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Expanding adolescent access to hormonal contraception

an update on over-the-counter, pharmacist prescribing, and web-based telehealth approaches

Williams, Rebekah L.a; Meredith, Ashley H.b; Ott, Mary A.a

Current Opinion in Obstetrics and Gynecology: December 2018 - Volume 30 - Issue 6 - p 458–464
doi: 10.1097/GCO.0000000000000497
SPECIAL COMMENTARY

Purpose of review Hormonal contraceptives are largely responsible for recent declines in unintended adolescent pregnancies, with oral contraceptives being the most commonly used. Young people face multiple barriers to accessing effective contraception in clinical settings. This article reviews innovations in contraceptive access.

Recent findings The three biggest innovations are over-the-counter oral contraceptives (OTC-OCs), pharmacist-prescribing, and web-based telehealth platforms. In many countries, oral contraceptives are available OTC, and FDA trials for OTC-OCs are underway in the United States. Many states have passed legislation allowing pharmacists to prescribe contraceptives after a brief health screening. Web-based telehealth platforms also provide prescription contraceptive access. There is a small but growing body of literature that demonstrates young people's interest in, and capacity to consent to, hormonal contraceptives in nontraditional settings. State-to-state variability in minor consent, pharmacist prescribing, and telehealth laws act as barriers to young people's access to these newer options.

Summary Access to hormonal contraception is expanding outside of clinical settings, reducing barriers. Adolescents’ unique needs should be considered in the design, implementation, and evaluation of these new approaches. More data is needed to ensure that adolescents are not excluded from expanded contraceptive access options, as they are disproportionately affected by unintended pregnancy.

aDivision of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis

bDepartment of Pharmacy Practice, Purdue University College of Pharmacy, Indiana, USA

Correspondence to Rebekah L. Williams, MD, MS, Associate Professor of Clinical Pediatrics, Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, 410W 10th St, Suite 1001, Indianapolis, IN 46202, USA. Tel: +1 317 274 8812; fax: +1 317 274 0133; e-mail: rw6@iu.edu

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