Are Women Who Obtain Oral Contraceptives over the Counter in Mexico More Likely to Be Contraindicated for OC Use? Results from a Cohort Study in El Paso, Texas

Daniel Grossman, Ibis Reproductive Health
Kari White, University of Texas at Austin

Some advocate making oral contraceptives accessible over the counter (OCT), although concerns exist about screening for contraindications. We took advantage of a natural experiment on the US-Mexico border where women can obtain pills from US clinics or OTC at Mexican pharmacies. In this analysis, we assessed the prevalence of WHO Category 3 and 4 contraindications among clinic and OTC users, and using multivariable-adjusted logistic regression, identified predictors of being contraindicated. The prevalence of Category 3 or 4 contraindications was higher among OTC users than among clinic users (24.7% vs 18.7%). After multivariable adjustment, including age and BMI, OTC users were not significantly different from clinic users. We also present a simplified tool to self-screen for contraindications. More research is needed to determine if unrecognized hypertension is common in other settings; alternatively a progestin-only pill might be the best candidate for the first OTC product.