Oral Contraceptive Compliance in Rural Colombia: Knowledge of Users and Providers

Errors in pill use among 341 new oral contraceptive acceptors in Magdalena, Colombia, were high, both in daily use and in the transition from one cycle to the next. Fifty-eight percent of the women had used the pill incorrectly during a single two-week period. Of that group, 43 percent made errors during the cycle (such as not taking the pill every day), 47 percent reported making an incorrect transition from one cycle to the next and 10 percent ran out of supplies. Most of the errors reported were intentional acts, such as taking the pill every other day to reduce side effects or taking the pill only around the time of sexual relations. The providers of oral contraceptives in this region--the Colombian Ministry of Health's rural health promoters--knew more about correct use than did their clients, but there were serious gaps in their knowledge as well. Use-effectiveness of the pill might be dramatically improved among these rural women if two messages were clearly given and consistently reinforced: that they must take the pill daily, regardless of sexual activity or minor physical discomforts, and that they must adhere to the proper interval between pill cycles (which depends on whether they are on a 21-day or 28-day cycle). Clear labeling of pill packets could reinforce this message.