摘要：Objectives. As part of the Border Contraceptive Access Study, we interviewed oral contraceptive (OC) users living in El Paso, Texas, to assess motivations for patronizing a US clinic or a Mexican pharmacy with over-the-counter (OTC) pills and to determine which women were likely to use the OTC option. Methods. We surveyed 532 clinic users and 514 pharmacy users about background characteristics, motivations for choosing their OC source, and satisfaction with this source. Results. Older women and women born and educated in Mexico were more likely to patronize pharmacies. 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. Both groups were very satisfied with their pill source. Conclusions. Women of different ages, parities, and educational levels would likely take advantage of an OTC option were OCs available at low cost. Improving clinic provision of OCs should be considered. Sixteen years ago, some distinguished reproductive health scholars outlined the arguments for reducing or eliminating the medical requirements for accessing oral contraception in the United States. 1 The argument was simply that only compelling health concerns could justify restrictions such as the prescription requirement and that evidence was mounting that neither safety nor efficacy concerns justified prescription status for oral contraception. In the intervening years, much has changed. More evidence has accumulated regarding the safety of oral contraception, 2 – 6 successful experiments have been conducted regarding ways to facilitate use of prescription pills, 7 , 8 and the Food and Drug Administration took an important related policy step when it approved an over-the-counter (OTC) emergency contraception product for adult women. For these reasons, as well as the high prevalence of unwanted pregnancies—especially among adolescents and women with low income and education 9 , 10 —the issue of removing the prescription requirement has again come to the fore. 11 , 12 Comparing the effectiveness of OTC access to oral contraceptives (OCs) or other hormonal methods with other innovative strategies for reducing unintended pregnancies is ranked in the top quartile of initial national priorities in the Institute of Medicine's report on comparative effectiveness research. 13 In the debate over removing the prescription requirement, 2 of the questions that need to be addressed are why women might prefer pharmacy access instead of obtaining pills at clinics and who would take advantage of the pharmacy option if it were made available. So far, most of the evidence on these points has come from studies of women residing in countries other than the United States 14 or from answers to hypothetical questions addressed to women in this country. 15 To explore these questions, we conducted a study along the US–Mexico border, 16 where women who live in the United States are afforded an unusual opportunity: crossing the border, they can purchase OTC hormonal contraception at pharmacies for a reasonable price—approximately US $5 per cycle. In the Border Contraceptive Access Study, we set out to compare the motivations and experiences of OC users who obtained their contraception from Mexican pharmacies with those of women who obtained their pills from family planning clinics in El Paso, Texas, where eligible low-income women often pay nothing. We addressed questions of why women chose one source over the other and what underlying factors played a role in their choice.
