Birth Control Pills Without a Prescription?

In what will undoubtedly be seen as a controversial report, the gatekeepers of oral contraception in America – the influential American College of Obstetricians and Gynecologists (ACOG) – recently recommended that birth control pills should be sold over the counter, without a prescription.

This theoretically shouldn’t be controversial; doctors have been arguing for this since 1968. As drugs go, oral contraceptives are remarkably safe; several studies have shown that taking them daily is safer than taking aspirin daily, not to mention driving a car, smoking, or (dare I say it) having a baby. Over 80 countries worldwide currently sell birth control pills over the counter, without a prescription. They include Portugal, Russia, Indonesia, Turkey, Yemen, the United Arab Republic, Mexico, all but four countries in South America, and 15 countries in Africa. Very few adverse effects have arisen from this practice.

And yet it will undoubtedly become controversial in the United States, for a number of reasons. One reason, of course, is a certain prevalent nanny mentality – some people still feel that others shouldn’t be allowed to have protected sex without a doctor’s supervision. Political furors in recent years have, after all, led to attempts to remove birth control pills from the list of drugs reimbursed by insurance companies and college or work health plans.

What reasons does ACOG have for their recommendation?

The obstetricians and gynecologists of America state clearly that one of their primary reasons for issuing this recommendation is to lower the number of unintended pregnancies, and with reason. At present, almost half of all U.S. pregnancies are unplanned. And although there may be some risks involved in making oral contraceptives available without a prescription, they pale in comparison to the risks involved in childbirth and unintended pregnancy. As Dr. Jill Rabin of the North Shore Long Island Jewish Medical Center says, “If you look at the degree to which unintended pregnancy affects women, and the risks that those unintended pregnancies carry … those risks outweigh the other risks of the medication.”

There are women who should not take birth control pills, but ACOG points out that almost all drugs have potential side effects, and are sold over the counter anyway. Their recommendation, if carried out, would merely require women to read the labels more carefully, and pay attention to warnings against using oral contraceptives if, say, they have high blood pressure or migraine headaches with aura (symptoms that result in changes to their vision, hearing, and motion).

ACOG also points out that many women have trouble affording the doctors’ visit they need to get a prescription, or getting an appointment with a doctor in time to refill an existing prescription, and this can lead to skipped doses, and unwanted pregnancies. If the pills did not require a new prescription, women could pick them up any time from any pharmacy.

What would happen if this recommendation were followed?

First, nothing would happen immediately. The Federal Drug Administration (FDA) has reacted to this recommendation by saying that it is willing to meet with any company willing to make the pill nonprescription, but it would also require a series of drug trials from each of the manufacturers to prove the drug’s safety. That would take some time, so not all brands of birth control pills would “roll out” to pharmacies for over-the-counter sales at the same time. Second, some of the manufacturers might choose not to participate in these tests and instead might keep their products prescription-only, because at present if they are prescribed for a patient, the cost of them is reimbursed by Medicaid and private health insurance companies. This provides a steady source of income to the pharmaceutical companies that they might not want to mess with.

The last point is a viable argument against making oral contraceptives available over the counter – many women for whom their birth control pills are currently paid for by their health insurers would have to either pay for them themselves, or provide a “copay” not reimbursed by their insurance companies. This would cause them an out-of-pocket expense of $15 to $80 per month, or $180 to $960 per year. The ACOG doctors admit this, but also realize that making birth control more accessible would tremendously lower overall health costs to women, by eliminating more unplanned pregnancies and the follow-up care they would incur. Claire Brindis, a reproductive health care researcher at the University of California, San Francisco, says that she is hopeful that “health plans recognize that it’s far cheaper for them to cover the cost of birth control than it is to pay for the cost of pregnancy.”

This decision will be argued for some time before any action is taken, but there do seem to be compelling reasons for ACOG’s recommendations. Many drugs that formerly required a prescription are now sold over the counter, such as Sudafed, Advil, Nyquil, and Claritin. And unlike other prescription drugs, there are very few “down sides” to birth control pills – they are not addictive (unlike cigarettes, which are sold in vending machines), and you can’t take a deadly overdose of them (unlike acetaminophen, which is sold over the counter). Even aspirin can cause stomach bleeding if too much of it is taken.

The controversy will undoubtedly continue, but for me one of the most compelling reasons to listen to ACOG’s recommendations is the one that might escape a lot of people’s notice. These are doctors – the very people who profit from the currently required yearly checkups necessary to get a prescription for oral contraceptives – saying that they don’t really believe these checkups are necessary. There’s really only one good reason for doing this – the doctors are valuing the welfare of their patients over their own ability to make money. And that’s a Good Thing any day.

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