Abstract One hundred thirty-three patients were enrolled in a study designed to evaluate and compare oral contraceptive use in three rural communities. The patients averaged 31 years old (range, 13 to 49 years); 92% were white, 4.5% Hispanic, and 3% Native American. Genora ®, Ortho-Novum ®, and Triphasil ® were the most frequently prescribed oral contraceptives. Triphasic oral contraceptives accounted for one third (n = 64) of 203 prescriptions, and conventional monoplastic preparations accounted for two thirds. Twenty percent (n = 26) of the patients studied were non-compliant. The most frequent causes of noncompliance cited were cost and inconvenience. However, generic alternatives were requested in only 43% of the cases for which generic equivalents were available. Less-expensive alternatives (eg, generic products, medroxyprogestrone acetate injection) should be advocated to deter patient noncompliance because of cost issues. Drug interactions and adverse effects were not reported in our patient population and thus did not contribute to noncompliance.