U. TEXAS-AUSTIN (US) — Women who have access to oral contraceptives over the counter are more likely to stay on them than women who need a prescription.
“Removing unnecessary barriers to access—such as limits on the number of pill packs dispensed or even possibly the prescription requirement—could have an important impact on reducing unintended pregnancy,” says Joseph Potter, professor of sociology at the University of Texas at Austin.
Along the United States-Mexico border women in the United States have the option of obtaining oral contraceptives over the counter in Mexico.
For the study, more than 1,000 El Paso, Texas oral contraceptive users were interviewed and followed for nine months.
Half of the women obtained their pills over the counter at pharmacies in Juarez, Mexico, while the other half got them from family planning clinics in El Paso. Most women in the study were low-income and uninsured.
Women who got their pills in El Paso clinics were 60 percent more likely to stop taking them during the nine-month study compared to those who purchased their contraceptives without a prescription in Mexico.
Women who received fewer than six packs of pills at one time at the U.S. clinic were about 80 percent more likely to discontinue taking the pill compared to over-the-counter users.
The study is published in the journal Obstetrics & Gynecology.
In a related paper from the Border Contraceptive Access Study, researchers found that women who purchased their pills over the counter in Mexico might not be making the best choice about which kind of birth control is safest for them.
The study, led by Daniel Grossman of Ibis Reproductive Health, a nonprofit research organization based in Cambridge, Mass., and Oakland, Calif., found that women who obtained combined oral contraceptives, which contain both synthetic estrogen and progesterone, in Mexico were significantly more likely than U.S. clinic users to have health conditions such as hypertension or smoking over age 34 that may put them at risk while using this type of pill.
While there was no difference in absolute contraindications, relative contraindications were significantly more common among over-the-counter users (13 percent) compared to clinic users (9 percent).
Although no woman in the study reported a medical complication related to pill use, these contraindications may put women at higher risk of having a heart attack or stroke while using pills containing estrogen.
The findings highlight the importance of self-screening for contraindications when pills are made available over the counter, says Grossman, who also coordinates a working group of researchers, clinicians, and advocates exploring the feasibility of an over-the-counter switch for pills in the United States.
“If combined oral contraceptives are available over the counter, we need to be sure that women have the necessary tools to determine whether they are appropriate for this kind of pill,” Grossman says.
“Alternatively, progestin-only pills, which don’t contain estrogen, might be the best option as the first over-the-counter oral contraceptive. Progestin-only pills are also very effective, but they have many fewer and rarer side effects.”
Researchers from New York University contributed to the study, which was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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