Side effects of oral contraceptives are a noteworthy problem, particularly among low-income young women who reside in inner-city communities. The problem may be compounded by inadequate family planning services, particularly when such services are provided by general medical practices with high volumes of clients. This study examined the prevalence and correlates of pill-related side effects, with particular attention to the role of clinic characteristics. Participants were 177 pregnant and parenting African American adolescents and young women (average age = 18.34). The experience of a pill-related side effect was the most frequently cited barrier to birth control use, and it was significantly related to contraceptive behavior. Finally, although participants attending comprehensive clinics experienced more barriers to medical service use than those attending neighborhood clinics, they reported fewer problems with pill-related side effects and better psychological functioning. Implications for future research and policy are discussed.