Moving Oral Contraceptives over the Counter: Theory-based Formative Research to Design Communication Strategy

The American College of Obstetricians and Gynecologists (ACOG) recommends that oral contraceptives (OC) should be available over the counter (OTC). This study explored women's attitudes toward OC OTC in rural South Carolina. In-depth, individual interviews were conducted with 52 women ages 18-44 years old. Data analysis was informed by a reproductive justice theoretical framework and included an inductive, constant-comparative approach using HyperRESEARCH 3.7.5. Participants self-identified as either Black (62%) or White (28%). Participants believed that OC OTC would prevent unintended pregnancy by improving anonymity, convenience, and access to contraception. Many participants faced barriers to receiving a prescription, including time, transportation, cost, stigma, embarrassment, and clinician refusal based on religious reasons. Participants believed OC OTC would improve women's control over their fertility and emphasized the importance of health insurance coverage for OC OTC. Some participants expressed concerns about the risk of side effects, contraindications, and the potential for abuse. Some participants believed women, especially adolescents, required physician guidance and an annual exam to use OC. Findings suggest that a lack of knowledge and misinformation about the risks of OC serve as a barrier among some women in rural areas. Widespread acceptance of OC OTC will require messaging strategies to dispel safety concerns about OC OTC and empower women.