Beyond a prescription: strategies for improving contraceptive care

      LJ, a 24-year-old graduate student, sat in our clinic room nervously pleating the corner of her shirt waiting to receive the medication to initiate her medical abortion. While I was reviewing her procedure and choice of contraception, LJ stated she that was planning to go back on Yaz��, a popular brand name oral contraceptive (OC), which she was using before she got pregnant. When queried about her insurance status, she told me she had no coverage. I wondered aloud about her choice of pills since she was paying out of pocket for the expensive patented medication. She told me her physician had started her out with sample packs from the office and given her a prescription. There had been no discussion about her insurance status or alternative pills. The month LJ could not afford to buy her pills is the month she had an unintended pregnancy.
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      1. Henshaw SK. Unintended pregnancy in the United States. Fam Plann Perspect 1998;30:24���9, 46.

        • Finer L.B.
        • Henshaw S.K.
        Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.
        Perspect Sex Reprod Health. 2006; 38: 90-96
        • Kost K.
        • Singh S.
        • Vaughan B.
        • Trussell J.
        • Bankole A.
        Estimates of contraceptive failure from the 2002 National Survey of Family Growth.
        Contraception. 2008; 77: 10-21
        • Institute of Medicine
        Crossing the Quality Chasm: A New Health System for the 21st Century.
        National Academy Press, Washington, DC2001
        • Houle C.
        • Harwood E.
        • Watkins A.
        • et al.
        What women want from their physicians: a qualitative analysis.
        J Women's Health. 2007; 16: 543-550
        • Stewart M.
        • Brown J.B.
        • Donner A.
        The Impact of patient-centered care on outcomes.
        J Fam Pract. 2000; 49: 796-804
        • Kindersley P.
        • Stott N.
        • Peters T.J.
        • Harvey I.
        The patient-centredness of consultations and outcome in primary care.
        Br J Gen Pract. 1999; 49: 711-716
        • Cecil D.W.
        • Killeen I.
        Control, compliance, and satisfaction in the family practice encounter.
        Family Med. 1997; 29: 653-656
        • Henbest R.J.
        • Stewart M.
        Patient-centredness in the consultation: 2. Does it really make a difference?.
        Fam Pract. 1990; 7: 28-33
        • Roter D.L.
        • Hall J.A.
        • Katz N.R.
        Relations between physicians' behaviors and analogue patients' satisfaction, recall, and impressions.
        Med Care. 1987; 25: 437-451
        • Stewart M.A.
        What is a successful doctor-patient interview? A study of interactions and outcomes.
        Soc Sci Med. 1984; 19: 167-175
        • Frost J.J.
        • Darroch J.
        Factors Associated with contraceptive choice and inconsistent method use, United States, 2004.
        Perspect Sex Reprod Health. 2008; 40: 94-104
        • Frost J.J.
        • Singh S.
        • Finer L.B.
        Factors associated with contraceptive use and nonuse, United States, 2004.
        Perspect Sex Reprod Health. 2007; 39: 90-99
        • Guttmacher Institute
        Improving contraceptive use in the United States. In Brief. 2008 Series.
        2008 (New York: No. 1, April)
        • Trussell J.
        • Wynn L.L.
        Reducing unintended pregnancy in the United States.
        Contraception. 2008; 77: 1-5
        • Speidel J.
        • Harper C.
        • Shields W.
        The potential of long-acting reversible contraception to decrease unintended pregnancy.
        Contraception. 2008; 78: 197-200
        • Stewart F.H.
        • Harper C.C.
        • Ellertson C.E.
        • et al.
        Clinical breast and pelvic examination requirements for hormonal contraception: current practice vs evidence.
        JAMA. 2001; 285: 2232-2239
        • Foy R.
        • Crilly M.
        Evidence-based reproductive health care: getting evidence into practice.
        J Fam Plann Reprod Health Care. 2004; 30: 17-20
        • Goodman S.
        • Hiendlish S.K.
        • Benedict C.
        • et al.
        Increasing intrauterine contraception use by reducing barriers to post-abortal and interval insertion.
        Contraception. 2008; 78: 136-142
        • Otero-Flores J.B.
        • Guerrero-Carreno F.J.
        • Vazquez-Estrada L.A.
        A comparative randomized study of three different IUDs in nulliparous Mexican women.
        Contraception. 2003; 67: 273-276
        • Suhonen S.
        • Haukkamaa M.
        • Jakobsson T.
        • Rauramo I.
        Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: a comparative study.
        Contraception. 2004; 69: 407-412
        • MacIsaac L.
        • Espey E.
        Intrauterine contraception: the pendulum swings back.
        Obstet Gynecol Clin North Am. 2007; 34: 91-111
        • Leeman L.
        Medical barriers to effective contraception.
        Obstet Gynecol Clin North Am. 2007; 34: 19-29
        • Westhoff C.
        • Kerns J.
        • Morroni C.
        • et al.
        Quick Start: novel oral contraceptive initiation method.
        Contraception. 2002; 66: 141-145
        • Lara-Torre E.
        • Schroeder B.
        Adolescent compliance and side effects with Quick Start initiation of oral contraceptive pills.
        Contraception. 2002; 66: 81-85
      2. ACOG practice bulletin. Cervical cytology screening. Number 45, August 2003.
        Int J Gynaecol Obstet. 2003; 83: 237-247
        • World Health Organization
        WHO statement on hormonal contraception and bone health.
        (Available at) (Accessed September 16, 2008)
        • Kunkel D.
        • Eyal K.
        • Finnerty K.
        • et al.
        Sex on TV 4. Kaiser Family Foundation, Menlo Park (Calif)2005
        • Espey E.
        • Cosgrove E.
        • Ogburn T.
        Family planning American style: why it's so hard to control birth in the US.
        Obstet Gynecol Clin North Am. 2007; 34: 1-17