Knowledge regarding oral contraceptive use, risks and benefits among clinic and pharmacy users in El Paso, Texas, and the impact of written information

The Border Contraceptive Access Study aims to understand contraceptive use among women in El Paso, Texas, who have the option to obtain oral contraceptives (OCs) over-the-counter (OTC) from Mexican pharmacies or from US public clinics. We asked 533 clinic and 515 pharmacy users a series of questions about pill use, side effects, warning signs, non-contraceptive benefits, and contraindications. Half of women in each group were randomized to receive an informational leaflet on OCs following the interview. After a three month period, women were re-interviewed and asked similar knowledge questions. At baseline, 93% believed OCs need to be taken daily at the same time, and 54% knew to use a back-up method after missing three consecutive pills. Fifty percent thought women needed a break from OC use in order to “rest” their body. While 73%-85% recognized severe symptoms as warning signs, only 30-55% correctly identified common, non-dangerous pill-related symptoms. 95%-96% knew OCs do not protect against STIs/HIV, but far fewer reported that OCs prevent some cancers (35%) and can improve acne (15%). Very few women were able to identify common contraindications. In regression analyses, women who were clinic users, had completed high school, were US-born, and nulliparous were more likely to answer correctly (p<0.001). There was no improvement in knowledge among women given the leaflet. Although basic knowledge about OCs was good in this population, overall knowledge was better among clinic users. Future research should examine whether knowledge discrepancies impact quality of OC use. Efforts to make OCs OTC in the US must include a strong informational campaign.