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    Attitudes, regulations hinder use of the pill.

    Townsend S

    NETWORK. 1993 Mar; 13(3):6-10.

    70 million women worldwide now use oral contraceptives (OCs), but many more women could use them if it were not for some medical attitudes, regulations, or practices preventing them from using OCs. For example, in the US, adolescents may need their parent's permission, even though the services cost nothing. 30 years of research on OCs, the most studied family planning method ever, show that they are a convenient, effective contraceptive. These medical practices and attitudes which limit access to OCs cannot be justified scientifically, particularly when weighing the risk of pregnancy. In fact, the only group of women at high risk of using OCs are smokers older than 35 years. Prescribing practices and safeguards when OCs were first marketed were necessary because the medical community knew little about them, but today they are needless barriers to access. Some unnecessary precautions are restricting OCs to women who have already experienced childbirth and OC users needing a rest period. Today's OCs have much lower doses than the earlier OCs. Many conditions once considered to be absolute contraindications should now be considered signs to closely monitor OC users. Moreover, present US guidelines for progestin-only OCs list contraindications which actually apply to combined OCs that contain estrogen and not to progestin-only OCs, e.g., lactation, yet progestin-only OCs are ideal for lactating women. WHO and other groups have joined together to standardize eligibility criteria for OCs at the international level. INTRAH has already produced some guidelines to get rid of the complicated method of classifying contraindications. Other barriers to OC use are requirements of undergoing a physical examination of having blood drawn. Adequate counseling can screen for contraindications as well as, or perhaps better than, exams and blood tests.
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