Why Do Women Miss Oral Contraceptive Pills? An Analysis of Women's Self-Described Reasons for Missed Pills

Janice D. Smith, CNM, MS; Deborah Oakley, PhD


J Midwifery Womens Health. 2005;50(5):380-385. 

In This Article

Clinical Implications

Although new OC users must understand to some extent the various risks and side effects of OCs, this study suggests that midwives might emphasize this area less and spend more time discussing with women the practical aspects of taking pills, such as how to prevent pills from being unavailable. Midwives might encourage women to keep a spare pack in their purse, at their boyfriend's house, or at other relevant locations. To avoid running out of pills, women might be encouraged to plan in advance and mark a day on their calendar reminding them to make a trip to the pharmacy. If insurance plans allow, these women might also be encouraged to buy more than one pill pack at a time and to fill their prescription at a 24-hour pharmacy. Reminders, such as a watch alarm, involving a responsible partner, or changing the current pill-taking time to a more appropriate time, may help to deal with forgetfulness. Consideration of over-the-counter access to OCs or access to a limited number of pills through a pharmacist might also be warranted, because it would enable women who forget to bring pills while traveling or away from home to continue taking their pills.

Midwives also must recognize that OC counseling is multidimensional and that a standardized approach will not be effective with all women.[14] How might midwives determine each woman's needs and develop individualized strategies in a hectic, time-limited work environment? After a brief review of OC use at the initial visit, midwives might give new users a diary for recording their daily use of pills, the reasons for missed pills, the days on which sexual intercourse occurred, backup methods used, and any side effects. After the third month, a telephone appointment could be scheduled to review the diary card, discuss challenges that hindered consistent pill taking, as well as behaviors that increased pregnancy risk, and determine together ways in which these barriers and risks might be minimized. When necessary, a return visit might be encouraged. This tailored approach would address individual risks based on the user's personal experience.


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