Over-the-Counter Access, Changing WHO Guidelines, and Contraindicated Oral Contraceptive Use in Mexico

Abstract

This study examines the prevalence of contraindications to the use of oral contraceptives in Mexico by sociodemographic characteristics and by whether this family planning method was obtained with or without a doctor's prescription. Using data on smoking behavior and blood-pressure measurements from the 2000 Mexican National Health Survey, the authors found that, under the 1996 World Health Organization (WHO) medical eligibility guidelines, the prevalence of contraindications is low and that no significant differences in contraindications exist at any level between those who obtain oral contraceptives at clinics and those who obtain them at pharmacies. In 2000, however, WHO substantially revised its criteria regarding the level of hypertension that would constitute a contraindication for oral contraceptive use. Applying the new guidelines, the authors found that 10 percent of pill users younger than 35 and 33 percent aged 35 and older have health conditions that are either relative or absolute (Category 3 or 4) contraindications. The relevance of these findings to the larger debate concerning screening and over-the-counter access to oral contraceptives is discussed.

Pharmacy Professionals’ Dispensing Practice, Knowledge, and Attitude towards Emergency Contraceptives in Gondar Town, Northwestern Ethiopia: A Cross-Sectional Study

“…First, women who need ECPs can purchase them from pharmacies since they are sold as an over-the-counter drug in the country. Women's access to ECPs over the counter makes use of ECPs more effective because they can get them as soon as they need them [15, 16]. Secondly, pharmacies are ideal settings for dispensing ECPs because of flexible hours of service and because they are open in nightfall and weekends when most health professionals are not available.…”

Necessity of Education for Oral Contraceptive Use in Korea: Results from the Fourth Korean National Health and Nutrition Examination Survey 2007-2009

“…It is still controversial whether OTC users had a higher prevalence of contraindications than prescription users. Studies of Mexican women reported no significant differences in contraindications between users of OTC and prescription drugs [9]. Grossman et al [10] have shown that the prevalence of contraindications is higher in OTC users than in prescription users in the same region.…”

“…In Mexico where OCs are also available without prescription, the proportion of contraindications to OC use was not significantly different between women obtaining OCs from pharmacies and those from clinics [9]. Another study from the USA has indicated that OTC users have higher odds of relative OC contraindications to OC use than prescription users.…”

Currently available combined oral contraception

“…Groups have shown that women are able to self-screen for contraindications to COC use, such as uncontrolled hypertension [75,76]. In addition, experts have demonstrated that the benefits of avoiding an unintended or mistimed pregnancy likely outweigh the potential medical risks of COC use [77,78]. Current COCs do not protect against sexually transmitted infections or HIV.…”