Table 4

Study descriptions and key findings of studies included in the values and preferences review examining OTC access

Study authors and yearCountryPopulationStudy designKey findings
Potential OC users
Barlassina, 201515IrelandOC users aged 18–50Cross-sectional survey (n=488)88% (429/488) of participants were in favour of OCs being available without prescription. 92% (448/488) said they were likely to obtain OCs without prescription if available. Convenience and ease of access were the main advantages of OTC availability, while safety was the biggest concern.
Baum et al, 201616USAWomen aged 13–45 who identified with at least one priority population: Black/African-American, Asian/Pacific Islander, Latina, and/or aged 13–24Qualitative study using focus groupsWomen reported potential benefits of OTC access, including convenience and privacy. Many believed OTC availability of OCs would help reduce unintended pregnancy and help destigmatise birth control. Participants expressed concerns about OTC access, such as worry that first-time users and young adolescents would not have enough information to use the pill safely and effectively, as well as concerns about whether women would still obtain preventive screenings. Women were also worried that OTC OCs would cost more if no longer covered by insurance.
Dennis and Grossman, 201218USALow-income womenQualitative study using focus groups and in-depth interviewsMost participants supported OTC access to OCs. Participants expected that OTC availability would save women time in clinician visits for prescriptions and increase the convenience of the method. However, they raised concerns about cost, continued use of other preventive screening options and the safety of such access for minors, first-time users and women with medical conditions.
Forman et al, 199719USAUndergraduate students at an urban women's liberal arts collegeCross-sectional survey (n=290)65% of all respondents felt OCs should not be available without prescription. The two most commonly cited reasons for not wanting OCs to be available OTC were: (1) side effect might occur that a healthcare provider could have prevented (59%) and (2) people would not go to their providers for regular check-ups (56%). The most commonly cited reason for wanting OCs to be available OTC was there would be fewer unwanted pregnancies. Race, previous OC use, previous sexual activity and perceived risk of pregnancy were not significant predictors of believing OCs should be available OTC. Having had a previous pregnancy was a significant predictor of believing OCs should be available OTC (p=0.047). Those who believed OCs should be available only with a prescription were willing to pay more for OCPs (p=0.033). Logistic regression controlling for race revealed that both younger age (p=0.030) and previous pregnancy (p=0.002) were independent predictors of believing OCs should be available OTC.
Grindlay et al, 201421USAWomen aged 15–46 seeking abortion servicesCross-sectional survey (n=651)81% of respondents supported OTC access to OCs. While 42% of women planned to use the pill after their abortion, 61% said they would likely use this method if it were available OTC. 33% of women who planned to use no contraceptive following their abortion said they would use an OTC pill, as did 38% who planned to use condoms afterward. In multivariable analysis, several subgroups had increased odds of likely OTC use: women older than 19 (OR: 1.8 for ages 20–29 and 1.6 for ages 30–46), uninsured (OR: 1.5), previous pill users (OR: 1.4), had difficulty obtaining a prescription refill for hormonal contraceptives (OR: 2.7) or planned postabortion pill use (OR: 13.0). Non-White women were less likely to say they would use OTC OCs (ORs ranged from 0.4 to 0.7).
Grindlay and Grossman,201823USASexually active adult women aged 18–44 not currently desiring pregnancy and female teens aged 15–17Cross-sectional survey (n=2539: 2026 adult, 513 teens)39% of adults and 29% of teens reported likely use of OTC POPs, with a greater likelihood if covered by insurance. Among adults, women who were never married or living alone (vs married), uninsured (vs privately insured), current pill or less effective method users (vs ring, patch, injectable or intrauterine device), tried to get a birth control prescription in the past year, or ever used a contraceptive pill/oral contraceptive or POP had higher odds of likely use. Among teens, Spanish speakers and those who ever had sex had higher odds of likely use; Black teens (vs White) had lower odds.
Grindlay and Grossman, 201522USAWomen aged 18–44 at risk of unintended pregnancyCross-sectional survey (n=2046)26% of respondents supported an age restriction for an OTC OC; 28% were against an age restriction; and 46% were unsure. In multivariable analysis, women were more likely to support an age restriction for an OTC OC if they had less than a high school degree (OR: 2.5), a high school degree (OR: 1.6) or some college (OR: 1.6) compared with a college degree; if they were married compared with never married (OR: 2.1); and if they lived in the Midwest (OR: 2.1) or South (OR: 2.1) compared with the West.
