title: One versus multiple packs for women starting oral contraceptive pills: a comparison of two distribution regimens.
abstract: BACKGROUND
  Despite World Health Organization and International Planned Parenthood Federation recommendations to provide multiple pill cycles to new users, many programs in developing countries still give only one pill cycle to new acceptors.
  
  
  METHODS
  To compare provision of a single versus multiple packs of pills, new pill users in 20 matched public sector clinics in Jamaica were assigned to one of two pill regimens in which they received either one (then subsequently three) or four pill cycles at method initiation. The primary outcome was the proportion of women who used pills beyond 4 months.
  
  
  RESULTS
  Among 655 women, those receiving one cycle of pills at initiation, followed by counseling and a three-pack resupply, were no more likely to be using pills after 4 months than women who received four packs at initiation (odds ratio=1.33; 95% confidence interval=0.88-2.0). In both pill regimen groups, returning late to the clinic for resupply was a problem. However, more women in the 1+3-pack regimen group returned late to study clinics to obtain their fifth cycle of pills than their counterparts in the 4-pack regimen group (53% vs. 28%).
  
  
  CONCLUSIONS
  Our findings support the recommendation that pill users should be given more than one cycle to start, because an extra visit for resupply contributes to clinic and provider costs. Moreover, providing more pill cycles at initiation would decrease the likelihood that women experience a gap in pill use between cycles.
authors.affiliation: Family Health International, Durham, NC 27713, USA. dchin-quee@fhi.org
authors.forename: Dawn
authors.initials: D
authors.lastname: Chin-Quee
authors.forename: Conrad
authors.initials: C
authors.lastname: Otterness
authors.forename: Maxine
authors.initials: M
authors.lastname: Wedderburn
authors.forename: Olivia
authors.initials: O
authors.lastname: McDonald
authors.forename: Barbara
authors.initials: B
authors.lastname: Janowitz