Oral contraceptive continuation along the US-Mexico Border: Does a prescription matter?

In Mexico, oral contraceptives (OCs) are available from pharmacies without a prescription, while in the US, a prescription is required. The Border Contraceptive Access Study interviewed pill users living in El Paso, Texas to assess the impact of choosing between clinic and cross-border over-the-counter (OTC) pharmacy access. Over a nine month period, we followed a sample of 533 pill users who obtained their pills at baseline at a family planning clinic in El Paso, Texas, along with a sample of 515 El Paso residents who obtained their pills at a pharmacy across the border in Ciudad Juarez, Juarez, Mexico. Here, we present life tables showing continuation in these two groups, followed by a hazards analysis of discontinuation for all causes, as well as discontinuation excluding the risk of stopping in order to get pregnant or switch methods. These hazards models include fixed and time-varying covariates. For clinic users only, the latter include the number of pill packs acquired at last supply. Discontinuation was not higher for pharmacy users. Indeed, estimated adjusted discontinuation rates for unwanted pregnancy and side effects were 38 percent higher (p=0.06) for clinic users. These results show that OTC provision of OCs would not adversely affect continuation or pregnancy rates, and provide support for removing the medical requirements for obtaining oral contraception in the US. For clinic users, the results also support the recent finding that continuation can be improved by providing a larger number of pill cycles at clinic visits.