Over the Counter Birth Control?

In a new committee opinion, the American College of Obstetricians and Gynecologists (ACOG) wrote that birth control pills should be sold as an over-the-counter drug, meaning "the pill" would be available to women without a doctor's prescription or a preliminary medical examination.

According to ACOG, unintended pregnancies accounted for 50% of all American pregnancies in the past 20 years, a rate that is "unacceptably high", according to ACOG. According to the Institute of Medicine, women with unintended pregnancy are "more likely to smoke or drink alcohol during pregnancy, have depression, experience domestic violence, and are less likely to obtain prenatal care or breastfeed. Short interpregnancy intervals have been associated with adverse neonatal outcomes, including low birth weight and prematurity, which increase the chances of children’s health and developmental problems."

"A potential way to improve contraceptive access and use, and possibly decrease the unintended pregnancy rate, is to allow over-the-counter access to [oral contraceptives]," the Committee on Gynecologic Practice wrote in the opinion.

Concerns regarding the use of birth control pills include their being linked to increased risk of blood clots and venous thromboembolism (VTE), a potentially deadly condition. The committee says that the risk is, however, "extremely low" and that only 3 out of every 10,000 women using oral contraceptives experience VTE, lower than the rate of women who experience VTE while pregnant or after having just given birth. (Abstract). ACOG says that women should self-screen for most contraindications to oral contraceptives using checklists and that a doctor's screening should not be required.

Other concerns cited are that, when no longer required to visit a doctor in order to obtain a prescription, many women will not receive the pelvic exams, pap smears and STD tests which they would typically receive when seeing a doctor to obtain birth control.

While ACOG asserts that making birth control available over the counter will lower the over-all cost of the pills (on average, uninsured American women spend $16 a pack for the pill) some worry that, when no longer covered by insurance as a prescription drug, the cost of their birth control will actually go up.

This opinion, though ground breaking, is unlikely to change the way oral contraceptives are dispersed in the immediate future. Changing the availability of birth control pills would require drug companies to seek permission from the government to sell the pills without a prescription, and it is unclear if any companies will do so.