Birth Control Pills Sold OTC? Smart Move, Doctors Say

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Birth control pills should be sold over-the-counter (OTC), according to the nation’s leading group of obstetricians and gynecologists.

The American Congress of Obstetricians and Gynecologists (ACOG) said in a statement this week that the move would reduce an unacceptably high rate of unintended pregnancies that costs taxpayers about $11.1 billion each year. About half of all pregnancies in the U.S. are unintended.

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Other countries sell birth control pills without a prescription, including Jamaica, Mexico, Kuwait and Thailand.

Birth control pills do have some risks, including a small chance of a blood clot, but these risks don’t outweigh the benefits, says ACOG.

“Nothing in life is without risk,” says Jill Rabin, MD, chief of ambulatory care, obstetrics and gynecology and head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, NY, who supports the move.

“In pregnancy, women produce more estrogen and progesterone than when they take a birth control pill,” she says. “If you have a reproductive-age woman who doesn’t want to be pregnant either by choice or for a medical reason, it’s safer to take the pill rather than get pregnant.”

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Some questions remain unanswered though, including a big one about cost.

Thanks to President Obama’s Affordable Care Act, contraception–including birth control pills–is free for women who have employer-sponsored insurance (although woman may have a co-pay for some branded drugs, and those without insurance are out of luck).

Would making birth control pills available over-the-counter shift the bill back to women? Most insurance companies don’t cover non-prescription drugs, so it’s unclear who would pay if the pill was sold at the local pharmacy without a prescription.

And then there’s the question of whether a shift from prescription to over-the-counter status of birth-control pills would ever actually happen. Dr. Rabin, for one, believes it has “a good chance of happening,” given the experience in other parts of the world.

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While there are concerns that women who shouldn’t be taking the pill for health reasons might do so anyway if the drugs were available over-the-counter, research suggests this is unlikely, according to ACOG. Another concern–that women will skip important health checkups if they don’t have to see their doc for a prescription–also doesn’t hold up, they said.

Surveys have shown that women are able to “self-screen” to determine if they are at higher-than-average risk for side effects. Pharmacists, too, were able to screen out inappropriate candidates using check lists.

In other countries where the pill is already available over-the-counter, studies show women still get their annual gynecological check-ups.

“Oral contraceptives have been out for many, many, many years in this country,” said Gerald F. Joseph, MD, ACOG’s vice president, practice activities, in a statement. “And although no drug is perfectly safe, even aspirin has its side effects, that oral contraceptives are a relatively safe drug, the benefits far outweigh the risks.”

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