Year of Publication



Martin School of Public Policy and Administration

Executive Summary

In 2012, the American College of Obstetricians and Gynecologists published an opinion statement in which they acknowledged that oral contraceptives were safe to be sold over the counter. Although there are several arguments that the lack of insurance of over the counter birth control would create a bigger cost barrier, research shows that women are in fact willing to pay for contraception if it is available over the counter. Some countries, such as Mexico, have this option available and because of the proximity to the United States, many women who live on the southern border take advantage of this. However, there are still some who choose the prescription option. What affects their decision? Is the time it takes to get their birth control more important than the price? What other factors play a role? Data from the Border Contraceptive Access Study (BCAS) was used to find the answers to these questions.

The BCAS was conducted between the cities of El Paso, Texas and Ciudad Juarez, Mexico and compared the experiences of American women who got their pills in clinics in El Paso to those who got their pills over the counter from pharmacies in Ciudad Juarez. In total, 1,046 women were surveyed, 532 of which were clinic users and 514 bought their pills from pharmacies. The questionnaire asked questions regarding sociodemographic characteristics, fertility, contraceptive use, social/sexual behavior, medical history, use of medical services, and health care sources.

In the regression estimate, purchasing in Mexico was the dependent variable and the explanatory variables were cost of contraception, insurance coverage, prescription requirement, feelings about having children in the future, current relationship status, frequency of sex, and whether the woman currently has a prescription for birth control pills.

Results show that prescription requirements are a major barrier to obtaining contraceptives. This effect is so large that if it were eliminated by making birth control pills over the counter most Mexican demand would be eliminated. Personal relationship matters make little difference to the decision about source of pills.

It is recommended that stakeholders (pharmaceutical companies, insurance companies, the FDA, health care providers, and policymakers) collaborate to establish a prescription-to-OTC switch, allowing easier access to oral contraceptives. In addition to that, a time-effect study would be useful to gauge how effective the Affordable Care Act is in combination with an over the counter policy.