Abstract
Objective
To model the impacts of out-of-pocket cost of an over-the-counter (OTC) progestin-only
pill on use and associated unintended pregnancy among U.S. women.
Study Design
Using data from a 2015 nationally representative survey of 2,539 U.S. women aged 15
to 44 assessing interest in using an OTC progestin-only pill, we used discrete survival
analysis and a Markov model to analyze women's likelihood of using of an OTC pill
at different price points and by sociodemographic characteristics. We modeled the
impact of product price on the potential total number of U.S. users and on unintended
pregnancies in 1 year among adult women at risk of unintended pregnancy.
Results
In a model assuming no out-of-pocket costs, more than 12.5 million adults and 1.75
million teens reported likely use of an OTC progestin-only pill if available. Among
adults, this resulted in an estimated 8% decrease in unintended pregnancy in 1 year.
Adult and teen women on average were willing to pay $15 and $10, respectively, resulting
in 7.1 million adult and 1.3 million teen users and an estimated 5% decrease in unintended
pregnancy among adults.
Conclusions
At low and no out-of-pocket cost, a large population of women in the United States
might likely use an OTC progestin-only pill. A low retail price and insurance coverage
are necessary to provide equitable access to this method for low-income populations
across the United States, fill current gaps in contraceptive access, and potentially
decrease unintended pregnancy.
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Biography
Alexandra Wollum, MPH, is a Senior Project Manager at Ibis Reproductive Health. Her research focuses on improving reproductive health in underserved communities and exploring innovative approaches to increase reproductive health access.
Biography
James Trussell, PhD, was emeritus professor of Public and International Affairs at Princeton University. He authored or co-authored more than 350 scientific publications, primarily in the areas of reproductive health and demographic methodology.
Biography
Daniel Grossman, MD, is the Director of Advancing New Standards in Reproductive Health at the University of California, San Francisco. His research focuses on improving access to contraception and safe abortion and evaluating the impact of integrating reproductive health and HIV services.
Biography
Kate Grindlay, MSPH, is an Associate at Ibis Reproductive Health and Project Director of the Free the Pill project. She oversees the implementation of a program to move an oral contraceptive pill over the counter in the United States.
Article info
Publication history
Published online: April 13, 2020
Accepted:
January 17,
2020
Received in revised form:
December 18,
2019
Received:
July 2,
2019
Identification
Copyright
© 2020 Jacobs Institute of Women's Health. Published by Elsevier Inc.
