Preventing unintended pregnancies

Over-the-counter availability of the pill is not a perfect solution for women’s health.
November 26, 2012

Fifty percent of all pregnancies are unplanned, according to the Guttmacher Institute, a nonprofit organization dedicated to reproductive health research. 

The American Congress of Obstetricians and Gynecologists believes we need to address the high rate of unintended pregnancies — a number that hasn’t changed in 20 years and costs taxpayers an estimated $11.1 billion each year. Last week, the group announced that it recommends oral contraceptives, the most popular method of birth control for women, be available over the counter.

ACOG, consisting of 65,000 members who represent about 90 percent of U.S. board-certified OB-GYNs, argues that going over the counter will increase both access and usage of contraception, as it believes the reasons women don’t use contraception consistently or at all are cost, access and convenience issues. Health advocates are saying it’s about time. But tackling a situation that has historically been handled with a doctor presents some issues. For example, certain birth control pills have been shown to potentially triple the risk of blood clots over other types of pills but are still sold. The Food and Drug Adminstration’s conclusion is that “women should talk to their health care professional about their risk for blood clots before deciding which birth control method to use.”

My concern with ACOG’s recommendation is that it minimizes the importance of this discussion with a doctor. ACOG advises that if birth control were available over the counter, women should “self-screen” by using a checklist such as the one used by the World Health Organization. Ask a woman who feels healthy if she has high blood pressure, as such self-screening methods do, and she will likely say no. High blood pressure generally shows no symptoms — that’s why it’s called the “silent killer.” Women who have this condition are advised not to take the pill, which can have a slight blood pressure-raising effect and, thus, can be dangerous. But not requiring a doctor’s visit to obtain a birth control prescription means this and other conditions might be missed, and women could put themselves at an unnecessary risk.

Needing a renewal of a birth control pill is also a catalyst to get women to the gynecologist to screen for sexually transmitted diseases and cervical cancer. ACOG recommends all women get annual checkups, but without the motivation of the birth control pill prescription, such visits are more likely to shift to the backburner of our busy lives.

Currently, programs like the Minnesota Family Planning Program or assistance offered through clinics like Planned Parenthood ensure the pill is accessible to women of all income levels. Plus, with the Affordable Care Act, the pill will be reimbursed for women with most workplace health plans. If it is sold without a prescription, it won’t be covered under the new law — just like condoms aren’t.

While being able to purchase the pill over the counter may assist in reducing unintended pregnancies, it’s not a perfect plan. It’s also a solution that perpetuates the misconception that unintended pregnancy is a female-specific issue. Why hasn’t the prospect of male birth control pills been more aggressively supported?

Women take the pill daily for an unknown amount of time — rare in over-the-counter medications. While accepted as safe, the pill is not entirely risk free. The high rate of unintended pregnancies undoubtedly needs to be addressed, and if ACOG’s recommendation comes to fruition in a way that does not present increased cost or safety issues for women, it should be supported. But can we do better?

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