Is over-the-counter birth control really a good idea?

If you've seen tweets and headlines about over-the-counter products birth control lately, you could be really excited. The idea behind the counter birth control You could go to a retailer, such as a pharmacy, and take a contraceptive without needing a prescription from a pharmacist or doctor. As huge Fans of the idea that all people who want birth control should be able to access it, we honestly understand the whole buzz. Hell yes to make contraception easier to get … no?

Like most things that seem 100% excellent, there is actually a lot more to consider when deciding whether over-the-counter birth control will become a reality in the United States. What would OTC birth control really look like in practice? Would it be a good idea for most people? How do the arguments against that resist? Here, the experts answer these questions and more.

For starters, what types of contraceptives could be sold over the counter?

With regard to over-the-counter birth control, the only feasible options are hormonal methods such as pill, the piece, and the RingEmily Stewart, vice president of public policy at the Planned Parenthood Federation of America (PPFA), told SELF. (This is in addition to the barrier methods already available at the counter, such as the internal method condomcondoms, a diaphragm and a contraceptive sponge.) Non-prescription birth control would not be possible for methods requiring insertion or administration by a physician, such as IUD, the arm implant, and the birth control shot. As smart and determined as you are, it's best to leave some things to the professionals.

Thus, in the most likely scenario, over-the-counter birth control would likely include moving the contraceptive pill (and perhaps just that method) to store shelves. Oral contraceptives are the most popular reversible birth control method in the United States, according to the Centers for Disaster Control and Prevention (CDC), and they are actually already legally available without prescription in dozens of countries. "The expectation is that the [Food and Drug Administration] would first get an application [for OTC status] of a manufacturer of oral contraceptives, "says Stewart. It would then take years of safety and efficacy testing for the FDA to approve the sale of an over-the-counter contraceptive pill.

What are the possible benefits?

Organizations like PPFA, the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG) have published statements supporting over-the-counter oral contraceptives because of their positive impact on people with a bad.

First, there is obvious prevention pregnancy thing.

"Improving access to contraception has benefits for public health [because] this could help reduce the rate of unwanted pregnancies in the United States, "says Sarah SORF, MD, MBA and Darney / Landy Graduate of ACOG,

According to a 2016 study in The New England Medical Journal Based on the pregnancy rates recorded between 2008 and 2011, 45% of pregnancies in the United States were unexpected in 2011. This was a significant decrease from the 51% of unwanted pregnancies in 2008. The authors of the study attributed this increase to increased use of birth control, particularly in long-acting reversible contraceptives (LARCs) such as IUDs, which would not be available over-the-counter. The conclusion is still that increased access to contraception would probably contribute to lowering the rate of unwanted pregnancies.

Hormonal contraception offers other possible benefits besides the prevention of pregnancy. Estrogen and progestin in these birth control methods can help regulate periods, manage the pain of conditions such as endometriosis, tame menstrual migraines in some people, and so much more. (Here is a ton of information about the various potential benefits of hormonal pills, in particular.)

For whatever reason a person wants to use a method of contraception, experts say that using more over-the-counter methods would greatly increase accessibility. For example, someone who does not have Insurance For doctor visits or for people living in areas where access to health care is limited, it would be easier to get contraception, says Dr. Horvath.

Even if you have good insurance, it can be difficult to have an appointment with a doctor. If you need this appointment to get a prescription for the pill, an over-the-counter version would reduce this waiting time. "Making oral contraceptives available at the counter gives women the power to control the timing of treatment, rather than waiting for an appointment," says Dr. Horvath.

Over-the-counter status could also help people stay on the pill or use it more effectively, says Dr. Horvath. Sometimes people can not get a prescription renewal on time or have a flaw in their insurance coverage, so they do not take their contraceptives regularly, which makes them less effective.

In the end, experts believe that it is possible to obtain non-prescription birth control for access to basic health care and reproductive independence. "Women know what's best for them, they know what's best for their health," said Stewart. "We've been advocating for all kinds of ways to support and offer choices for decades," such as making hormonal contraceptives available over-the-counter.

Would it be safe to sell birth control at the counter?

Experts agree that over-the-counter contraceptive pills would generally be safe, with the benefits outweighing the possible risks.

