March 28, 2014 — Summary of "Attitudes Toward Over-the-Counter Access to Oral Contraceptives Among a Sample of Abortion Clients in the United States," Grindlay et al., Perspectives on Sexual and Reproductive Health, June 2014.
Over-the-counter "access to oral contraceptives has been proposed as a way to improve the availability of this effective [birth control] method, and may be particularly attractive to those who have faced barriers to obtaining prescription birth control, including some women seeking abortion," according to Kate Grindlay, senior project manager at Ibis Reproductive Health, and colleagues.
While a "growing body of research" suggests that women in the U.S. are interested in over-the-counter (OTC) access to oral contraceptives, "no research has been conducted among women seeking abortion, a population at particularly high risk of unintended pregnancy," Grindlay and colleagues wrote. For this study, the researchers aimed to "assess support for and use of [OTC] access to oral contraceptives among this population."
Between May 2011 and July 2011, the researchers recruited "women who were seeking an abortion or a follow-up appointment after an abortion, and who could read and write in English or Spanish ... in the waiting rooms of six large, urban clinics that provide abortion services at a range of gestational ages in the first and second trimesters." The researchers noted that the clinics -- located in Arkansas, California, Georgia, Illinois, New Jersey and Texas -- "were selected to represent geographic and demographic diversity."
The study's data were "collected as part of a larger survey that included questions on women's attitudes toward new contraceptive methods, empowerment and abortion care," the researchers wrote. The participants also provided demographic information, such as their age, race and ethnicity, and marital status.
Among other questions, the researchers asked study participants about their contraceptive use in the three months prior to their pregnancy, including whether they had ever used the pill, tried to obtain a prescription for birth control or had difficulty in obtaining birth control. Women who said that they had experienced difficulty were asked to describe the problems, and all the women were asked about the contraceptive methods, if any, they intended to use after their abortion.
Study participants also were asked about their opinions on OTC access to birth control, including their reasons for supporting or opposing it. In addition, women were surveyed about the likelihood of using OTC or pharmacy access to oral contraceptives, and again asked to detail their reasons.
The researchers also asked women about their willingness to use a progestin-only pill -- because it likely would be the first type made available OTC in the U.S. -- and to explain the reason for their responses. Lastly, women were asked how much they would be willing to pay for a month's supply of oral contraceptives if the pills were available OTC, and whether they would be willing to pay an additional amount to consult with a pharmacist about any contraceptive-related questions.
Grindlay and colleagues determined that 81% of the 651 respondents in the final sample said that they were in favor of OTC access to oral contraceptives, with higher support among whites (91%), Hispanics (86%), women with higher education levels (84%-87%), and women who had used oral contraceptives before, intended to use them or had difficulty obtaining a refill (87%-90%).
However, there was no difference among women who had difficulty obtaining a prescription and those who did not. Support was lower among black women compared with white women and among women without a high school degree compared with women with at least a college degree.
The 514 women who supported OTC access to oral contraceptives cited several reasons, including convenience (76%) and beliefs that such access would reduce teenage pregnancy (58%), result in fewer unintended pregnancies (55%), be less expensive (39%) and not require an appointment with a health care provider (16%).
Meanwhile, the 118 women who did not support OTC access cited concerns about needing to meet with a provider beforehand to discuss pill use (44%), contributing to earlier and increased sexual behavior among teenagers (27%), incorrectly using the pill (25%), choosing the wrong pill (16%), forgoing other well-women visits (11%) and raising the cost of the pills (9%).
Likelihood of Use
According to the study, 61% of respondents said that they would likely use oral contraceptives if they were available OTC, with white women (73%) and Hispanic women (66%) being more likely than women of other races and ethnicities (52%-55%) to say they would take advantage of OTC access. In addition, uninsured women (68%) were more likely than insured women (55%-61%) to say they would use OTC access.
The study also found that women who intended to use the pill post-abortion (86%) were more likely than those who planned to use an alternative method (33%-52%) to say that they would use OTC access. Women who previously had difficulty obtaining prescriptions (81%) also were more likely than women who did not report difficulty (57%) to say that they would obtain pills OTC.
The 391 women who said they would use OTC access cited several reasons for their responses, including saving time (63%), convenience of location and hours (54%), and financial savings from not having to visit a clinic (47%). Meanwhile, among the 41 women who said they would support prescription-only access, the most commonly cited reasons included wanting to meet with a provider to discuss the pill (54%), privacy (42%), wanting to ask questions about proper pill use (42%), wanting a physical or pelvic exam (29%), and wanting provider supervision (24%).
The study found that 62% of respondents said that they would likely use pharmacy access to obtain oral contraceptives, with the likelihood increasing among women who were intended to use the pill post-abortion and among women who had difficulty obtaining a prescription.
Meanwhile, 46% of respondents said that they would likely use an OTC progestin-only pill.
The researchers also found that the 394 women who said they would be likely to use OTC oral contraceptives said that they would be willing to pay, on average, $21 per month for such access. By comparison, the study found that the average additional amount that a women would be willing to pay for a pharmacist consultation would be $5, with 72% saying that they would not pay anything for such consultation services.
"These results indicate a high level of interest in [OTC] access to oral contraceptives among this sample of women seeking abortion -- higher than among women in the general U.S. population," the researchers wrote, adding that such interest might reflect how "this population has had more difficulties accessing contraceptives in the past or that they are more interested in oral contraceptives generally."
The researchers noted that one-third of women who were not planning to use contraceptives post-abortion, as well as nearly 40% of those who intended to only use condoms, said they would likely use oral contraceptives if they were available OTC, "suggesting that such access has the potential to increase the use of effective methods in this population."
Grindlay and colleagues added that while there were some women who said they would use OTC access to oral contraceptives instead of IUDs or implants, this "reduction in use of more effective methods would likely be dwarfed by the number of new pill users who would otherwise be using no method or a less effective one."
"Support for and interest in [OTC] access to oral contraceptives were high in this sample of abortion clients," the researchers wrote, adding, "Initiation and continuation of oral contraceptive use among women at high risk of unintended pregnancy may increase if oral contraceptives are made available without a prescription."