Clinical Question: Is dispensing a 1-year supply of oral contraceptives associated with less risk of unintended pregnancy?

Bottom Line: Dispensing a 1-year supply of oral contraceptive pills (OCs) to low-income women receiving family planning services is associated with a significant reduction in unplanned pregnancies and abortions as compared with dispensing a 1-month or 3-month supply. (Level of Evidence: 2b)

Reference: Foster DG, Hulett D, Bradsberry M, Darney P, Policar M. Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies. Obstet Gynecol 2011;117(3):566-572.

Study Design: Cohort (retrospective)

Funding Source: Unknown/not stated

Setting: Population-based

Synopsis: The authors linked data from Medi-Cal registries regarding births and abortions with data from Family Planning, Access, Care and Treatment (PACT), a Medicaid family planning waiver program that provides contraceptives at no cost to women with incomes up to 200% of poverty level. Nearly all women who are eligible for PACT are also eligible for Medicaid in the event of pregnancy. Some PACT clinics are not bound by pharmacy regulations limiting the dispensing of Ocs to a maximum 100-day supply, and may instead dispense up to a 1-year supply. These authors compared pregnancy rates between women who received a 1-year supply (12 or 13 packs) of Ocs with the rates of those who received 1 or 3 packs at a time (N = 84,401women) . Databases were linked based on social security number when possible (46%); otherwise by name plus numerous demographic variables. Most women received 3 packs of Ocs (58%), 20% received 1 pack, 11% received a 1-year supply, and 10% received another quantity of Ocs. Women younger than 20 years were most likely to receive a 1-year supply and women 40 years and older and Spanish-speaking Latina women were the least likely to get a 1-year supply. Women who received a 1-year supply were less likely to have a pregnancy (1.2% vs 2.9% for women getting 1 pack and 3.3% for women getting 3 packs). Women who received a 1-year supply were also significantly less likely to have a Medicaid-funded induced abortion (0.18% vs 0.63% for women receiving 3 packs (P < .05%). Multivariate analysis concluded that dispensing a 1-year supply was associated with a 30% reduction in the odds of pregnancy in the subsequent year and a 46% reduction in the odds of having an induced abortion. The study is limited by its observational methodology. However, younger patients are typically less adherant.