Grossman et al, 20132462.2% of respondents were strongly (31.4%) or somewhat (30.9%) in favour of OCs being available OTC. 37.1% reported being likely to use OCs if available OTC, including 58.7% of current users, 28.0% using no method and 32.7% using a less effective method. Covariates associated with a higher odds of reporting interest in using OTC OCs were younger age; being divorced, being separated or living with a partner (vs married); being uninsured or having private insurance (vs public insurance); living in the South (vs North-East); and current use of OCs or less effective methods, or non-use of contraception (vs use of another hormonal method or intrauterine device).
Landau et al, 200629USAWomen aged 18–44 years at risk of unintended pregnancyCross-sectional survey (n=811)Women were more likely to be potential OTC users of OCs if they had problems with obtaining prescription contraception (OR: 2.55), were uninsured (OR: 2.31), were low income (OR: 1.53), had an unintended pregnancy or pregnancy scare (OR: 1.82), or were African-American (OR: 1.59) or Latina (OR: 1.90).
Manski and Kottke, 201530USAYoung women aged 14–17Cross-sectional survey (n=348)73% of participants supported OTC access to OCs, and 61% reported they would be likely to use OCs available OTC. 79% of participants supported pharmacy access to OCs, and 57% reported they would be likely to use OCs available through pharmacy access. Few subgroup differences were noted, except that sexually experienced participants were more likely to both support OTC access and be likely to use it. Suburban teenagers were more likely to support pharmacy access than those from rural and urban areas. The most commonly cited advantage to OTC access was fewer teenage pregnancies (45%). Other common responses were that it would be easier for teenagers to get birth control (22%) and it would be more confidential (14%). Disadvantages cited included teenagers not using condoms to protect against STIs (22%), needing a doctor decide if OCs are safe for them (19%), might have sex at a younger age (18%) and might use OCs incorrectly (18%).
Nayak et al, 200531USAUniversity womenCross-sectional survey (n=500)37% of participants favoured the acquisition of OCs without a prescription. Women associated OTC access to OCs with increased likelihood of adverse medical consequences and the prescription-only system with an increased likelihood of pregnancy avoidance. Women who preferred OTC availability reported more favourable attitudes towards OC use and stronger intentions to buy OCs without a prescription.
Potter et al, 201013USA/MexicoOC users aged 18–44Cohort study following 1046°C users who obtained OCs either OTC from a Mexican pharmacy (n=514) or from a family planning clinic in El Paso (n=514)Cost of pills was the main motivation for choosing their source for 40% of pharmacy users and 23% of clinic users. The main advantage cited by 49% of clinic users was availability of other health services. Bypassing the requirement to obtain a doctor’s prescription was most important for 27% of pharmacy users.
Providers
Billebeau et al, 201617FranceHealth professionals concerned with contraception (internal medicine, obstetricians, medical gynaecologists and midwives)Cross-sectional survey (n=956)53.4% of respondents were in favour of OTC access to progestin-only contraceptive pill/oral contraceptives. Compared with other professional categories, medical gynaecologists were the least likely to be supportive (aOR: 0.63, 95% CI 0.46 to 0.87). 19.3% of respondents supported OTC access to combined oral contraceptives. Missed examination for medical contraindications was the main obstacle that respondents saw to free OC access.
Howard et al, 201326USAPhysicians (primarily residents training in obstetrics and gynaecology and family practice)Cross-sectional survey (n=638)Most physicians (71%) were against a switch to OTC availability for combined oral contraceptives. Of those opposed, safety (92%) was cited as the primary concern. Respondents were fairly evenly divided on making progestin-only pills available OTC—52% were against and 48% were in favour. Of those opposed to POPs, 73% cited safety as their primary concern. Geographic location was not associated with attitude, but female physicians were more likely to favour OTC availability for POPs than their male counterparts.
Rafie et al, 201635USAReproductive healthcare providers (physicians (mostly gynaecologists), nurse practitioners, certified nurse-midwives, physician assistants and registered nurses)Cross-sectional survey (n=482)Overall, 28% of providers supported complete OTC access to hormonal contraceptives (OCs, patch and ring). Physicians were somewhat more supportive of expanding contraceptive access than mid-level providers, but the differences were not significant.
  • OC, oral contraceptive; OCP, Oral Contraceptive Pill; OTC, over the counter;POP, progestogen-only pill; STI, sexually transmitted infection; aOR, adjusted OR.