Prescription requirements and over-the-counter access to oral contraceptives: A global review

Introduction: A growing body of evidence indicates that over-the-counter (OTC) access to oral contraceptives (OCs) is safe and that removing the prescription barrier may increase continuation of the method. In many low- and middle-income countries, OCs are available in commercial outlets without prescription, either as a recognized OTC drug or informally in practice; however, the extent of OTC availability worldwide is not known. This study was conducted to ascertain the prescription requirements and de facto OTC availability of OCs.

Methods: From April 2011-February 2012, we conducted a short online survey and researched published articles and country drug registers to determine countries' prescription requirements and de facto commercial availability of OCs, as well as whether women have to undergo some sort of health screening to get OCs without prescription. The survey was sent to ministries of health, family planning associations, and other reproductive health experts.

Results: Data were obtained for 137 countries. OCs were reported to be available de facto without prescription in 46 countries, legally available without prescription (no screening required) in 36 countries, legally available without prescription (screening required) in 12 countries, and available by prescription-only in 43 countries. Most countries not requiring a prescription (84 out of 94) are low- and middle-income countries.

Conclusion: OCs are available without prescription in a significant number of countries in the world. These countries may provide evidence about the safety and effectiveness of OTC provision and serve as an example for other countries considering removing the prescription barrier to OCs.