As ACOG stresses that no medicine is safe. Some of the most commonly used over-the-counter medications, such as acetaminophen and aspirin, can have adverse effects on the health of some people. But the serious side effects of hormonal contraceptives, especially contraceptive pills, are very rare. "We have decades of evidence showing [their] safety, "says Dr. Horvath. "So we know they're safe enough to be available at the counter."

One of the biggest safety concerns with hormonal contraceptives is the increased risk of deep vein thrombosis (also called Venous thromboembolism), a type of blood clot that can lead to pulmonary embolism, that is, a blood clot moves and blocks the blood supply to the lungs. Estrogen seems increase the ease with which blood clots, so that all forms of estrogen-based contraceptives are badociated with an increased likelihood of deep vein thrombosis, according to the American Heart Association (AHA). But research has shown that this risk is low overall, according to ACOG. (The risk is higher with the patch, which provides about 60 percent more estrogen For perspective, the risk of blood clot formation is actually much higher during pregnancy and the postpartum period than for hormonal contraception.

Although the risk of hormonal contraception leading to serious adverse events such as deep vein thrombosis is low, it increases with certain risk factors such as smoking and poorly controlled control. high blood pressureand a history of stroke, according to the Mayo Clinic. Before prescribing birth control pills, doctors usually discuss all of these factors with patients before prescribing pills. This is why some people fear that the elimination of the doctor's visit is a problem.

A convenient way to get around this, as proposed by ACOG, is the use of a simple medical checklist to help people screen for an increased risk of serious side effects. "The evidence has repeatedly shown that women are able to self-screen effectively for possible contraindications," says Dr. Horvath.

Take this survey published in The American Journal of Obstetrics and Gynecology In 2008, researchers conducted an experiment on 1,271 people aged 18 to 49 recruited from three shopping centers in El Paso, Texas. First, the researchers asked participants if they thought they were medically eligible for combined oral contraceptives. Then, the participants received a simple medical checklist allowing them to look for the contraindications themselves, and then asked again if they thought they were medically eligible. Finally, the researchers tested the accuracy of these self-tests using nursing badessments and blood pressure measurements. The results of the first selection – when participants did not have the medical checklist – were not great. Only 56% of people with contraindications reported having one. But the medical checklist provided enough information to help most participants accurately badess their eligibility. After reviewing the checklist, 83% of those identified as having contraindications by nurse practitioners and the blood pressure test realized that they did.

Yet, the consensus of the industry is that the progestin-only pill (also called tiny pill) would be the first type of birth control that people could get over the counter. Since it does not contain estrogen, the risks of serious side effects such as blood clots are much lower. But the minipill is slightly less efficient than the combined version, according to the Mayo Clinic. This is partly because his diet is much less tolerant than the combined pills; you must take the minipill within the same three hour period each day in order to use it perfectly, ACOG said.

But would that make people less likely to use more effective birth control methods?

One of the concerns of some people about over the counter birth control is that it could almost be as well practical, in a sense. If birth control, like the pill, becomes available without a prescription, would this easy access make some people less likely to opt for more effective methods of birth control, such as: IUD? Of course, this could happen. But experts generally believe that the benefits of putting in contraceptives available over the counter are still worth it.

Depending on the specific type of IUD, failure rate are estimated to be between 0.2% and 0.8%, which means that less than one in 100 will become pregnant in the first year of use of an IUD. Contraceptive pills have an overall failure rate of 0.3% in perfect use, which still means that less than one in 100 people will become pregnant during the first year of perfect use of the contraceptive pill. But perfect the use of the pill is quite difficult to manage; it means that you have to take it correctly every time – do not take it too late or forget about it. When we talk about typical (including errors such as forgetting the pill), the failure rate increases by 9%, or nine out of 100 people who go wrong by taking their birth control pills in one way or another when they become pregnant during the first year of use. The advantage for a LARC, such as an IUD, is that the error made by the user can not falsify the failure rate as he can with the contraceptive pills.

In their opinion of the commission on birth control over-the-counterACOG solves this problem by explaining that improving access to LARCs and expanding access to OTC birth control should not be mutually exclusive. It is possible to support both causes. If the medical facility refuses to perform birth control without a prescription because these options are not as effective as the LARCs, many people who would benefit from over-the-counter birth control would be ineligible for this protection.

