November 21, 2012 — The American College of Obstetricians and Gynecologists on Tuesday issued a policy statement recommending that oral contraceptives be sold without a prescription to help reduce unintended pregnancy rates in the U.S., the Los Angeles Times reports (Bardin, Los Angeles Times, 11/20).
In the statement, which was published in the journal Obstetrics & Gynecology, ACOG noted that about 50% of pregnancies in the U.S. are unintended, costing taxpayers about $11 billion annually (Grens, Reuters, 11/20). Making birth control available over-the-counter would reduce barriers to access and use and possibly decrease unintended pregnancy rates, ACOG wrote (Wilson, CNN, 11/21).
In the past, some physicians have expressed reservations about nonprescription access to oral contraceptives because of concern about side effects and that women might skip preventive health exams if they do not need to visit the doctor for a prescription. Some birth control pills can raise the risk of blood clots and stroke.
Kavita Nanda, a physician with FHI 360 who co-wrote the ACOG statement, said, "Oral contraceptives are very safe, and data show women can make these decisions for themselves." She noted that the risk of blood clots and stroke is much higher for women who are pregnant than for women using birth control. In addition, she said studies show that women are capable of using self-administered health questionnaires to determine whether they should use birth control pills.
ACOG also addressed concerns that women might forgo other health care services, such as Pap tests, breast exams and screening for sexually transmitted infections. The group cited one study that found women who purchased oral contraceptives without a prescription were nearly as likely as those who had prescriptions to stay up-to-date with their other care (Painter, USA Today, 11/20).
Role of Drugmakers
The shift to nonprescription birth control would require a drug manufacturer to submit an application to FDA for approval. The company would have to research its birth control product's safety as an over-the-counter medication. Although FDA said it is willing to meet with drug companies that are interested in such a move, OTC approval of a medication taken daily for an unlimited period of time would be "uncharted territory," according to Daniel Grossman, vice chair of ACOG's Committee on Gynecologic Practice Bulletins (CNN, 11/21).
Grossman also noted that even if oral contraceptives become available without a prescription, cost and insurance coverage will continue to create obstacles to increased use. Under rules being implemented through the Affordable Care Act (PL 111-148), most health plans must cover prescription birth control without copayment or deductibles. However, it is unclear how nonprescription birth control would be affected, according to Reuters.
Diana Greene Foster, a professor at the University of California-San Francisco, said ACOG's opinion is a " big deal, because they're currently the gatekeepers," adding, "So when the gatekeepers are willing to let women have access to (over-the-counter) oral contraceptives, it does support it" (Reuters, 11/20).
The National Latina Institute for Reproductive Health in a statement noted that the move could help improve access to birth control for certain populations. "Over-the-counter access will greatly reduce the systemic barriers, like poverty, immigration status and language, that currently prevent Latinas from regularly accessing birth control and [result] in higher rates of unintended pregnancy," the group said (CNN, 11/21).