OB/GYN society says birth control pill should be sold over-the-counter

Birth control pills should be sold over-the-counter, the nation's leading group of obstetricians and gynecologists announced Tuesday.

The American College of Obstetricians and Gynecologists (ACOG) wrote in a new Committee Opinion that after reviewing evidence of risks and benefits, easier access to oral contraception may reduce unintended pregnancy rates, as well as the economic burden and health care costs pregnancies cause.

According to ACOG, unintended pregnancy rates remain "unacceptably high," accounting for about 50 percent of all pregnancies over the past 20 years. Estimates suggest the elevated numbers could costs taxpayers more than $ 11 billion each year.

What's more, women who unexpectedly become pregnant are more likely to smoke or drink during pregnancy, be depressed, experience domestic violence, not breastfeed and/or seek prenatal care, potentially putting mother and baby at risk.

While oral contraception is the most commonly used form of birth control in the U.S., reasons why women don't use the pills or stop them for periods of time include access issues and costs. Some access issues include logistical or practical limitations, like not being able to fill a prescription in time.

"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.

As the authors note, such a plan could raise considerable concerns for many doctors and patients. Oral contraceptives are sometimes linked to an increased risk for blood clots or venous thromboembolism (VTE), a potentially deadly condition that could obstruct blood flow or cause a clot that travels to the lungs and cause death. The FDA said last year that newer birth control pills that contain a hormone called drospirenone may lead to a greater risk for dangerous blood clots than older pills that contain estrogen and progestin.

Overall, however, the committee said risk remains "extremely low" with three to 10 out of every 10,000 women experiencing VTE. Those rates are lower than VTE rates in women who are pregnant or just gave birth.

Over-the-counter oral contraceptives may also mean women would not need a doctor's visit for a prescription. That raises concerns that some women who shouldn't take the pills, such as those at risk for blood clots or who have an unrecognized ailment like hypertension, may risk their health by taking them. ACOG said women should self-screen for most of these contraindications by using a checklist, such as the one from the World Health Organization.

Skipping the doctor also raises concerns that women would miss out on other important women's health services like screening for sexually transmitted diseases and cervical cancer. ACOG itself recommends all women get an annual checkup that includes a discussion on a woman's reproductive health plan.

The Committee cited a study that compared screening habits of women who had obtained birth control from a doctor and women who had obtained them over-the-counter from pharmacies in Mexico. Both groups reported high screening rates for Pap tests, STD tests and breast exams. What's more, screening for these diseases are not medically required to provide hormonal contraception, ACOG noted. However, the Committee did note that there is not that much information about the long-term effects of over-the-counter oral contraceptives.

Adherence issues could also arise, in that women who choose to purchase birth control over-the-counter may be even less likely to take the pills than they do now with a prescription. Adherence problems with birth control was a reason why the American College of Obstetricians and Gynecologists in September said that teenage girls considering contraception should use hormonal implants or IUDs as a "first-line" option.

But in the new guidance, the Committee pointed out studies that found women may be more likely to adhere to the pill with over-the-counter access, including one study that found women who are able to obtain multiple pill packs at a time were more likely to continue using birth control.

Any plan put forth on bringing birth control over-the-counter should include cost considerations, according to ACOG. On average, uninsured women pay about $16 per pack, a significant cost for many.

A provision of the 2010 Affordable Care Act that required insurers pay for contraception began in August 2012,and all men and women will need to be insured by 2014. The ACOG notes it remains to be seen how these guidelines will be implemented.

Tait Sye, a spokesperson for the Department of Health and Human Services told the Associated Press that if the pill were sold without a prescription, it would not be covered under the provision, similar to how condoms aren't.

Another hurdle may be that pharmaceutical companies would need government permission first before putting the pill over-the-counter. The FDA told the AP Tuesday that it would be willing to meet with any company interested in making the pill nonprescription to discuss what studies would be needed.

Birth control is currently available over-the-counter without a prescription or screening in more than 30 countries, and other countries informally allow the pill to be sold over-the-counter even though it technically requires a prescription, according to the nonprofit Oral Contraceptives Over-the-Counter Working Group.

A world map of global oral contraception availability can be found on the coalition's website.

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