Home distribution of hormonal contraceptives by public health nurses

Home based distribution of contraceptives is a recognized intervention used in developing countries to prevent unintended pregnancy. To our knowledge, this intervention is not widely or systemically practiced in the United States for several reasons, including concerns about scope of practice of health workers and nurses. Our study is a multisite randomized clinical trial evaluating home-based distribution of hormonal contraceptives by public health nurses through the Nurse Family Partnership home visiting program. These contraceptives include pills, patches, vaginal rings and depomedroxyprogesterone injections. Although our results are preliminary, we believe that giving the nurses the ability to distribute hormonal contraception in the home has enabled nurses to improve access to contraceptive options, increase knowledge of hormonal contraceptive options and bring about change in the reproductive health behavior of women at risk for unintended pregnancy. We will describe development of our clinical protocol, how we trained nurses in the protocol, and facilitators and barriers nurses experienced in adopting the practice. Lessons learned from our study will be useful in other public health settings within the United States.