We have come a long way since the early 1960s when women had to face the Supreme Court to have access to contraceptives. For over 50 years, women in America have relied on oral contraceptive pills to prevent pregnancy, in addition to managing other health conditions. Oral contraceptives are now the most widely used form of prescription contraception in the United States, and require an office visit with a doctor. Since the implementation of the Affordable Care Act in 2010, women with private insurance and Medicaid receive no-cost coverage of oral contraceptive pills.
Prescription contraceptive pills consist of the hormones progestin and estrogen, or only progestin, and must be taken by mouth every day in order to prevent pregnancy. Currently, there are three prescription types available on the market: the combination pill, the progestin-only pill, and the continuous use pill. With correct and consistent use, they are 99 percent effective at preventing pregnancy.
Plan-B One Step often called the “morning after pill” is available over-the-counter at drugstores without a prescription or proof of age. It is a progestin-only birth control pill that is taken once after unprotected sex and is supposed to be used as a backup. Yet, the use of Plan-B is becoming more routine than initially intended. Unfortunately, it is not as effective as the daily oral contraceptive pills. Daily oral contraceptive pills should be available over the counter so that women who wish to be proactive about their health have that choice. We should try to limit the financial and physical barriers for women seeking oral contraceptive pills.
In the March 2016 issue of the Journal of Women’s Health, one-third of adult U.S. women who have ever tried to obtain prescription contraception reported access barriers. This included cost, challenges obtaining an appointment and difficulty accessing a pharmacy, to name a few. More often than not, these are women at risk of unintended pregnancies. Unintended pregnancies have a public health impact. Births resulting from unintended pregnancies are associated with adverse maternal and child health outcomes. The unintended pregnancy rate is significantly higher in the United States than in many other developed countries. Over-the-counter access to oral contraceptive pills can facilitate continuity of use and decrease some of these barriers.
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During the office visit with women wanting to start or continue on oral contraceptives, we discuss possible side effects. Oral contraceptives are safe for most women, and they want to take the medication despite the side effects. While most women (about 86 percent) who use oral contraceptive pills take them to prevent pregnancy, a small percentage solely use them for non-contraceptive reasons such as menstrual pain, irregular menstruation, fibroids and menstrual-related migraines. In a national survey, 62 percent of women reported that they support over-the-counter access to oral contraceptive pills, and 37 percent said they would be likely to use it.
The Food and Drug Administration has processes in place that allow prescription products to be reclassified as over-the-counter medications if certain criteria are met. Reclassified products have had clinical and economic effects on the U.S. health care system. Nonprescription medications now account for about 60 percent of all medications used in the United States and may be used to treat or cure about 400 illnesses.
Reclassification of prescription medication to over-the counter brings up concerns among health care providers, and rightly so. Patient education and counseling are particularly important to promote safe and effective use of over-the-counter products. It is well known that the prolonged and persistent use of nonsteroidal anti-inflammatory drugs such as Advil or Motrin increases the risk of upper gastrointestinal bleeding, yet we often see and treat patients with this problem. Fortunately, the majority of people consult their doctor when selecting an over-the-counter product, so there is an excellent opportunity to prevent common problems associated with over-the-counter medications, possibly including oral contraceptive pills in the future.
Lan Nguyen, a primary care physician, is a member of The Olympian’s 2016 Board of Contributors. She may be reached via firstname.lastname@example.org