Improving Oral Contraceptive Access

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Should oral contraceptives (OCs) be available without a prescription?  The American ImageCollege of Obstetrics and Gynecology (ACOG) thinks that they should.  In a committee opinion issued late last year, this governing body for women’s healthcare physicians stated that “Weighing the risks versus the benefits based on currently available data, OCs should be available over-the-counter.”  The ultimate benefit to improving access to the most popular form of reversible contraception in the U.S. is to reduce the rate of unintended pregnancy, which has held steady at around 50% for the past 20 years, and potentially leads to adverse neonatal outcomes.

Women taking combination OCs (COCs), which contain both an estrogen and one of several different progestins, incur risks that include a slight increase in venous thromboembolism (VTE), stroke and heart attacks.  These have been deemed acceptable in light of the benefits to COC use, and the fact that they are much lower than during pregnancy and the postpartum period.  But what about women with conditions that increase these potentially catastrophic risks, such as those with hypertension, smokers over the age of 35, and the 28 to 37% of women affected with migraines? A recent study found that 7.6% of women with a history of migraine with aura on one of the newer COCs developed deep venous thrombosis, compared to 6.3% of those without aura.

In light of these findings, do we have the potential to harm too many women by providing COCs over-the-counter (OTC)?  Not if we put in place safeguards to insure they are informed of risk factors and that only select COC formulations are available OTC.  Restricting OTC status to COCs with the lowest estrogen dose and the progestins associated with the lowest thrombotic risk, and requiring consultation with a pharmacist with a checklist of risk factors to determine appropriate COC use could insure safe OTC use.

Cautious over-the-counter provision of COCs could safely give more women the ability to plan their lives more effectively, improving both their lives and the lives of their children.

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2 Responses to “Improving Oral Contraceptive Access”

  1. sc112 Says:

    Dear Lhuff2013,

    Thank you for your post. I think you raise a very interesting question, and one the impacts most in our society, in some way. Improving access of oral contraceptives by removing the barrier of a prescription requirement, would greatly empower women who cannot afford to pay to see a physician, in addition to the costs of contraception. As you discussed, there are certain challenges regarding the health risk associated with taking such drugs. Similar to the administration on the flu vaccine, I believe these barriers could be overcome with appropriate education and engagement of pharmacists and distributors. An additional concern is that women could potentially avoid or delay routine visits to an OBGYN (e.g., for cervical cancer screening) because they are able to obtain the OC at the local drug store . Here again, it will be important to ensure that women are provided with accurate information to ensure that increased access does not deter women from seeking important preventative health care. The issue has been discussed since the 1990’s – it will be interesting to see if the pharmaceutical companies take action. This map shows that most HICs still require a prescription, while many LMICs do not (http://www.cnn.com/2012/11/20/health/birth-control-over-the-counter).

  2. swamphoxphotography Says:

    This is very interesting and poignant topic. Thank you for researching and for posting the article. Frankly, it is baffling that such a debate should still take place considering the benefits of oral contraceptives. Access to oral contraception is not an issue of empowerment but an issue of human rights and freedom (see Articles 1, 2 and 3 of the Universal Declaration of Human Rights). Birth control for anyone was legalized in 1967 (see Supreme Court case Eisenstadt v. Baird) but we have gone backwards since then, and a few representative are pushing anti-birth control legislations in their states, although they are being defeated when put to a vote. Having the prescription requirement waived would benefit not only women, but all of society.

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