Press Release

For Immediate Release August 14, 2000

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Hopkins Report: Pill Users Need Better Information to Prevent Pregnancy

More accurate information for Pill users could help millions of women avoid unintended pregnancies, according to a new report from the Johns Hopkins School of Public Health.

Forty years after oral contraceptives (OCs) were first introduced, much misinformation and lack of information abounds about OCs and the best way to use them. Women need better information about how OCs work, how to manage side effects, and what to do about missed pills, the report finds.

Taken correctly, OCs are one of the most effective family planning methods. Nonetheless, an estimated 10 percent of the 106 million women who start taking the pill each year become pregnant. If women used the pill perfectly, only one woman in 1,000 would become pregnant (0.1%). But typical first-year pregnancy rates are much higher and vary widely. In Bangladesh the first-year pregnancy rate among OC users is 1.7%; in the United States, 6.9%; and in Bolivia, 10.5%, according to the report in the latest issue of Population Reports, Helping Women Use the Pill, published by the Johns Hopkins Population Information Program.

Each year an estimated 6.8 million women become pregnant after they stop taking the pill and fail to take up another method even though they want to avoid pregnancy, according to the Hopkins report. Many women stop taking the pill because of common side effects such as breakthrough bleeding and spotting, nausea, and weight gain. In some countries—Bangladesh, Ecuador, Egypt, and Tunisia, for example—surveys reveal that about half of women who stop taking pills do so because of side effects. Another 2 million pregnancies occur for reasons related to improper oral contraceptive use—not starting a new packet on time, missing pills and not making them up correctly, taking breaks in pill use, and taking pills out of sequence. Others skip pills, thinking incorrectly that this will reduce side effects. A further 1.1 million women become pregnant after switching to a less effective method.

“Telling women about common side effects before they start OCs would prevent many problems,” according to Vera Zlidar, author of the report. “In addition, each user needs to know how to take the pill successfully. For example, many women don’t know that starting a new pill pack late poses the greatest risk of pregnancy,” adds Ms. Zlidar.

The report calls on family planning programs to focus on helping women continue using OCs with satisfaction or switch to new methods without a gap in contraceptive protection. Training can help many family planning providers, including clinic staff, pharmacists, social marketing agents, and community-based health workers, to improve their counseling skills and the accuracy of their information. Some providers, for example, incorrectly advise pill users that they need to give their bodies a “rest period” from the pill. Others fail to tell women what to do if they miss pills.

The report emphasizes that health care providers should not have to bear the entire responsibility for informing women about pill use. Family planning programs can use community outreach and the mass media, including radio, TV, video, and newspapers, to remind women about effective pill use. In a Nepal radio drama, for example, messages about pill use and other family planning methods are woven into an entertaining story line about the lives of the characters. In one 15-minute episode listeners could learn: How pills prevent pregnancy; who are good candidates for pill use; cancer prevention benefits of the pill; the need to take the pill at the same time every day; how to make up a missed pill; common side effects; and where to get pills.

Lack of accurate information about how to take pills can create a “self-defeating sequence of events that makes side effects even more frequent,” warns the Hopkins report. For example, a woman misses a pill, causing spotting or breakthrough bleeding. She takes two pills the next day to make up for the missed pill, but this brings on nausea and perhaps vomiting. Because of these problems she skips more pills—mistakenly thinking the break will alleviate her side effects—and so she experiences still more side effects. This cycle can soon lead her to stop pill use altogether.

What are key points women need to know about taking the pill? According to the report:

• The pill works if you take it correctly.
• Be sure to start each new pill packet on time.
• Take action if pills are missed. It is important to make up missed pills.
• Vomiting, diarrhea, and a few medications can make the pill less effective.
• OCs do not prevent sexually transmitted infections (STIs).
• Most common side effects do not mean something is seriously wrong.
• You should immediately see a health care provider if you experience: constant, severe, pain in chest, legs, or abdomen; severe headaches; brief loss of vision; seeing flashing lights in front of the eyes; or yellowing of eyes or skin.

Population Reports is an international review journal of important issues in population, family planning, and related matters. It is published four times a year in four languages by the Population Information Program at the Johns Hopkins Center for Communication Programs for more than 170,000 family planning and other health professionals worldwide, with support from the US Agency for International Development (USAID). USAID administers the US foreign assistance program, providing economic and humanitarian assistance in more than 80 countries worldwide.

For more information contact: Timothy Cline at Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA. Tel: 410 659-6149; Fax: 410 659-6266; e-mail PopRepts@jhuccp.org.

Disclaimer: The information provided on this web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.