204394 Oral contraceptive continuation along the US-Mexico Border: Does a prescription matter?

Wednesday, November 11, 2009: 9:30 AM

Joseph E. Potter, PhD , Population Research Center, University of Texas at Austin, Austin, TX
Sarah McKinnon, MPH , Department of Sociology, Population Research Center, University of Texas-Austin, Austin, TX
Kristine Hopkins, PhD , Population Research Center, University of Texas at Austin, Austin, TX
Jon Amastae, PhD , Center for Inter-American and Border Studies, University of Texas at El Paso, El Paso, TX
Michele Shedlin, PhD , College of Nursing, New York University, New York, NY
Daniel A. Powers, PhD , Population Research Center, University of Texas at Austin, Austin, TX
Daniel Grossman, MD , Ibis Reproductive Health, Oakland, CA
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.

Learning Objectives:
1. Describe how patterns of OC continuation differ among women who receive pills from family planning clinics versus over-the-counter at pharmacies 2. List the factors associated with higher contraceptive continuation 3. Identify impact of number of pill packs supplied on continuation 4. Discuss the relevance of these findings to the potential availability of hormonal contraception over the counter in the US

Keywords: Contraception, Family Planning

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the P.I. of the project, and the lead person in designing and writing the study presented.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.