Survey of Available Information on the Risks and Contraindications of Oral Hormonal Contraceptives on Higher Education Websites

Background: Venous thromboembolism (VTE) is one of the most common cardiovascular disorders after myocardial infarction and stroke. Primary manifestations include deep vein thrombosis and pulmonary embolism, which are often preventable and often underdiagnosed. Patients with inherited thrombophilia or family history of VTE are at increased risk for VTE. Acquired VTE risk factors include the use of oral hormonal contraceptives, such as combined oral contraceptive pills (COCPs) containing estrogen and progestin. Women with a family history of VTE are advised not to take COCPs; possible alternatives include use of progestin-only contraceptive pills or non-oral contraceptive methods. Currently it is unknown if young women at college are given information regarding this potential risk when seeking oral contraceptives. Thus, higher education websites can provide a potential venue to promote awareness of this risk. In this study, we reviewed a sample of higher education websites in the US to assess availability of information on oral hormonal contraceptives and their risks for young women.

Methods: US higher education institutions for this survey and categorized into 5 major types: community colleges, liberal arts institutions, private for-profit institutions, public non-profit institutions, and private non-profit institutions; 25 institutions from each category were included for analysis. The study was conducted using the Google search terms "birth control pills," "oral contraceptive pills," OR plus the university name. Mention of contraindications, risk factors, and blood clot warnings was noted for each website and categorized as to whether the information appeared on the institution's webpage or as a link to an external reference source. Information listed was further classified by risk factors and contraindications mentioned.

Results: A total of 125 US higher education institution websites were assessed. Eighteen (14.4%) of the 125 offered information on COCP-related clotting risks. Community colleges and private, for-profit institutions had no information on birth control available either on their webpage or through an external link. Only 3 of 25 (12%) liberal arts institutions discussed clotting risk information. Five of the 25 (20%) public, nonprofit institutions surveyed provided information on their student webpages; three of these 5 offering information through their website as well as through a link to an external website. Of the private, non-profit institutions surveyed, 2 (8%) provided information through their institution's website and 4 (16%) provided information through external sources. Regarding contraindications, 2 (8%) liberal arts schools provided information on their website only, identical to the percentages seen with private and public non-profit institutions. Additionally, 4 (16%) private non-profit universities and 2 (8%) public, non-profit institutions provided information only through external sources. Two (8%) public non-profit institutions provided information both on their website and through external links. Overall, only 6 (4.8%) of the 125 institutions described family history or inherited prothrombotic blood disorder as a potential contraindication or risk factor for COCP-related clotting, all 6 of which were public or private non-profit institutions.

Conclusion: The results of this study raise the question of whether higher education institutions are providing the appropriate risk and contraindication information for women considering oral contraceptives as a birth control method. This suggests that there is an opportunity for more birth control education to be provided by higher education institutions.

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