Birth Control Pills Going Over the Counter?

The American College of Obstetrics and Gynecologists (ACOG) have released a committee opinion statement that they recommend over-the-counter access to oral contraceptive pills (OCs). ACOG believes that access and cost are the major barriers to women using contraception, and that OTC birth control pills will greatly reduce those barriers, thus lowering the unintended pregnancy rate. ACOG feels that there is no significant safety risk when OCs are compared with medications such as aspirin, which has been OTC for decades. (Note, however, aspirin would unlikely be approved if it were starting the whole FDA approval process in 2012! Great drug, very useful, but the side effect profile is much higher than tolerated in drug trials today.)

This issue will surely be open to widespread debate, pulling in religious and political arguments as well as medical. I’d like to share my thoughts on purely the medical front. As a family physician, I appreciate the value of an “annual” physical exam and know that OC prescriptions are usually a tiny portion of that visit. As a busy mom, however, I know that many women are only motivated to make time for that exam when that visit is a requirement to continue taking a prescription medication- which for many healthy women, is only an oral contraceptive. I worry that women will push aside their other often silent health issues such as weight, blood pressure, blood sugar, cholesterol if there is not another reason “forcing” them back in to see their physician. Additionally, there is significant counseling that we pair with birth control prescriptions- from logistics about the medication itself (taking it the same time every day; what to do if spotting or missed pills, etc.), discussions about the impact of OC’s on other conditions such as depression or migraines,  and of course, education about sexually transmitted diseases. Additionally, I believe most clinicians and many OC users would agree that there is an art to choosing the correct OC that goes well beyond a basic flow chart. I shudder to think of the media war that will ensue as the drug companies ramp up their ads to try and capture their piece of the OC market. The pharmacists, though well-versed in OC pharmacology, simply will not have time to individually counsel women about these issues.

BOTTOM LINE: OTC OC’s? Buyer beware.

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