Pushing the Boundaries for Women’s Health: Why Over-the-Counter Access for the Pill Makes Sense… Now

Kirsten Moore and Aimée Thorne-Thomsen

The case is strong for over-the-counter access to the pill. Birth control pills are a safe, effective medication used by over 10 million women in the United States alone, and the pill has 50 years of global data backing it up.  There is no "one good time" to do this, so women's advocates need to take the initiative and make this happen.

Rewire is partnering with key sexual and reproductive health and justice organizations to examine the facts on birth control methods.  See also the article by Erica Sackin, “Just Facts: Will the Pill Make me Fat?”

In recent weeks, the blogosphere has been buzzing over the prospect of an over-the-counter (OTC) switch for a daily oral contraceptive regimen. Amanda Marcotte recently took on the topic in “The Pill: A Counter to “Over-the-Counter,” raising many valid questions about the timing, purpose, and effects of an OTC switch. This is an issue that the Reproductive Health Technologies Project and other women’s health advocates have examined for more than a decade. The decision to move forward at this point in time in support of a switch comes after thoughtful discussion and careful examination of the scientific evidence and other relevant considerations.

The bottom line is this: we believe an OTC switch for a birth control pill would increase access to contraception by providing a highly effective, woman-controlled option that can be obtained without a trip to the doctor’s office, and the difficulties that often entails. We think this will be good for women. And it may even have the potential to transform the way we think about birth control by decreasing stigma and normalizing contraceptive use.

Medically speaking, the case is strong for OTC access. Birth control pills are a safe, effective medication used by over 10 million women in the United States alone, and the pill has 50 years of global data backing it up. Women can easily decide whether they are candidates for pill use (“Do I want to get pregnant or not?”). Birth control pills aren’t addictive, and you can’t overdose. While contraindications, especially hypertension, present a concern, labeling, advertising, and public education campaigns could be used to close the information gap and encourage women to seek regular preventive care. A recent study shows that with the proper information and support women can screen themselves for contraindications nearly as well as providers do.

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Most concerns about contraindications apply specifically to combined oral contraceptives, making a progestin-only pill (POP) the most likely candidate for a switch. As Kelly Blanchard points out in “Let the Pill Go Free,” POPs have fewer and rarer contraindications and potential complications. This is confirmed by the newly released CDC guidelines on medical eligibility for contraceptive use. In fact, one formulation of a progestin-only pill is already available over-the-counter for women 17 and older—as emergency contraception (EC) products Plan B® and Next ChoiceTM.

But there is more to a switch than medical statistics. In fact, for many advocates the most important question is: How would an OTC switch make a difference in women’s lives?

Let’s look at young women for example. For young women, an OTC option could be a game-changer. It would begin to close the gap in contraceptive access created by the stigma and shame associated with being sexually active. This stigma can prevent young women, and young women of color in particular, from seeking or continuing medical care with a doctor or other provider. We know from research by the Pro-Choice Public Education Project that many young women do not feel comfortable talking with their doctors about their sexual and reproductive health, and “may be more inclined to forgo a checkup than risk the possible humiliation or stress of a doctor’s visit.” Prescription-only access means that forgoing a checkup may also mean interrupting use of birth control pills, or never starting them at all.

Societal stigma also acts as a barrier to access for young women or any woman who feels she may be judged for being sexually active. When you don’t want to be “found out,” it can be difficult or impossible to access birth control from an on-campus health center, Planned Parenthood clinic, or local family doctor for fear that “everyone will know” the reason. The ability to buy a pill pack from nearly any pharmacy or grocery store could be transformative for women for whom other sources are not acceptable or available.

An OTC option could also help to close the gaps in contraceptive use created by changing circumstances in a woman’s life. A survey by the Guttmacher Institute found that for more than half of women who had a gap in contraceptive use of at least one month, the gap in use “coincided with an important life event, such as the beginning or ending of a relationship, a move to a new home, a job change or a personal crisis.” Understandably, getting an appointment with a provider can be especially difficult in these situations, and an OTC birth control pill would provide a highly-effective method that is easier to start or continue during chaotic times.

We know that an OTC switch will not meet the needs of every woman, and that both prescription and over-the-counter options have benefits and limitations. Ultimately, it is difficult to predict all the outcomes of an OTC switch. This is partially because the causes of contraceptive nonuse and unplanned pregnancy are incredibly complex, and partially because we won’t know until we try.

Maybe it isn’t the perfect time to pursue an OTC switch. But in our experience, there is rarely a perfect moment to initiate change. We are in the business of transforming women’s lives for the better, and we cannot afford to wait for policymakers to roll out the red carpet or for the opposition to step out of the way. Improving women’s access to reproductive health care is not easy, and not always popular: that’s exactly why it’s so important.

We hope health care reform will mean more women have better health insurance coverage, including coverage for reproductive health care and contraception, though the reality remains to be seen. Yet, even under the most optimistic implementation scenario, there will still be problems with access. Our health care system is already overburdened, under resourced, and precariously reliant on a workforce aging toward retirement. As millions of newly-insured Americans become eligible for care, it is unclear whether this system will be able to meet the demand.

The OC OTC Working Group recognizes that a successful path for a switch involves tackling the policy question of how OTC products are covered (or not covered) by public and private insurance. The Working Group also takes seriously the importance of women’s access to a full range of preventive health services and information. Confronting these challenges will require successful partnerships between insurers and advocates, significant legislative or administrative policy change, and the allocation of public and private resources in a manner that prioritizes women’s health. We also recognize that these questions are much bigger than an OTC switch for a single pill formulation.

We know it won’t be easy. We bring to this campaign the lessons learned from the fight for an OTC switch for Plan B. Women’s health advocates, led by the inspiration of Sharon Camp, made that happen. Most people didn’t believe it would actually go over-the-counter and of course, for some, it still hasn’t. But for many women, we were able to expand access. Just as important, we were able to advance a positive message about being sexually active and taking charge of your life. We anticipate that pushing for an OTC birth control pill with further test the boundaries of our society’s comfort and sense of normalcy around sex—and we welcome the challenge.

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