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Monitoring Contraception Trends

The rising use of contraception and its effect on nurses

The CDC recently released data detailing trends in contraception. Among the findings, the use of emergency contraception has more than doubled in recent years. In addition, 99.1% of sexually experienced women ages 15-44 have ever used at least one contraceptive method at some point in their lifetime.

Increase in Contraception Use

Denise Link, PhD, WHNP, FAAN, program director and women's health NP at NP Healthcare-Grace, a Title X funded family planning clinic in central Phoenix, believes the wide variety of contraceptive agents currently on the market helps women find a method of birth control that fits their needs at a given point in time.

"As the CDC report points out, women will change contraceptive methods over the course of their childbearing years based on their need/desire to avoid or postpone a pregnancy, and a number of other factors, such as access, cost, convenience and risks associated with using the method. Having more methods to choose from helps to increase the likelihood that a woman will find a method that is acceptable," she said.

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Tamara Ballard, RN, Vancouver General Hospital Emergency Department, Vancouver, British Columbia, Canada, and founder of Nursing on Set (, agrees that variety and availability have enabled most sexually active woman to use contraception. "There are daily options, such as birth control pills, condoms, vaginal rings and spermicides, or long-term options, such as IUDs and injections," she noted.

Emergency Contraception Rises

The CDC also reports that the percentage of sexually experienced women who've ever used emergency contraception has more than doubled. Making emergency contraception available over the counter likely had the greatest impact on use, observed Link.

"I think the increase in direct-to-consumer marketing and articles in the popular press about emergency contraception that happened when emergency contraception became available over the counter, plus efforts to increase education among healthcare providers, have all had an impact on increasing awareness, understanding and comfort with using emergency contraception," she remarked.

Today, at least four brands of over-the-counter emergency contraceptive pills are available. When asked if she thought this has contributed to the increase of emergency contraception use, Link replied that the increase in products is accompanied by advertising for each method, which could also be a factor in increased use of emergency contraception in general.

Ballard concurs that the rise in emergency contraception is at least in part due to the morning-after pill being sold over the counter at most pharmacies.

"Before, you would have to schedule an appointment with your doctor or go to a walk-in clinic, which would be an inconvenience for many people. I think the increased availability of the morning-after pill has led to it being an option for more women," she said.

The Nurse's Role

The role of the healthcare professional should be to provide unbiased, evidence-based information for patients, to help patients reflect on their own health needs and help patients themselves choose a course of action from the options available that best fit their personal beliefs and situation, said Link.

"Nurses are excellent and reliable sources for healthcare information in many topics, so nurses can and should be resources for reliable information about contraception," she stated.

As far as nurses prescribing contraception, authority is determined by the legislature of each state through a practice act. In states that extend prescriptive authority to registered nurses, the nurse must have a graduate degree (master's or higher) in nursing and be certified in one of the advanced practice nursing roles (nurse practitioner, clinical nurse specialist, certified nurse midwife or certified nurse anesthetist).

Programs that prepare advanced practice nurses include course work in pharmacology, pathophysiology, advanced health assessment, as well as classroom and clinical practice in diagnosis and management of health problems.

"For contraception, as in prescribing any pharmaceutical agent, the clinician must know how the agent works in the body, the potential benefits and risks of a given agent, what side effects a patient might experience, and how to recognize and manage them appropriately," said Link.

Contraception care can be provided in a setting that allows for confidential interviewing, performance of any physical assessment if required, performance of any diagnostic or screening tests if needed, documentation of the interview, physical assessment findings, test results and method selected, and ongoing follow up of the patient for continued satisfaction with the chosen method, efficacy of the method and monitoring for side effects.

Link believes contraception should be one part of a comprehensive "family planning" service; not just preventing pregnancy, but also helping women/couples develop their reproductive life plan and then review it as needed as life situations change that affect reproductive health needs.

"So, clinicians must collect more than just information about health; they have to know something about the context of the woman's/couple's life to really help them achieve their childbearing goals before, during and after pregnancy," she concluded.

References for this article can be accessed by clicking here.

Beth Puliti is a freelance writer.

All About AB 2348

Monica Weisbrich, BSN, RN, director of health issues at the American Nurses Association\California (ANA\C) recently took time to speak with ADVANCE for Nurses about AB 2348 and its effect on nurses.

ADVANCE: What has AB 2348 allowed nurses in California to do?

Weisbrich: AB 2348 allows a registered nurse to dispense birth control pills, using standardized procedures, in family planning clinics. Before this legislation, the only RNs that could dispense medications were APRNs.

ADVANCE: Why has the bill caused controversy?

Weisbrich: NPs believed dispensing should be limited to APRNs. The California Nurses Association was opposed because they believed it would require the RN to do more without reimbursement; anti-abortion groups were opposed because it was a Planned Parenthood sponsored bill.

ADVANCE: What kind of effect does this bill have on nurses?

Weisbrich: ANA\C strongly supports legislation to allow RNs to dispense under standardized procedure. We believed the nurse could dispense and administer medications under standardized procedure. Legislation was pursued to allow this practice and ended up in a compromise allowing NPs only to furnish and dispense. Later certified nurse midwives were added.


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