Should birth control pills be available without a prescription?

By Deborah Kotz, Globe Staff

I was pleasantly surprised to hear about a new recommendation from the medical society that represents gynecologists supporting over-the-counter sale of oral contraceptives. After all, many women -- myself included -- see their gynecologist every year in order to get their pill prescription renewed, and they may stop if they can buy their pills off the shelf.

And while Pap smears used to be recommended annually, women now only need to have the cervical cancer screening every three years, erasing another reason for them to thrust their feet into stirrups for a dreaded pelvic exam.

Given how much the new recommendations could harm their members’ bottom lines, I applaud the American College of Obstetricians and Gynecologists for taking a hard look at the evidence concerning the minimal risks posed by birth control pills and putting women first.

In a committee opinion published Tuesday in the journal Obstetrics and Gynecology, the gynecologist group highlighted the high rate of unintended pregnancies -- about half of all pregnancies are unplanned -- pointing out that access and cost are common reasons why women don’t use contraception consistently.

“A potential way to improve contraceptive access and use, and possibly decrease the unintended pregnancy rate, is to allow over-the-counter access to oral contraceptives,” wrote the committee authors.

They argued that all over-the-counter medications, including aspirin and acetaminophen, have the potential for serious side effects like gastrointestinal bleeding and liver damage on par with the pill’s rare likelihood of causing blood clots and strokes. There are, however, some women -- such as those who smoke -- who shouldn’t take the pill because of a heightened risk of blood clots. So any over-the-counter packaging would need to communicate this effectively to women.

The committee opinion also dismissed the issue of women skipping their annual physical, citing studies that suggest women will continue to see their doctors for screening and preventive services even if allowed to purchase birth control pills without a doctor’s appointment.

In order to the pill to become available without a prescription, the US Food and Drug Administration would need to give their nod of approval. Last March, FDA head Dr. Margaret Hamburg said the agency was working on a new designation called OTC-plus that would enable some safer drugs like statins to go over-the-counter to address common conditions that are undertreated, often because patients fail to get prescription renewals.

When I asked whether birth control pills might fall under this category, Hamburg wouldn’t say and added that the plan was still in its early stages.

Also still unresolved is the issue of possible added costs. The new health law requires that insurance companies, as of January, provide birth control pills without copayments, which means women can essentially get them for free as part of their coverage. That probably wouldn’t be the case if the pill went over-the-counter.