Birth Control Available Over the Counter? Providers Say 'Yes'

Hooray!  'They' (some nebulous collaboration of physician's organizations and government officials) are considering making birth control pills available over-the-counter.  It seems providers and physician's organizations would naturally be against the movement as it will result in decreased health care revenue (goodbye yearly GYN visit?) but they are not.  Maybe as medical providers we have all seen one too many 14 year old girls with a child...or two.  

What are the positives and negatives of selling OCP's unregulated to the masses?  How will this effect women's health screenings?  Will this policy actually affect unwanted birth rates?

Why is the American Congress of Obstetricians and Gynecologists Recommending OTC Access to 'The Pill'?

According to the American Congress of Obstetricians and Gynecologists (AOGC), the rate of unintended pregnancy has remained unacceptably high, 50%, for over 20 years.  Yes, there is a 50% chance your mother didn't want...OK plan...on having you.  Women who aren't planning on pregnancy are more likely to smoke or drink alcohol during pregnancy, become depressed, experience domestic violence and are less likely to seek prenatal care.  Adverse neonatal outcomes such as low birth weight and developmental problems are correlated with unintended pregnancy.  A recent estimate indicates that unintended pregnancy costs U.S. taxpayers $11.1 billion each year.  Unintended pregnancy takes a toll on mothers, infants and taxpayers.  The AOGC believes more measures should be taken to prevent it. 

But What About Safety and Screening?

The natural reaction I expected from providers in regards to transitioning OCP's to OTC was something along the lines of "Impossible, now no one will go for pap smears and breast exams, women everywhere will die of DVT's related to uncontrolled use of these hormone-containing medications and GYN's will be out of work (but don't say that last one out loud)".  Not so.  The AOCG points out that no drugs, including those currently sold over-the-counter are without harm.  Take too much Tylenol and you will experience significant liver damage, or even death.  Excess Ibuprofen results in gastrointestinal bleeding.  Although there are safety concerns about DVT with birth control pills, the risk is actually quite low (especially compared to risk of DVT in pregnancy or postpartum).  A simple questionnaire included in birth control packaging could screen and warn women if they are at increased risk of this complication.

Concern arises that with birth control pills over-the-counter, patients will become non-compliant with recommended screenings such as pap smears and breast exams.  In many other countries birth control pills are already available over-the-counter.  Researchers found that rates of screenings for those receiving prescription birth control pills and patients purchasing birth control OTC were very similar.  Both groups reported high rates of STI testing, Pap tests within the past three years and clinical breast exam.  Crisis averted. 

It Looks Like the Data Supports the OTC Move, But What are the Drawbacks?

Currently, under many insurance plans, birth control is free, or at least low cost.  There are concerns that if birth control moves to over the counter status it will no longer be paid for by insurance companies and will become unaffordable.  A recent national survey reported the average woman taking birth control pills in the U.S. pays about $16 each month for these medications.  For some women this proves a significant cost (I would like to know how much they are spending each month on cigarettes but that's a different post...).  The government, pharmaceutical companies and insurance carriers will likely need to work together to formulate a plan for addressing the issue of cost associated with transitioning OCP's over-the-counter.

I, for one, am in favor of selling birth control pills over-the-counter.  They have a relatively benign safety profile, especially when used properly, and are already widely used.  Increasing access will prevent unintended pregnancy and simply make life easier for those of us taking OCPs on a daily basis.