Should oral contraceptives move over the counter? Readers speak out

When it comes to moving oral contraceptives over the counter (OTC), most participants in the Contraceptive Technology Update Contraception Survey say they support such a move. Almost 50% say they would support OTC availability of progestin-only pills, while 32% say they would support similar availability of combined hormonal pills.

A variety of factors contribute to nonuse of contraception, gaps in use, and early discontinuation, all of which put women at risk of unintended pregnancy, states a just-published article on OTC access to pills.¹ For some women, difficulties accessing contraception, including challenges obtaining a prescription or a method and problems paying for a method, lead to nonuse, the article notes.

In one study that looked at gaps in use, 40% reported problems accessing or using methods.² Results from a nationally representative sample indicate 30% of women who had ever tried to obtain a prescription for hormonal contraception reported difficulties obtaining the prescription or refills.³

Momentum is growing in the move toward putting pills within women’s reach. Support for OTC access has been voiced by medical groups such as the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.^4,5

“FREE THE PILL”

In December 2014, Ibis Reproductive Health and the Oral Contraceptives (OCs) Over the Counter Working Group launched Free the Pill, a website (www.freethepill.org) and social media resource (on Facebook and Twitter) to provide information and updates on making a birth control pill available without a prescription in the United States, says Kate Grindlay, MSPH, senior project manager at Ibis Reproductive Health. Ibis, based in Oakland, CA, is an international nonprofit organization with a mission to improve women’s reproductive autonomy, choices, and health worldwide. Ibis convenes the OCs OTC Working Group. It was formed in 2004 by researchers, advocates, and healthcare providers to work toward moving a pill over the counter to improve access to safe and highly effective contraception.

The website contains frequently asked questions and answers; information about the pill; and a “Voices” page, featuring quotes from women and men around the country on their opinions on making a birth control pill available over the counter. It also offers such resources as information on the full range of birth control options and where people can access them, how women can tell if the pill is right for them, and a map of countries around the world where the pill already is available OTC, says Grindlay. The Facebook and Twitter pages are regularly maintained with the latest news articles and updates on moving a pill OTC, as well as infographics and other materials designed to educate and engage, she states.

“Together, these resources aim to provide accessible, evidence-based information to a general audience in the U.S. that may have heard about the issue and wants to learn more, as well as to new audiences being reached for the first time,” Grindlay observes.

The Free the Pill campaign is rooted in the philosophy that an over-the-counter birth control pill should be available at a low cost, covered by insurance, and accessible to people of all ages, says Grindlay. To date, more than 5,300 people have “liked” the Facebook page, and nearly 550 people have followed Free the Pill on Twitter, she reports.

“Free the Pill serves an important role as a platform for raising awareness around this issue and creating a space for dialogue in which people can engage with each other and expert resources to learn more, ask questions, and push the conversation forward,” says Grindlay. “And the conversation has just begun.”

WHICH PILL WILL BE FIRST?

What will it take to move a pill over the counter?

At first glance, it seems likely that oral contraceptives meet the Food and Drug Administration (FDA) criteria to be accessed without a prescription.¹ Birth control pills have no significant toxicity if overdosed and are not addictive. Women themselves determine if they are at risk of unintended pregnancy, which means they essentially self-diagnose the condition for appropriate use of the product.

The FDA also will want to see that women can safely take the medication without a clinician’s screening and take the medication as indicated over time without a clinician’s explanation.¹

Progestin-only pills (POPs) meet the criteria for over-the-counter status, states Susan Wysocki, WHNP-BC, FAANP, president and chief executive officer of iWomansHealth in Washington, DC, which focuses on information on women’s health issues for clinicians and consumers.

“First, they are safe for most women. The conditions in which POPs are not ideal are identifiable to the user since, in most cases, that individual would be receiving medical care for that condition,” states Wysocki. “Other OTC products, such as cold products, list conditions in which use of those products should be avoided.”

By moving POPs to over-the-counter status, it would give women an opportunity to obtain an effective method of contraception easily, notes Wysocki. It might be a continued method or a bridge method to a longer-acting method, she states.

REFERENCES

1. Grossman D. Over-the-counter access to oral contraceptives. Obstet Gynecol Clin North Am 2015; 42(4):619-629.
2. Frost JJ, Singh S, Finer LB. U.S. women’s one-year contraceptive use patterns, 2004. Perspect Sex Reprod Health 2007; 39(1):48-55.
3. Grossman D. Moving oral contraceptives over the counter.
4. American Academy of Family Physicians. Over-the-counter oral contraceptives.
5. American College of Obstetricians and Gynecologists. Committee Opinion No. 615: Access to contraception. Obstet Gynecol 2015; 125(1):250-255.