Over-the-Counter Access, Changing WHO Guidelines, and the Prevalence of Contraindicated Oral Contraceptive Use in Mexico

Sara Yeatman, University of Texas at Austin
Daniel Grossman, Ibis Reproductive Health

This paper examines the prevalence of contraindications to use of oral contraceptives (OC) in Mexico by sociodemographic characteristics and whether or not this method was obtained over-the-counter. Using data on smoking behavior and blood pressure measurements from the 2000 Mexican National Health Survey, we find that, using World Health Organization (WHO) 1996 medical eligibility guidelines, the prevalence of contraindications is low and screening against inappropriate OC use is taking place at both clinics and pharmacies. However, in 2000, WHO substantially revised its criteria regarding the level of hypertension that would constitute a contraindication for OC-use. Using the new guidelines, we find that 10% of pill users under 35 and 33% age 35 and over have health conditions that are either relative or absolute (Category 3 or 4) contraindications. We close by discussing the relevance of our findings to the larger debate over screening and over-the-counter access to oral contraceptives.