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The Birth Control Pill Over-the-Counter: Safe Enough to Sell Without a Rx

January 3, 2013
Different kinds of birth control pills.

Different kinds of birth control pills. (Photo credit: Wikipedia)

Is the higher income phenomenon a curse when it comes to birth control?  Apparently it is for women who want to purchase the birth control pill.  Countries with higher incomes made it more difficult for women to get access to the birth control pill:

Dr. Daniel Grossman, of Ibis Reproductive Health in Oakland, California, and his colleagues found that women in the U.S. and 44 other countries need a prescription to get birth control pills.

The group reported in the medical journal Contraception that while another 56 countries had laws requiring prescriptions, in practice women could access the contraception over-the-counter.

Thirty-five countries legally allowed access to oral contraceptives over-the-counter, and 11 countries allowed over-the-counter access as long as the woman is screened to ensure that she is a good candidate.

“The patterns we saw were interesting,” said Grossman. “Higher income countries – western Europe, Australia, Japan and North America – generally require a prescription.”

Grossman told Reuters Health he couldn’t explain why these patterns have emerged.

“Perhaps in places like China and India that have pills available over-the-counter formally without a prescription might be consistent with strong national family planning programs,” he speculated.

Dr. Ward Cates, of FHI 360, a research organization in Durham, North Carolina, said the lack of a prescription requirement might also reflect a general approach to making health care more accessible in countries where it is less available.

In some countries, “healthcare tends to be more fragmented and healthcare oversight tends to be more fragmented. Therefore the availability of products tends to percolate to outlets that tend to be more accessible to the public,” said Cates, who was not part of the study.

Grossman said it will be useful for countries looking to ease restrictions on birth control access to look to the experiences of these countries.

“Will this information about the availability of pills being over-the-counter in other countries influence policy here? Probably not,” Grossman told Reuters Health.

“But I do think it helps to put it in perspective that this is not something revolutionary.”

While the United States prides itself on cutting-edge medical environments, it certainly falls far below the standards of other countries in giving women unrestricted access to birth control.

For those who say this practice might not be safe, consider the fact that the American College of Obstetricians and Gynecologists advocate selling the pill over the counter, just like condoms:

Half of the nation’s pregnancies every year are unintended, a rate that hasn’t changed in 20 years — and easier access to birth control pills could help, said Dr. Kavita Nanda, an OB/GYN who co-authored the opinion for the doctors group.

“It’s unfortunate that in this country where we have all these contraceptive methods available, unintended pregnancy is still a major public health problem,” said Nanda, a scientist with the North Carolina nonprofit FHI 360, formerly known as Family Health International.

Many women have trouble affording a doctor’s visit, or getting an appointment in time when their pills are running low — which can lead to skipped doses, Nanda added.

If the pill didn’t require a prescription, women could “pick it up in the middle of the night if they run out,” she said. “It removes those types of barriers.”

ACOG says:

—Birth control pills are very safe. Blood clots, the main serious side effect, happen very rarely, and are a bigger threat during pregnancy and right after giving birth.

—Women can easily tell if they have risk factors, such as smoking or having a previous clot, and should avoid the pill.

—Other over-the-counter drugs are sold despite rare but serious side effects, such as stomach bleeding from aspirin and liver damage from acetaminophen.

—And there’s no need for a Pap smear or pelvic exam before using birth control pills. But women should be told to continue getting check-ups as needed, or if they’d like to discuss other forms of birth control such as implantable contraceptives that do require a physician’s involvement.

Prescription-only oral contraceptives have long been the rule in the U.S., Canada, Western Europe, Australia and a few other places, but many countries don’t require a prescription.

Switching isn’t a new idea. In Washington state a few years ago, a pilot project concluded that pharmacists successfully supplied women with a variety of hormonal contraceptives, including birth control pills, without a doctor’s involvement. The question was how to pay for it.

Some pharmacies in parts of London have a similar project under way, and a recent report from that country’s health officials concluded the program is working well enough that it should be expanded.

And in El Paso, Texas, researchers studied 500 women who regularly crossed the border into Mexico to buy birth control pills, where some U.S. brands sell over the counter for a few dollars a pack. Over nine months, the women who bought in Mexico stuck with their contraception better than another 500 women who received the pill from public clinics in El Paso, possibly because the clinic users had to wait for appointments, said Dr. Dan Grossman of the University of California, San Francisco, and the nonprofit research group Ibis Reproductive Health.

“Being able to easily get the pill when you need it makes a difference,” he said.

For women who take the pill, and women like myself who have taken the pill in the past, getting regular and convenient access to birth control can be a lifesaver, literally.  The question is: why did it take the U.S. so long to get to this point?  Why can’t women take a medication that has been proven relatively safe, with women being able to have more control over their reproduction?  More people have acetaminophen-related liver damage and death each year than most medications, and yet Tylenol is sold over the counter; why the bias against birth control?


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