Recently, a number of Republican politicians have been promoting the idea of allowing stores to sell birth control over the counter (OTC). Considering how many lawmakers have been making birth control harder to get by defunding the family planning clinics that often provide it (or even advocating laws that could make it illegal), this may seem like a massive policy shift. But is OTC birth control really a good thing? Here, everything you need to know about the debate.
1) Over-the-counter birth control really only refers to birth control pills. When a politician says he or she is in favor of OTC birth control, what that lawmaker or candidate really means is hormonal contraception, and almost exclusively the birth control pill. After all, a pharmacist or cashier isn't going to place an implant in your arm or insert an IUD in your uterus. So while it may be easier to just pick up your pills than, say, having a yearly exam and getting a prescription, you are going to be limited in exactly what sort of contraception you are able to use.
2) The American College of Obstetricians and Gynecologists says over-the-counter birth control is a good thing. In 2012, the American College of Obstetricians and Gynecologists (ACOG) officially endorsed the idea of birth control pills being available over the counter and without a prescription, saying that since 50 percent of pregnancies are unplanned, more access to more reliable contraception like the Pill means fewer accidental pregnancies. According to ACOG, taking birth control isn't a large health risk, so demanding a doctor's exam and prescription in order to buy it is overkill as a safety precaution.
3) Reproductive rights groups like it too. Many reproductive rights and reproductive justice groups also support OTC birth control, saying that more access means fewer unwanted pregnancies for communities of color, immigrants, and the poor, all of whom are less likely to have health insurance or regular doctors. This is one place where the safety of the Pill, even without a doctor's guidance, is key. "The comparison isn't taking the Pill or not taking the Pill," Kirsten Moore, president and CEO of the Reproductive Health Technologies Project, told CNN in 2012. "It's taking the Pill or not taking the Pill and risking becoming pregnant."
"The recommendation that birth control be available over the counter supports what we know about Latinas and contraception: over-the-counter access will greatly reduce the systemic barriers, like poverty, immigration status, and language, that currently prevent Latinas from regularly accessing birth control and results in higher rates of unintended pregnancy," agreed the National Latina Institute for Reproductive Health back in the early days of the announcement.
The caveat, however, from all of these groups is that OTC birth control can't just be accessible in a physical way. It has to be economically accessible too, with a low price point that doesn't keep people from being able to afford the medication.
4) People who get the Pill OTC may be more likely to keep using it. One study conducted in 2011 compared patients who got birth control pills from their family planning clinic to those who got them over the counter from a Mexican pharmacy. The results? Those who got their pills from the pharmacy were more likely to continue using the pills than those who had to continue obtaining them from their local clinic. That number went down when those who got their pills from a clinic were allowed to get six or more months of birth control at one time, making it appear that the real issue is the inconvenience of being forced to return to a specific clinic repeatedly to restock.
5) That yearly exam to renew your prescription may be totally unnecessary. One of the major arguments against OTC birth control is that it means that a woman isn't going to get her annual exam. The question is whether that exam is even necessary. Medical best practices now say that you only need a Pap smear every three years if you don't have any risk factors, such as prior irregularities in your exam or a family history of cervical cancer, and every three years is just fine for breast exams too. Some public health experts are not only calling annual pelvic exams "obsolete" but also a waste of resources.
However, it should be clear that there are no solid proposals for how a patient would choose the birth control pill that she would like to take, and without a doctor's exam, that could put a lot more responsibility on her to navigate the pros and cons of each available medication. Some OTC backers say that this isn't an issue, that women should already be researching their medication before they purchase it, and that doctors sometimes use trial and error too. Others suggest kiosks at drugstores so a consumer can enter her personal information to find the best fit. All of these concerns would need to be weighed if OTC birth control ever becomes a reality.
