New Study Examines Women's Ability to Self-Screen for Birth Control Safety

A new study in the journal Obstetrics and Gynecology reports on the results of a survey of 1,271 women in El Paso, TX . The survey was designed to assess how accurately women can determine whether they are safe candidates for oral contraceptive use.

Women at a flea market and shopping malls were first simply asked whether they thought oral contraceptives were safe for them, and then completed a checklist of their possible contraindications. The women were then screened by a nurse practitioner, and their results were compared.

Because the participants in this study were not randomly selected and may not reflect those of all communities, I’m including the study’s description of them here: “The participants, on average, were in their early 30s, had completed 13 years of schooling, and had between one and two children. The sample was overwhelmingly Latina, and the majority primarily spoke Spanish or were bilingual. Four out of five of the respondents lived in the United States, and two thirds had completed their schooling in the United States.”

In responding to the initial question about the safety of the pill for them, about 52% said the pill would be medically safe for them, and nearly 48% said it was unsafe or they were not sure. Providers, on the other hand, assessed that oral contraceptives would be safe for nearly 61% of the women. The authors note that “respondents were significantly more likely to incorrectly assess themselves as contraindicated with the initial self-screen than to assess themselves eligible when they were not.”

When the women filled out checklists of contraindications to pill use, their accuracy improved. The authors explain that “the positive predictive value of self-screening using the checklist was 82.8% (95% CI 79.2–86.0%), and the negative predictive value was 89.0% (95% CI 86.6–91.1%).” This means that women who thought the pill would be unsafe for them were correct 82.8% of the time, and those who thought it would be unsafe were correct 89% of the time.

There were two specific contraindications that accounted for the biggest gaps in the women’s knowledge of the pill – previously undiagnosed hypertension (a contraindication) and migraine without aura (only migraine with aura was considered a contraindication) – perhaps suggesting areas where public education may be beneficial. Younger women, Spanish-speaking women, and women with some college education were most likely to correctly assess the safety of the pill for them – interestingly, number of children or contraception use did not seem to have any effect on the rate of correct answers.

I found this study particularly interesting because safety and ability to self-screen is an issue that often arises in discussion of making birth control available over the counter. The authors briefly address this:

“In an over-the-counter environment, however, women who want to use the pill and find that they are contraindicated by self-screening likely would seek the counsel of a clinician rather than deciding definitively that the method is dangerous for them. It is also possible that a truly contraindicated woman who is very motivated to use oral contraceptives might ignore the results of her self-screening and use the method regardless, much as a woman might conceal elements of her medical history, such as smoking, from a clinician to obtain a prescription for pills.”

For additional reading, the blogger at the Well-Timed Period has a summary of a similar study from last year.

Citation: Grossman D, Fernandez L, Hopkins K, Amastae J, Garcia SG, Potter JE. Accuracy of Self-Screening for Contraindications to Combined Oral Contraceptive Use. Obstet Gynecol. 2008 Sep;112(3):572-578.