I distinctly remember counseling a patient at a local family planning clinic.  She was a 22-year-old; she had just taken a home pregnancy test and was pregnant and now in our clinic in tears.

“I don’t understand! I took the birth control pills the doctor gave me! I’ve been on them 2 to 3 months, how did this happen?” On further questioning of how she took her pills, she was prescribed oral contraceptives but was only taking a pill every time she had sex.

Pills can be amazing, but starting them really needs to be patient-centered care with a discussion between patient and provider. If the patient doesn’t independently state how she will take them, ask about what side effects she may have, or ask what she can do for side effects, then lower health literacy can become a substantial barrier in successful use of pills.