Contraceptive Pearl: Promoting Contraceptive Adherence

User-dependent hormonal contraceptives have a disappointing real-world efficacy rate. For multiple reasons, people miss doses of their medications. Low adherence raises the risk of unintended pregnancy. What can clinicians do to promote contraceptive adherence and improve efficacy? 

The Cochrane Collaborative examined randomized controlled trials aiming to improve adherence to hormonal contraceptives. Nine trials met their criteria. Five focused on counseling and four used reminders. Structured-counseling and peer-counseling interventions did not show benefit. One study used daily text messages reminding patients to take their birth control pill and informing them of the pill’s benefits. Patients receiving these messages were more likely than control patients to continue the pill beyond six months and had fewer gaps in pill use. Another study combined intensive counseling with follow-up phone calls, showing greater pill adherence at three months (but not at 12 months). 

Reviewers concluded that intensive counseling combined with frequent reminders may improve contraceptive adherence. 

Helpful Resources

Your Birth Control Choices

Reminder Apps for patients




Halpern V, Lopez LM, Grimes DA, Stockton LL, Gallo MF. Strategies to improve adherence and acceptability of hormonal methods of contraception. Cochrane Database of Systematic Reviews 2013(10):CD004317


The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.