ACOG cites a 2006 study published in the journal Contraception, in which researchers interviewed 811 women aged 18 to 44 at risk of unwanted pregnancy. Sixty-eight percent said they would take advantage of over-the-counter hormonal contraceptives (including the pill, patch, ring, and emergency contraceptives), and 41% of those surveyed did not use any form of contraception . Even though LARCs offer better protection against pregnancy, those who need it some A form of contraception that can access it more easily remains a victory.

"The theory about the decisions that women will make in this scenario should not play a major role in limiting their choices here," says Stewart.

Will people stop doing health screenings if they do not need to see a doctor for British Columbia?

Another frequently cited concern is that if people do not need to see their doctor for birth control prescriptions, they will omit rendez-vous ob / gyn and miss out on all the important health services that usually occur during these visits. But the evidence suggests the opposite.

A 2018 study published in the journal Studies on women's health interviewed 2,026 badually active women aged 18 to 44 and 513 adolescent girls aged 15 to 17 who did not want to be pregnant. Eighty-five percent of respondents said that even if they were taking an over-the-counter, progestin-only pill, they would continue to undergo the recommended preventative screenings.

Previous research shows that there are good reasons to take them at their word. A study published in the journal Contraception in 2012, over 500 US residents who received over-the-counter oral contraceptives in pharmacies in Mexico were compared to more than 500 US residents who received contraceptive pills at family planning clinics in the United States. United. They found that the vast majority of over-the-counter users still report being screened for key preventative cervical cancer (91 percent) bad cancer (almost 90 percent), and badually transmitted infections (72%).

Would over-the-counter birth control be more expensive?

Many experts believe that the most worrying potential involvement in over-the-counter birth control is higher costs.

Currently, the Affordable Care Act prescribed that an employer-provided health insurance covers birth control prescribed without a share, ie at least one form approved by the FDA for each category of contraceptives. (Although the Trump administration has weakened this mandate, it still remains largely in place. SELF previously reported, the Department of Health and Social Services estimates that the new exemptions authorized by the Trump administration will have a relatively small impact, affecting 200 or fewer employers and between 6,400 and 127,000 people who may become pregnant .)

Since ACA's mandate applies only to prescription drugs, insurance companies would not be required to purchase over-the-counter contraceptives. Some would argue that it does not matter, because birth control would become inexpensive if it went over the counter, but there is no reason to think that would be the case. In fact, as the Guttmacher Institute highlights, the best case study we have …emergency contraception– suggests the opposite, because it has remained expensive despite having been sold over the counter since 2006 (for people aged 17 and over, it became over-the-counter for everyone in 2014).

Thus, this change could essentially break down one barrier to access (the need for a prescription) while erecting another (cost to the charge). Making birth control available without a prescription is not helpful if it is also harder for people to pay for it.

"Women should not have to negotiate affordability for access," says Dr. Horvath. "Any effort to make birth control available at the counter should address the problem of affordability by ensuring the same level of insurance coverage as prescription birth control."

Stewart agrees that this point is essential to any political discussion about the possibility of making birth control available over-the-counter. "The most important thing to do is to make sure that ACA's birth control benefit always applies to everything [form of] birth control, "she says.

Fortunately, there is a possible solution to the problem of costs. An effort to avoid a cost / convenience compromise is already under way. In June, Democratic House and Senate lawmakers adopted a preventative measure aimed at preserving the accessibility of birth control at all levels. the Affordability, that is the Access Law would ensure that if the FDA allowed the availability of over-the-counter oral contraceptives, the cost would still be covered by insurance. Nor does it mention the minimum age required for the purchase, unlike other over-the-counter birth control bills this would only make it accessible to people 18 years and older. (Although the price may be potentially out of reach for those who do not have insurance, family planning clinics like Planned Parenthood and community health clinics may offer contraception on a sliding scale. many are doing it now.)

For many people, this scenario would really offer the best of both worlds. This would allow people who currently have no insurance or do not have easy access to medical care to obtain birth control without having to withdraw anything from those who currently benefit from certain types of control of birth control. free births through ACA. This could mean a free birth control option and convenient for everyone, and it's hard to think of a more ideal scenario. This, says Stewart, should be "part of basic health care".

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