Expanding Access to Oral Contraceptive Pills: Do Consumers Prefer Over-the-Counter Availability?

backgroundExpanding access to oral contraceptive pills (OCPs) through over-the-counter (OTC) reclassification may reduce barriers to contraception, but Australian consumer preferences for OTC OCP access remain poorly understood.

methodsWe conducted a discrete choice experiment (DCE) to quantify women's preferences for OTC OCP access in Australia. The DCE incorporated five attributes: method of accessing OCPs, provider training, ability to discuss other health issues, consultation time, and out-of-pocket cost. A D-efficient design generated 12 choice sets. Data were collected through quota sampling from 878 women during November to December 2023, including 359 current OCP users and 519 non-OCP users. Preferences were analysed using mixed logit models.

resultsWomen using less effective contraceptive methods or no contraception favoured OTC access, whereas current OCP users did not show the same preference. Across groups, online general practitioner consultations and pharmacist consultations without a private setting were strongly disliked. Predicted uptake of, and switching to, OTC options was highest when OCPs received a high level of government funding, pharmacists had additional training in contraceptive care, women could discuss other health issues, and consultations were brief. Current OCP users were more likely to switch to OTC OCPs if they faced GP co-payments. Support for OTC access was greater among younger women, high-income women, and those with greater household decision-making autonomy.

conclusionsOTC access to OCPs is likely to be acceptable to many Australian women, particularly if pharmacists have received additional training in contraceptive care and consultations are affordable, private, and sufficiently comprehensive. Careful policy design will be needed to ensure acceptability, support informed contraceptive choices, and maximise the potential public health benefits of OCP reclassification.