6) Not everyone advocating for OTC birth control is actually in favor of birth control. Some of the candidates who are now saying birth control pills should be sold over the counter are the same politicians who have previously supported bills that would have potentially made those pills harder to obtain. One prime example is Colorado Senate candidate, Republican Rep. Cory Gardner. Prior to his campaign for Senate, Gardner backed the state's "personhood" ballot amendment, which would likely have banned most hormonal birth control, including the Pill. Now he's saying that birth control should be available over the counter, despite his cosponsorship of a "Life at Conception Act" on the federal level that could ban some forms of hormonal birth control.
Rep. Gardner isn't alone. Kentucky Senator Rand Paul, Louisiana Governor Bobby Jindal, North Carolina Senate candidate Tom Tillis, and other Republican politicians who have been anti-reproductive rights have begun to very publicly and very ardently support the idea of OTC birth control.
Why the shift? Because backing OTC birth control means that these politicians can pander to religious businesses and organizations who refuse to allow birth control coverage in their health insurance plans, while at the same time argue that they aren't actually against contraception.
7) It probably won't save you any money. One of the biggest issues customers have with any drug that was formerly available by prescription moving to OTC is that it often increases the cost. Insurance companies subsidize medications that are prescription only, and customers often have only a small copay so, depending on the drug, being able to purchase it directly means more out-of-pocket expense.This already has happened with many allergy, antacids, and other medications. The cost increase would be even bigger when it comes to the birth control pill, since one of the provisions of the Affordable Care Act is that those with insurance should be getting no-copay birth control already, eliminating your monthly expense. Put the Pill in stores, and that will likely send you back to paying a bill every 28 days.
8) There is a small chance it could increase unintended pregnancy. While the birth control pill is great for a lot of people, it's not the best option for everyone. More studies are showing that the most effective ways of preventing pregnancy are long-lasting, reversible birth control methods. As The New York Times reported in September, birth control has two different types of failure rates — one if you use it correctly all the time, and one that takes the likelihood of user error into account.
Comparing perfect use and typical use, the Pill has only a 3 percent likelihood of failure in 10 years of use if used correctly, but with typical use, that error rate increases to 61 percent. Meanwhile, birth control methods like IUDs and implants have nearly identical rates of failure between perfect and typical use, even over a 10-year span, because there is so little room for error. Yet because they would require a doctor's visit and the Pill would just require a trip to the store, women may be inclined to use less effective contraception for the sake of convenience.
9) That pharmacist could be an even bigger barrier than before. It's no longer anecdotal: Some pharmacists are refusing to fill birth control prescriptions, saying that they find it morally objectionable. In fact, over the last few years "conscience clause" legislation has spread across the country, vastly expanding the definition of who is allowed to object to dispensing birth control or in other ways assisting in reproductive health care.
While OTC birth control pills may remove the doctor from the purchase, they aren't likely to remove the pharmacist. Although there are no formal discussions of exactly how birth control would be dispensed if it were sold over the counter, the recent experience with Plan B, a form of emergency contraception (EC) that can be taken up to 72 hours after unprotected intercourse to prevent pregnancy, shows that OTC pills are still likely to have a number of restrictions. As in the case of EC, we can expect an age limit and, because of that, you can bet the pills will still be locked away behind counter, meaning a pharmacist or clerk will need to approve the purchase. Whereas a pharmacist may be a little squeamish about denying a patient a doctor-prescribed medication, that same pharmacist may have fewer reservations blocking a sale of a non-prescription medication.
10) Just because the Pill is OTC, it may not be at your local store.
Pharmacies already have a right to choose not to stock medications for any reason and, as a Washington state law suit shows, that can include religious beliefs. Making birth control pills over the counter doesn't mean that a store will inevitably carry every brand – or even carry them at all. Even worse, it would open the door to people like pharmacist Philip Hall in Tennessee, who bought every package of Plan B in his store so he wouldn't have to sell them to anyone.
For big metro areas, heading to a different store to buy your pills may not be a big deal. For rural areas, college campuses, and places where people may not have easy access to cars, however, it could be a much bigger problem. In fact, it sort of defeats the purpose of "more accessible" birth
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