Daily context matters: predictors of missed oral contraceptive pills among college and graduate students

Am J Obstet Gynecol. 2010 Oct;203(4):323.e1-7. doi: 10.1016/j.ajog.2010.05.039.


Objective: The purpose of this study was to understand the relationship between daily contextual factors and oral contraceptive (OC) adherence among students who attend college or graduate school.

Study design: Data on OC adherence, demographics, contextual factors, and side-effects were collected as part of the acceptability of the NuvaRing (Merck & Co, Whitehouse Station, NJ) vs OC study, in which students were assigned randomly to the contraceptive vaginal ring or to a low-dose OC. We performed bivariate and multivariable analyses to create an explanatory model for nonperfect OC adherence (missed at least 1 pill during 3 months of use).

Results: In a multivariable predictive model, missing a pill was associated positively with high perceived stress (odds ratio [OR], 3.16; P = .007), having ≥10 hours per week of paid employment (OR, 2.13; P = .075), and living with a partner (OR, 9.92; P = .040).

Conclusion: Stressful and hectic lives contribute to poor OC adherence. When counseling women about contraception, clinicians should consider the influence of daily life on contraceptive adherence.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Contraceptives, Oral / administration & dosage*
  • Employment
  • Female
  • Humans
  • Medication Adherence*
  • Multivariate Analysis
  • Residence Characteristics
  • Stress, Psychological / epidemiology
  • Students*
  • Surveys and Questionnaires
  • Universities
  • Young Adult


  • Contraceptives, Oral