CONTEXT Sterilization is the most commonly used contraceptive in the United States, yet access to this method is limited for some. METHODS A 2006–2008 prospective study of low‐income pill users in El Paso, Texas, assessed unmet demand for sterilization among 801 women with at least one child. Multivariable logistic regression analysis identified characteristics associated with wanting sterilization. In 2010, at an 18‐month follow‐up, women who had wanted sterilization were recontacted; 120 semistructured and seven in‐depth interviews were conducted to assess motivations for undergoing the procedure and the barriers faced in trying to obtain it. RESULTS At baseline, 56% of women wanted no more children; at nine months, 65% wanted no more children, and of these, 72% wanted sterilization. Only five of the women interviewed at 18 months had undergone sterilization; two said their partners had obtained a vasectomy. Women who had not undergone sterilization were still strongly motivated to do so, mainly because they wanted no more children and were concerned about long‐term pill use. Among women's reasons for not having undergone sterilization after their last pregnancy were not having signed the Medicaid consent form in time and having been told that they were too young or there was no funding for the procedure. CONCLUSIONS Because access to a full range of contraceptive methods is limited for low‐income women, researchers and providers should not assume a woman's current method is her method of choice.

Objective To estimate differences in continuation of oral contraceptive pills (OCPs) between U.S.-resident women obtaining pills in U.S. family planning clinics compared with over-the-counter in Mexican pharmacies. Methods In El Paso, Texas, we recruited 514 OCP users who obtained pills over-the-counter from a Mexican pharmacy and 532 who obtained OCPs by prescription from a family planning clinic in El Paso. A baseline interview was followed by three consecutive surveys over 9 months. We asked about date of last supply, number of pill packs obtained, how long they planned to continue use, and experience of side effects. Retention was 90%, with only 105 women lost to follow-up. Results In a multivariable Cox proportional hazards model, discontinuation was higher for women who obtained pills in El Paso clinics (25.1%) compared with those who obtained their pills without a prescription in Mexico (20.8% [hazard ratio 1.6, 95% CI: 1.1--2.3]). Considering the number of pill packs dispensed to clinic users, discontinuation rates were higher (hazard ratio 1.8, 95% CI: 1.2 -- 2.7) for clinic users who received 1-5 pill packs. However, there was no difference in discontinuation between clinic users receiving 6 or more pill packs and users obtaining pills without a prescription. Conclusion Results suggest providing OCP users with more pill packs and removing the prescription requirement would both lead to increased continuation.