The following can help programs make the pill more affordable, convenient, and accessible:

• Better access to family planning clinics,
• Community-based distribution,
• Social marketing,
• Encouragement for the commercial sector,
• Links between pill provision and other health services.

For example, in Thailand a study found that the closer clients lived to a family planning delivery site, the more likely they were to use contraception. Even living a few more minutes away made a considerable difference. For instance, among women who lived less than three minutes from a clinic, 47% were using the pill compared with just 24% among women living six or more minutes away (49). Similarly, in Egypt, pill use fell markedly as travel time to the source of supply increased (108).

Having a convenient place to obtain more pills also helps ensure continued use. For example, in Ghana a study of women obtaining pills from a clinic found that nearly half of the pill users who did not return to the clinic for more pills nevertheless kept using the pill. They preferred to buy pills from a more convenient location—often chemists' shops near their homes. Women with a convenient source of supply were over three times as likely to continue OCs over a year-long period and twice as likely to continue using them over a two-year period as women without a convenient source of supply (227).

This study suggests that family planning clinics should not assume that clients who do not return for resupply have stopped using the pill. Particularly where pills are accessible in many types of places, many women obtain them from the most convenient source. Thus, even for women who obtain pills initially from clinics, making pills accessible in all kinds of public and commercial locations, including those unrelated to other health care, can help women continue using the pill. Providers can inform clients not only about clinic-based services but also about other sources of pills (151).

Giving more pill packets. Giving a woman more than one pill packet at a time reduces the chances that she will run out of pills. In addition, decreasing the number of times a client has to return to a clinic reduces clinic congestion and waiting time. Giving a woman 13 packets—a full year's supply—is ideal if she has no health condition, such as nonvascular diabetes, that needs to be monitored (84, 85). After the first year of pill use, clients can have another year's supply or even an 18-month supply, if expiration dates on the pill packs permit (84, 95).

If not enough supplies are on hand to give pill users a full year's supply, women should receive at least three or four packets. Plans for follow-up should leave enough time to obtain more pills well before her supply runs out (84, 111, 180, 235). In the early years of the pill, monthly follow-up was sometimes recommended with higher-dose pills to monitor women closely for any serious side effects. Today's lower-dose pills, however, are safer than ever, and no routine follow-up is needed except for resupply (220). Still, providers often limit how many packets they give out because they think, incorrectly, that they need to monitor the health of pill users (228).