Oral contraceptives are the most widely used hormonal method of contraception globally and the most commonly used reversible method in less developed countries other than China.1 The pill is highly effective and with perfect use has a failure rate of 0.3% in the first year.2 But in practice failure is much higher—closer to 8% or 9%.3 In most countries, women must have a doctor’s prescription to obtain oral contraceptives, although many developing countries do not enforce this and pills are effectively available over the counter.

Data from the United States suggest that, for at least some women, the prescription requirement represents a barrier to both initiation and continuation of hormonal contraceptives. A US national survey of women in 2004 reported that 41% of women not currently using contraception said they would start using the pill, patch, or …