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Abstract #158642

Daniel Grossman, MD¹, Leticia Fernandez, PhD², Kristine Hopkins, PhD³, Jon Amastae, PhD², Sandra Garcia, ScD, ScM⁴, Cate McNamee³, and Joseph Potter, PhD³. (1) Ibis Reproductive Health, c/o Department of Obstetrics and Gynecology, San Francisco General Hospital--Ward 6D, 1001 Potrero Avenue, San Francisco, CA 94110, 415-206-4394, dgrossman@ibisreproductivehealth.org, (2) Center for Inter-American and Border Studies, University of Texas at El Paso, 1514 Hawthorne St., El Paso, TX 79902, (3) Population Research Center, University of Texas at Austin, 1800 Main Building, Austin, TX 78712, (4) Population Council Regional Office for Latin America and the Caribbean, One Dag Hammarskjold Plaza, New York, NY 01070

Combined oral contraceptives (COCs) are a very safe and effective family planning method. While women in many countries can purchase COCs over-the-counter, in the US a prescription is required, creating a barrier to contraceptive access. Even with clinician screening, it is estimated that 6% of COC users in the US are contraindicated for use. We aimed to determine how well a convenience sample of women from the general population could self-screen for contraindications to COCs using a checklist. 1,271 women 18-49 years old were recruited at shopping malls in El Paso, Texas, and asked to use a checklist to determine the presence of level 3 or 4 contraindications to COCs according to the WHO Medical Eligibility Criteria. Women were then interviewed by a blinded nurse practitioner who also measured blood pressure. The sensitivity of the checklist to detect true contraindications was 84.5% (95% CI: 80.9%-87.6%) and specificity 88.4% (85.9%-90.5%). 6.0% (4.6%-7.3%) of women incorrectly thought they were not contraindicated when they truly were, largely due to unrecognized hypertension of > 140/90 mmHg. Using a cut-off of 160/100 mmHg (WHO category 4 contraindication), 1.8% (1.1%-2.6%) incorrectly thought they were not contraindicated. In regression analysis, younger women, Spanish-speakers and non-contraceptive-users were significantly more likely to correctly self-screen than older women, English-only-speakers and hormonal-users (p<0.05). Self-screening with a checklist would not result in more contraindicated women using COCs than the current clinician-screening system. Over-the-counter provision of COCs would be safe, especially for younger women and if independent blood pressure screening were encouraged.

Learning Objectives:

• Assess the accuracy of a checklist to self-screen for contraindications to combined oral contraceptives
• Describe how unrecognized hypertension affects the accuracy of self-screening

Keywords: Contraceptives, Screening Instruments

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.