Plotting the Past and Future of Hormonal Contraception: A Narrative Public Health Ethics Approach to Centering Patients' Voices in the Pharmacogenomic Era of Birth Control.

This article examines the emerging socio-ethical-legal challenges as hormonal contraception enters the pharmacogenomic era, where genetic testing (GT) could personalize birth control prescribing to improve safety and efficacy. Despite decades of evidence linking genetic variants—such as Factor V Leiden (FV) and BRCA mutations—to increased risks from hormonal contraceptives, North American clinical guidelines and regulations remain limited, while direct-to-consumer genetic testing (DTC-GT) for contraceptive users is expanding without comprehensive oversight. Using a narrative public health ethics framework, the article highlights the historical marginalization of patient voices, especially women and racialized groups, and argues for patient-centered research and policy development to address autonomy, justice, maleficence, and privacy concerns. It concludes that integrating diverse patient perspectives and improving education and regulation around pharmacogenomic testing are essential steps toward ethically informed contraceptive care in this evolving landscape.