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Should We Need a Prescription for Birth Control Pills?

The Food and Drug Administration is charged with, among other things, protecting the public health by regulating prescription and non-prescription drugs.  As part of that responsibility, they decide which drugs are safe for over-the-counter use and which can be obtained only with a doctor’s prescription.  Drugs that are intended to be taken daily for an unlimited amount of time are never approved for use without a prescription.  But when it comes to birth control pills, is this kind of restricted access really in the best interest of women?

Members of the Oral Contraceptive Over-the-Counter Working Group think not.  They are working to make a progestin-only pill available as an over-the-counter, daily-use oral contraceptive.  This ‘mini-pill’ differs from what most women take in that it does not contain synthetic estrogen, which is known to increase the risk of stroke, heart attack and blood clots as well as clear up acne, relieve cramps and lessen flow.

Considering the fact that the so-called morning after pill, which contains the same synthetic progesterone, is already approved for use without a prescription, the matter would seem to be a no-brainer.  But making birth control pills available without a prescription is a complicated issue that has both positive and negative implications for women.

On the plus side, making birth control pills available without a prescription would likely prevent a whole lot of unwanted pregnancies, particularly in teens who may not be able to see a doctor without parental approval.  In addition, those who cannot afford an annual pelvic exam would no longer be denied access to this safe and effective birth control method.

But what about that yearly pap smear?  According to Dr. Daniel Grossman, it has no place in this discussion.  “Holding birth control hostage until women have had a pelvic exam is a paternalistic attitude to women’s health,” he says.  “The Pap smear is for cancer screening, not contraception, and we shouldn’t spread misinformation by linking the two.”

But, surprisingly, while making birth control pills available over-the-counter would in theory make them more accessible to more women, the opposite might end up being true.   Dr. Vanessa Cullins, vice president for medical affairs of the Planned Parenthood Federation of America, says that when any medication is offered over-the-counter, it often becomes out of reach for women on federal programs like Medicaid, which doesn’t cover non-prescription drugs.

Despite all that, the FDA has shown a willingness to consider the idea.  FDA representative Shelly Burgess urges interested companies to present the data that demonstrate that “the proposed oral contraceptive can be used appropriately and safely by consumers without the input of a health-care provider.”

What do you think? Would you like to see the pill go over-the-counter? If you didn’t need to see your doctor to get it, would you still make appointments for regular pelvic exams?

Image: nateOne/Flickr

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