Assessment of dispensing and counseling practices of hormonal contraceptives among community pharmacists and pharmacist assistants in Erbil city: a cross-sectional study
Copyright (c) 2025 Zeytun Hameed Abdullah, Sherzad Abdulahad Shabu (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
- Articles
- Submited: April 13, 2025
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Published: December 22, 2025
Abstract
Background and Objective: Hormonal contraceptives play a critical role in family planning and women’s health, yet pharmacists’ involvement in dispensing and counseling on their use remains underexplored in Iraq. This cross-sectional study investigates the dispensing and counseling knowledge of community pharmacists and pharmacy assistants in Erbil, Kurdistan Region, Iraq.
Methods: A total of 450 participants were recruited from 37 randomly selected quarters using cluster sampling. All pharmacies in these clusters were included, and all eligible staff were invited to participate. Data were collected via a structured questionnaire face to face covering demographics, contraceptive knowledge, dispensing and counseling practices, challenges, and pharmacy setting.
Results: The study identified notable knowledge gaps, especially regarding long-acting methods such as IUDs and injectables. While 78% believed they had adequate information for counseling, 27.8% lacked formal training. Familiarity was significantly associated with public sector employment (P <0.001), increased years of experience (P <0.001), and educational level (P <0.001). Although females showed higher familiarity than males, the association was not statistically significant (P = 0.554).
Conclusion: Although almost all pharmacists and assistants were familiar with hormonal contraceptives and willing to counsel, gaps in formal training specially on long-acting methods parsest. Familiarity was linked to experience, public sector work, and education. Structured, targeted training programs are essential to address the knowledge gaps in hormonal contraceptive methods, particularly among early-career pharmacists.
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References
- De Leo V, Musacchio MC, Cappelli V, Piomboni P, Morgante G. Hormonal contraceptives: pharmacology tailored to women’s health. Hum Reprod Update. 2016; 22(5):634-46. DOI: 10.1093/humupd/dmw016
- Salih RA. Assessment of contraceptive methods choice among women during childbearing age in Mosul, Iraq. Saudi Med J. 2024; 45(12):1368. DOI: 10.15537/smj.2024.45.12.20240565
- MOC C. Update on current contraceptive options: A case-based discussion of efficacy, eligibility, and use. Cleve Clin J Med. 2023; 90(3):181. DOI: 10.3949/ccjm.90a.22075
- Salh FM, Abdulridha MK. Assessment of awareness about contraception among a sample of Iraqi women using hormonal contraceptives: a cross-sectional study. Pharmacia. 2025; 72:1-14. DOI: 10.3897/pharmacia.72.e140451
- Kooner M, Joseph H, Griffin B, Lynch S, Vest K, Stewart-Lynch A, et al. Hormonal contraception prescribing by pharmacists: 2019 update. J Am Pharm Assoc. 2020; 60(5):e34-e9. DOI: 10.1016/j.japh.2020.01.015
- Ipingbemi A, Ajanaku O, Umaru O. Assessment of community pharmacists’ knowledge and counselling practices on oral contraceptives use. J Contemp Stud Epidemiol Public Health. 2023; 4(2):ep23008. DOI: 10.29333/jconseph/13848
- Chappell BT, Griffin BL, Howard B. Mechanisms of action of currently available woman- controlled, vaginally administered, non-hormonal contraceptive products. Ther Adv Reprod Health. 2022; 16:26334941221107120. DOI: 10.1177/26334941221107120
- Busund M, Bugge NS, Braaten T, Waaseth M, Rylander C, Lund E. Progestin‐only and combined oral contraceptives and receptor‐defined premenopausal breast cancer risk: The Norwegian Women and Cancer Study. Int J Cancer. 2018; 142(11):2293-302. DOI: 10.1002/ijc.31266
- Whalen A, Bratberg J, Cohen L, Orr K, Lemay V. Assessing pharmacist and clinician perspectives on pharmacist-prescribed hormonal contraceptives. J Am Pharm Assoc. 2024; 64(1):314-20.e3. DOI: 10.1016/j.japh.2023.11.013
- Virro JJ, Besinque K, Carney CE, Gross D, Bernick B, Mirkin S. Long-lasting, patient-controlled, procedure-free contraception: a review of annovera with a pharmacist perspective. Pharmacy (Basel). 2020; 8(3):156. DOI: 10.3390/pharmacy8030156
- Tomaszewski D, Aronson BD, Kading M, Morisky D. Relationship between self-efficacy and patient knowledge on adherence to oral contraceptives using the Morisky Medication Adherence Scale (MMAS-8). Reprod Health. 2017; 14:1-7. DOI: 10.1186/s12978-017-0374-6
- Levin A, Berger K. Call to action: The pharmacist’s role in improving contraceptive knowledge and access. J Am Pharm Assoc. 2023; 63(1):43-5. DOI: 10.1016/j.japh.2022.08.021
- Aduke EI, Ajanaku OO, Umaru OT. Assessment of community pharmacists’ knowledge and counselling practices on oral contraceptives use. J Contemp Stud Epidemiol Public Health. 2023; 4(2):ep23008. DOI: 10.29333/jconseph/13848
- Grindlay K, Wollum A, Karver J, Grossman D. Over-the-counter oral contraceptive use among women in Mexico: results from a national survey. BMJ Sex Reprod Health. 2021; 47(3):205-10. DOI: 10.1136/bmjsrh-2020-200778
- Schivone GB, Blumenthal PD, editors. Contraception in the developing world: special considerations. Semin Reprod Med. 2016; 34(1):11-16. DOI: 10.1055/s-0036-1571437
- Travlos DV, Baumgartner JL, Rouse M, Wadelin JW, Vlasses PH. Forty years of ACPE CPE accreditation. Am J Pharm Educ. 2017; 81(9):5998. DOI: 10.5688/ajpe5998
- Krashin JW, Zapata LB, Morgan IA, Tepper NK, Jatlaoui TC, Frederiksen BN, et al. Required examinations and tests before initiating contraception: Provider practices from a national cross-sectional survey. Contraception. 2021; 103(4):232-8. DOI: 10.1016/j.contraception.2021.01.004
- Batra P, Aquilino ML, Farris KB. Pharmacy staff perceptions and self-reported behaviors related to providing contraceptive information and counseling. J Am Pharm Assoc. 2015; 55(5):481-7. DOI: 10.1331/JAPhA.2015.15037
- Chirewa B, Wakhisi A. Emergency hormonal contraceptive service provision via community pharmacies in the UK: a systematic review of pharmacists’ and young women’s views, perspectives and experiences. Perspect Public Health. 2020; 140(2):108–16. DOI: 10.1177/1757913919867356
- Ibrahim OM, Hussein RN. Knowledge of pharmacists on proper use of oral contraceptive pills and missed dose instructions in United Arab Emirates. Trop J Pharm Res. 2017; 16(4):947-54. DOI: 10.4314/tjpr.v16i4.29
- Almalag HM, Mansy WH, Alwhaibi AM, Syed W, Babelghaith SD, Arifi MNA. Community pharmacists’ knowledge, willingness, and readiness to prescribe oral contraceptives in Saudi Arabia. Healthcare (Basel). 2022; 10(1):503. DOI: 10.3390/healthcare10030503