administrators managers and others who were involved in the initial process to describe the experience. The story that emerged described here is one of strong high-level support for family planning services that created an ideal platform for expanding emergency contraception services establishing collaborations between relevant agencies and increasing the number of state programs and the range of service providers offering emergency contraception services. The result was an innovative approach to service delivery that made it possible to reach underserved and low-income populations including those not served by Title X--funded clinics. Our objective in sharing Washington States experience is to stimulate further state-level innovation for expanding access to emergency contraception. (excerpt)