Barriers to contraceptive use in product labelling and practice norms

Daniel Grossman, Population Council
Charlotte Ellertson, Ibis Reproductive Health
Katrina Abuabara, Independent consultant
Kelly Blanchard, Ibis Reproductive Health
Francisco T. Rivas, Independant Consultant

Many contraceptives have restrictions in their use that may unnecessarily limit access to these methods. We reviewed the labelling of the major contraceptives available worldwide, as well as the contraceptive practice guidelines of the leading professional and public sector organizations active in family planning. We found that both labelling and practice guidelines create barriers to access, which if removed, could increase the number of users. Hormonal methods currently require a prescription in the US, although research suggests that women can adequately screen themselves for contraindications, manage side-effects, and determine an appropriate start-date. Sizing, spermicidal use, and length-of-wear limits burden cervical barrier users and may be unnecessary. Similarly, several requirements restrict intrauterine device use and the type of providers authorized to insert them. While additional research is necessary for some methods, existing data indicate evidence-based demedicalization of contraceptive provision could reduce costs and improve access.