Tylenol, sudafed, and... birth control? The American Congress of Obstetricians and Gynecologists (ACOG) released a statement last week endorsing over-the-counter access to oral contraceptives, meaning the birth control pill would be accessible without a doctor’s exam or prescription. But don’t hit the drugstore just yet: Though the ACOG supports OTC access, the pill probably won’t be on shelves any time in the near future.
The announcement stems from serious concerns about the rate of unintended pregnancy, which the ACOG says is a major public health problem in the United States. If women had better access to oral contraceptives, they reason that unintended pregnancy rates would likely decrease. Over the past two decades, the unintended pregnancy rate has hovered around 50 percent, meaning about one in every two pregnancies is unplanned Unintended pregnancy in the United States: incidence and disparities, 2006. Finer, L.B., Zolna, M.R. Guttmacher Institute, New York, NY. Contraception, 2011 Nov;84(5):478-85.. There are a ton of reasons for unintended pregnancy and the accompanying risks, but the ACOG says access to and cost of contraceptives are high on the list.
While there may be safety concerns about the pill being an arm’s length away from consumers (like possible interactions with other medications), the ACOG argues that other OTC drugs have their fair share of possible adverse affects. Overall, studies have found oral contraceptives are safe when used correctly, and the benefit of contraception outweighs the possible risks Cardiovascular disease and combined oral contraceptives: reviewing the evidence and balancing the risks. Farley, T.M., Meirik, O., Collins, J. Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. Human Reproduction Update, 1999 Nov-Dec;5(6):721-35. Cardiovascular risk and combined oral contraceptives: clinical decisions in settings of uncertainty. Beller, J.P., McCartney, C.R. Division of Endocrinology and Metabolism, Department of Medicine, Center for Research in Reproduction, University of Virginia Health System, Charlottesville. American Journal of Obstetrics and Gynecology, 2012 Feb. 1..
The ACOG (and others) also argue that easy access would actually make the pill more effective. The birth control pill is up to 99.9 percent effective when used correctly, but in reality the failure rate is much higher (with only 93 to 97 percent effectiveness). One reason for the discrepancy is that some people leave gaps between each monthly prescription either because they forget to refill it, or lose a pack and have to wait for a doctor’s approval. One study found that access to multiple pill packs at a time meant people were more likely to continue their use without missing pills The effect of pack supply on oral contraceptive pill continuation: a randomized controlled trial. White, K.O., Westhoff, C. Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts. Obstetrics and Gynecology, 2011 Sep;118(3):615-22..
The bottom line: Many women would appreciate easier access to the pill. A 2004 national survey of women between the ages of 18 and 44 found that 47 percent of uninsured women and 40 percent of low-income women who were not using oral contraceptives, the contraceptive patch, or the contraceptive vaginal ring said they would use those methods if they had access to them without a prescription Birth control within reach: a national survey on women's attitudes toward and interest in pharmacy access to hormonal contraception. Landau, S.C., Tapias, M.P., McGhee, B.T., Pharmacy Access Parnership, Oakland, CA. Contraception, 2006 Dec;74(6):463-70.. While the sample for this survey was small (just 811 women), it’s an indicator that people would like pharmacy access.
Still, over-the-counter sales of the pill probably aren’t feasible any time soon. The Food and Drug Administration (FDA) would require drug companies to prove that the pill’s safe for OTC use (mainly that it’s safe without a doctor explaining how to use it the right way). Another issue is insurance. Currently, women shell out an average of $192 for a year’s supply. If the pill sat on shelves among cold medicines, pain relievers, and other OTC drugs, insurance companies might not cover them, and without insurance coverage, birth control could cost up to $1210 for a year’s supply. Under provisions of the Affordable Care Act (which will take effect in 2014) insurance companies will cover prescription contraception that has been FDA approved, but there’s no mention that this would apply to over-the-counter contraception.
While there’s still a ways to go before the pill ever makes the move to pharmacy shelves, the fact that the ACOG made its statement means it could happen sooner than most of us ever imagined.
Do you think it’s a good idea to make the pill available over-the counter? Let us know in the comment section below or tweet the author @nicmcdermott.