Continuation of Prescribed Compared With Over-the-Counter Oral Contraceptives

Abstract

Objective To estimate differences in continuation of oral contraceptive pills (OCPs) between U.S.-resident women obtaining pills in U.S. family planning clinics compared with over-the-counter in Mexican pharmacies. Methods In El Paso, Texas, we recruited 514 OCP users who obtained pills over-the-counter from a Mexican pharmacy and 532 who obtained OCPs by prescription from a family planning clinic in El Paso. A baseline interview was followed by three consecutive surveys over 9 months. We asked about date of last supply, number of pill packs obtained, how long they planned to continue use, and experience of side effects. Retention was 90%, with only 105 women lost to follow-up. Results In a multivariable Cox proportional hazards model, discontinuation was higher for women who obtained pills in El Paso clinics (25.1%) compared with those who obtained their pills without a prescription in Mexico (20.8% [hazard ratio 1.6, 95% CI: 1.1--2.3]). Considering the number of pill packs dispensed to clinic users, discontinuation rates were higher (hazard ratio 1.8, 95% CI: 1.2 -- 2.7) for clinic users who received 1-5 pill packs. However, there was no difference in discontinuation between clinic users receiving 6 or more pill packs and users obtaining pills without a prescription. Conclusion Results suggest providing OCP users with more pill packs and removing the prescription requirement would both lead to increased continuation.

Happiness About Unintended Pregnancy And Its Relationship to Contraceptive Desires Among a Predominantly Latina Cohort

“…Although women with incongruent intentions and feelings could have higher discontinuation rates using the same methods as women with congruent intentions and feelings, the few previous studies that have examined the relationship between pregnancy feelings and contraceptive continuation suggest that this hypothesis is unlikely to be true. [34][35][36] A key implication of these findings is the importance of recognizing a range of interpretations of incongruent feelings and intentions, including ambivalence about avoiding conception, indifference toward conception and, as shown here, strong motivation to avoid conception despite a positive feeling about pregnancy. Doing so is crucial to differentiating between pregnancies that are not deliberately prevented (i.e., those that women neither actively intend nor actively try to avoid) and pregnancies that are truly unintended (i.e., those that women actively try to prevent).…”

Over-the-counter access to oral contraceptives as a reproductive healthcare strategy

“…In a study of US residents who purchase oral contraceptives OTC in Mexican pharmacies [18], continuation among women who obtained pills in pharmacies without a prescription was significantly higher compared to those who got pills in US clinics [19]. This prospective cohort study recruited 532 women obtaining pills by prescription at public clinics in El Paso, Texas, and 514 women obtaining pills OTC in Mexican pharmacies and followed them over 9 months.…”

Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks

“…The type of progestogen [Lawrie et al 2011;Maitra et al 2004] and the number of oral contraceptive pill packages dispensed [Foster et al 2006], prescription drug or over-the-counter [Potter et al 2011] have all been proposed as determinants for continuation. Improvements of formulations of combined hormonal contraception, including new routes of administration and different regimens, that is, monophasic, biphasic, triphasic and quadriphasic pills, patches and vaginal rings, have been performed in order to increase compliance and continuation [Sucato et al 2011;Murphy and Brixner, 2008], but, so far, there is only limited evidence that use of a specific formulation or route of administration would be a better choice concerning continuation rates.…”