The New York Times wonders. The American College of Obstetricians and Gynecologists thinks they should be over the counter. The Catholic Medical Association and the American Association of Pro-Life Obstetricians and Gynecologists disagree, of course, because their religious beliefs should obviously dictate the kind of health care that the rest of us are able to access.
After all, oral contraceptives have been available in the United States for more than half a century, and few medicines have been so thoroughly vetted. Despite some catchy new brand names, the pills I took 25 years ago are essentially the same as those my daughter takes today. If anything, pills have become safer because they contain lower doses of estrogen.
While oral contraceptives bring with them some tiny risks, especially if used improperly, they arguably pose fewer dangers than many other medicines bought freely at the pharmacy, experts say, including nonsteroidal pain pills like Motrin (which can cause stomach bleeding) and decongestants like Sudafed (which may raise blood pressure). With a simple packaging insert about proper use and precautions, women would be fully capable of using them safely, the gynecologists’ group maintained.
“Nonsteroidal medicines kill far more people than birth-control pills,” said Dr. Eve Espey, a professor of obstetrics and gynecology at the University of New Mexico, who was involved in writing the position paper. “For most women, the absolute risk of taking the pill is far less than the risks incurred in pregnancy.”
There are actually some good reasons to require a prescription for birth control pills. It does require women to go to the gynecologist, which usually means a Pap smear, STI screening and a chance to talk to your doctor about your health. For lots of women, the gynecologist is the only doctor we regularly see. Making birth control over the counter would almost surely decrease regular gynecological appointments, potentially to the detriment of women’s health.
But I’m not sure that’s more important than making birth control accessible. Requiring a doctor’s appointment means that women without health insurance or who are under-insured aren’t easily able to get the birth control they need, leading to higher rates of unintended pregnancy.
The Times article also highlights the fact that while birth control is incredibly safe, like any medication it poses risks, especially for certain patients — women who smoke, for example. But there’s a pretty simple fix for that:
As for safety, the most common birth-control pill — which combines progestin with a low dose of estrogen — poses a very slightly elevated risk of blood clots and a few other conditions. But that is mostly for certain groups of women, including those with high blood pressure or those who are over 35 and smoke, for example (these women are advised not use them). But warnings could be conveyed in package labeling, just as patients with a history of ulcers are advised not to take certain pain medications. And a few alternative birth-control pills that contain only progestin are generally safe for all.
So far the debate has been argued in black and white. But there is, in fact, a middle ground: many countries that allow pharmacies to sell birth-control pills require that a pharmacist screen women for contraindications with a few simple questions.
My daughter spends hundreds of dollars a year for a gynecologist’s visit to obtain a prescription for the same pill I got a quarter-century earlier. She goes through elaborate machinations to get them if she runs out while away on a summer job. The Affordable Care Act of 2010 seeks to improve access to the pills by eventually eliminating patient copays when prescriptions are filled. But many doctors think it would be even smarter to just eliminate the prescription.