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Accuracy of Self-Screening for Contraindications to Combined Oral Contraceptive Use

From ¹Ibis Reproductive Health, San Francisco, California; the ²U.S. Census Bureau, Washington, DC; the ³Population Research Center, University of Texas at Austin, Austin, Texas; the ⁴College of Health Sciences and Department of Languages and Linguistics, University of Texas at El Paso, El Paso, Texas; and the ⁵Population Council, Mexico City, Mexico.

OBJECTIVE: To estimate how well a convenience sample of women from the general population could self-screen for contraindications to combined oral contraceptives using a medical checklist.

METHODS: Women 18–49 years old (N=1,271) were recruited at two shopping malls and a flea market in El Paso, Texas, and asked first whether they thought birth control pills were medically safe for them. They then used a checklist to determine the presence of level 3 or 4 contraindications to combined oral contraceptives according to the World Health Organization Medical Eligibility Criteria. The women then were interviewed by a blinded nurse practitioner, who also measured blood pressure.

RESULTS: The sensitivity of the unaided self-screen to detect true contraindications was 56.2% (95% confidence interval [CI] 51.7–60.6%), and specificity was 57.6% (95% CI 54.0–61.1%). The sensitivity of the checklist to detect true contraindications was 83.2% (95% CI 79.5–86.3%), and specificity was 88.8% (95% CI 86.3–90.9%). Using the checklist, 6.6% (95% CI 5.2–8.0%) of women incorrectly thought they were eligible for use when, in fact, they were contraindicated, largely because of unrecognized hypertension. Seven percent (95% CI 5.4–8.2%) of women incorrectly thought they were contraindicated when they truly were not, primarily because of misclassification of migraine headaches. In regression analysis, younger women, more educated women, and Spanish speakers were significantly more likely to correctly self-screen (P<.05).

CONCLUSION: Self-screening for contraindications to oral contraceptives using a medical checklist is relatively accurate. Unaided screening is inaccurate and reflects common misperceptions about the safety of oral contraceptives. Over-the-counter provision of this method likely would be safe, especially for younger women and if independent blood pressure screening were encouraged.

LEVEL OF EVIDENCE: II