Abstract

In July 2023, the US Food and Drug Administration approved the first non-prescription oral contraceptive, a progestin-only pill, in the United States. Transgender, nonbinary, and gender-expansive people assigned female or intersex at birth face substantial contraceptive access barriers and may benefit from over-the-counter oral contraceptive access. However, no prior research has explored their perspectives on this topic.To measure interest in over-the-counter progestin-only pill use among transgender, nonbinary, and gender-expansive individuals assigned female or intersex at birth.We conducted an online, cross-sectional survey from May-September 2019 (before Food and Drug approval of a progestin-only pill) with a convenience sample of transgender, nonbinary, and gender-expansive people assigned female or intersex at birth, aged 18-49 years, from across the United States. Using descriptive statistics and logistic regression analyses, we estimated interest in over-the-counter progestin-only pill use (our outcome) overall and by sociodemographic and reproductive health characteristics (our exposures). We ran separate logistic regression models for each exposure. In each model, we included the minimally sufficient adjustment set to control for confounding pathways between the exposure and outcome. For the model for age, we ran a univariable logistic regression model; for all other exposures, we ran multivariable logistic regression models.Among 1,415 participants in our sample (median age: 26 years), 45.0% (636/1,415; 95% CI: 42.3-47.6%) were interested in over-the-counter progestin-only pill use. In separate logistic regression models for each exposure, there were higher odds of interest among participants who were aged 18-24 years (OR 1.67, 95% CI: 1.33-2.10; versus aged 25-34 years), uninsured (aOR 1.91, 95% CI: 1.24-2.93; versus insured), currently using oral contraceptives (aOR 1.69, 95% CI: 1.17-2.44; versus non-users), had =high school degree (aOR 3.02, 95% CI: 1.94-4.71; versus college degree), had ever used progestin-only pills (aOR 2.32, 95% CI: 1.70-3.17; versus never-users), and who wanted to avoid estrogen generally (aOR 1.32, 95% CI: 1.04-1.67 versus those who did not want to avoid estrogen generally) or specifically because they viewed it as a "feminizing" hormone (aOR 1.72, 95% CI: 1.36-2.19; versus those who did not want to avoid estrogen because they viewed it as a "feminizing" hormone). There were lower odds of interest among participants with a graduate or professional degree (aOR 0.70, 95% CI: 0.51-0.96; versus college degree), who were sterilized (aOR 0.31, 95% CI: 0.12-0.79; versus not sterilized), and who had ever used testosterone for gender affirmation (aOR 0.72, 95% CI: 0.57-0.90; versus never-users).Transgender, nonbinary, and gender-expansive individuals are interested in over-the-counter progestin-only pill access, and its availability has the potential to improve contraceptive access for this population.

View details for DOI 10.1016/j.ajog.2024.02.006

View details for PubMedID 38365096