Contraindications to use among women in Texas who obtain combined hormonal contraceptives over-the-counter in Mexico

Combined hormonal contraceptives (pills, patch and vaginal ring) are safe and effective family planning methods. Although a prescription is required to obtain these methods in the US, women living near the Mexican border can purchase pills and patches in Mexican pharmacies over the counter. We aimed to assess the safety of this by comparing the prevalence of contraindications among women who obtained these methods in US clinics or Mexican pharmacies.

1,271 women 18-49 years old were recruited at shopping areas in El Paso, Texas, and interviewed about contraceptive use and provision source. A nurse practitioner screened women for level 3 or 4 contraindications (WHO Medical Eligibility Criteria) to combined hormonal contraceptives and measured blood pressure.

1,269 women reported data on contraceptive use; 239 (19.0%) used hormonal methods, of which 73 (5.8%) reported obtaining the method in a Mexican pharmacy. 192 women were pill users. In regression analysis, speaking primarily Spanish, living in Mexico and completing last year of school in Mexico were associated with obtaining hormonal methods in a Mexican pharmacy (p<0.05). The prevalence of contraindications to combined hormonal use was not significantly different between clinic-users (hypertension 11.2%, any contraindication 27.6%) and users of Mexican pharmacies (hypertension 16.1%, any contraindication 28.6%). In regression analysis, having one or more contraindications was not associated with the provision source (clinic or pharmacy).

The prevalence of contraindications to combined hormonal methods is higher than expected but no higher among women obtaining them over the counter, suggesting that self-screening is as accurate as clinician screening.