Oral contraceptive pill dispensing policy and unintended pregnancy

Nationally, discontinuation and imperfect use of oral contraceptive pills (OCPs) is a leading cause of unintended pregnancy. Among women presenting for abortion, one in seven were using OCPs in the month they conceived. Previous work has shown that dispensing a whole year's supply of oral contraceptive pills at a family planning clinic visit can be cost effective and result in fewer gaps in coverage than dispensing only one or three cycles. However, the previous work also did not randomize women to receive one, three or thirteen cycles and more experienced pill users may have received more cycles of pills.

Using claims data from the California State family planning program and matched claims for birth and abortion in the Medi-Cal program, we compare incidence of unintended pregnancy by number of pill packs dispensed to provide a generalizable result about the impact of oral contraceptive dispensing practices on unintended pregnancy.

This analysis shows the difference in abortions and births by whether a woman received a year's supply of pills or needed to return to a clinic or pharmacy each month or quarter in order to continue use. By relying on several natural experiments – one set of clinics only dispensed one cycle of pills to all clients in a month due to stocking problems and another set of clinics changed its clinic policy to increase the percentage of women getting a full year's supply of pills – we can also remove the selection effect of more experienced users receiving more cycles of pills.