Interest in over-the-counter oral contraception among BIPOC

Interest in over-the-counter oral contraception among BIPOC | Image Credit: © WindyNight - © WindyNight - stock.adobe.com.

Interest in an over-the-counter (OTC) oral contraceptive pill (OCP) was common in Black, Indigenous, and people of color (BIPOC) US populations, which often faced challenges accessing contraceptive care, according to a recent study.

Despite the importance of contraception in allowing full bodily autonomy, there are many remaining barriers to accessing contraception. The includes the prescription requirement, being unable to pay, being unable to take time off school or work, lack of a full range of contraceptive options in clinics, and difficulty traveling to clinics.

BIPOC often experience more barriers because of systematic racism and oppression, which causes disparities in contraceptive care. BIPOC also are more often uninsured than White populations, and BIPOC individuals are more likely to distrust providers because of limited options given to them, leading to further challenges.

OCPs are the most common reversible hormonal methods in the United States, but there are currently no OTC OCPs available. Interest in OTC OCPs has ranged from 29% of teenagers to 37% to 39% of adults. Younger, Spanish speaking, and uninsured adults have shown the highest rates of interest.

To determine the interest in OTC OCPs among BIPOC, investigators conducted a cross-sectional survey using data from a community-engaged research project. The survey was available in English, Spanish, Vietnamese, and Urdu.

Participants were aged 13 to 50 years, identified as American Indian, Alaskan Native, Black, Asian, Hispanic, or Pacific Islander, identified as a woman regardless of sex assigned at birth, had a working email address, and had used or wanted a contraceptive in the prior year. Recruitment occurred from May 2021 to March 2022.

In the survey, participants who used contraception in the prior year listed challenges they had faced accessing contraception, while those who had not used contraception provided reasons. The challenges selected included logistical challenges such as cost and transportation and interpersonal challenges such as privacy and interactions outside the health care system.

The survey included a description of OTC OCPs, and asked participants how likely they were to use them if they were available. Participants who selected very likely or somewhat likely were considered likely to use an OTC OCP. If participants were not considered likely, they were asked their reasons for not using an OTC OCP.

Covariates included age, race and ethnicity, education status, nativity, insurance status, student status, employment status, gender identity, interest in using a contraceptive method not currently using, contraceptive use in the prior year, and history of giving birth.

There were 727 participants in the final sample, 86% of which were aged 18 to 34 years. Of participants, 34% were Black, 31% Hispanic, 29% Asian American, Native Hawaiian, or Pacific Islander (AANHPI), and 13% American Indian or Alaskan Native.

A challenge accessing contraception in the prior year was reported by 45% of participants, with challenges more common in AANHPI, younger, and uninsured participants, along with those who were not working, had a lower level of education, and had never given birth. Challenges accessing contraception were reported in 57% of participants who hadn’t used one in the prior year and 44% who had.

Sixty-seven percent of participants reported being likely to use an OTC OCP, with 36% very likely and 31% somewhat likely. Participants who were younger, Hispanic, and had never given birth were more likely to use an OTC OCP, along with those who had used an OCP.

Black patients and those who had used non-OCP contraceptives in the prior year were less likely to use an OTC OCP. Reasons for not using an OTC OCP included not being interested in an OCP and wanting a clinician to make sure an OCP was right for them.

Reasons for using an OTC OCP included saving time and not having to visit a doctor or nurse. Participants were more likely to use an OTC OCP if they had experienced a challenge accessing contraception in the prior year.

Reference

Key K, Wollum A, Asetoyer C, et al. Challenges accessing contraceptive care and interest in over-the-counter oral contraceptive pill use among Black, Indigenous, and people of color: An online cross-sectional survey. Contraception. 2023;120. doi:10.1016/j.contraception.2023.109950