Strategies for Informing and Empowering Patients for Self-Care

Expanding the range of contraceptive services that people can access and use on their own or with reduced reliance on a clinic or provider can help people overcome barriers to accessing contraceptive care. The World Health Organization (WHO) defines self-care broadly as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health and cope with illness and disability with or without the support of a health worker” and includes “drugs, devices, diagnostics and/or digital interventions that can be provided fully or partially outside formal health services and be used with or without a health worker.”107 Selfcare interventions include provision of user-administered methods, including contraceptive pills, rings, patch, injection, and barrier methods, as well as strategies to enable patients to access methods without a provider. Options for self-care shift frequently due to innovation, new technologies, and evidence as well as changes in clinical guidance and federal and state policy. Providers should be aware of what is permissible in their state and stay abreast of changes that allow or constrain self-managed care to enable patients to access care in alignment with their personal preferences.

Self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC).
DMPA-SC self-administration is safe and effective and should be offered when possible along with a full range of contraceptive methods, including provider-administered DMPA.108, 109 Providers can share information—with patients who are interested—about how to administer DMPA-SC, including how to safely dispose of sharps and that administration could be done by the patient or the patient’s partner, friends, and family.105

Over-the-counter progestin-only pills (OTC POPs).
A progestin-only daily oral contraceptive pill is FDA approved and available OTC, online, and in stores. Providers should be prepared to support users of OTC oral contraceptive pills in the successful use and management of this method. Consult ACOG guidance for further information about supporting patients in using OTC oral contraceptives.110

Fertility awareness apps.
Fertility awareness−based methods (FABM) are among the oldest methods of selfmanaged contraception. Many mobile applications exist to track people’s fertility and help them either achieve or avoid pregnancy as well as gain more familiarity with their own cycle. The FABM app that is FDA cleared and CE marked has an algorithm that uses each person’s body temperature to predict their fertile window.

Providers can include a discussion of these tools as part of person-centered contraceptive care. Relevant information about apps includes whether they are effective and evidence based, whether they are intended for pregnancy prevention or pregnancy planning or both, and the value of additional items for purchase advertised on the sites. Patients interested in fertility awareness apps can be encouraged to explore data privacy, sharing, and security standards related to mHealth apps broadly and fertility apps in particular.109 Evidence suggests that the accuracy of these apps to predict fertile windows and ovulation can vary because of multiple factors, including variation in individual cycles, which fertility indicators the apps track, and completeness of information entered into the apps by the users. Apps use proprietary algorithms, and those that collect a combination of indicators such as basal body temperature and characteristics of cervical mucus in addition to calendar dates of menses may be more accurate.111