Why Do We Need a Prescription for Birth Control Pills?


The president of Ibis Reproductive Health, Kelly Blanchard, argues in the New York Times for over-the-counter access to the pill. I’ve long thought that the pill should be nonprescription. What’s the argument for requiring a consultation with a doctor? The doctor will tell you not to smoke while on the pill, and perhaps remind you to continue to use condoms to prevent STI transmission. These are things many women know already, and they can, and should, be clearly indicated on the pill’s packaging. If a smoker has decided she’s going to risk it and smoke while on the pill, a doctor’s warning may not deter her, anyway.

The pill’s prescription status seems like a holdover from the days when contraception was forbidden: when women who wanted it were reprimanded and those who provided it were jailed. (Not that the days of contraception stigma are over—far from it.) As Blanchard points out, there are far more hazardous drugs on drugstore shelves: Tylenol, which can be deadly, and potentially addictive drugs like Benadryl or sleep aids. So why does a woman have to go through her doctor to get hormonal contraception? So that her doctor can remind her how STIs are contracted? With many women in this country unable to afford regular checkups, we don’t rely on the doctor-patient relationship to educate people about sexual health; this happens (hopefully) in school, in our families, if we’re lucky, and through public health campaigns.

The one downside to sending the pill over the counter is cost:

We also need to address the problem of pricing. Plan B became more expensive when it went over the counter. If that happened to the pill, it could be unaffordable for many women on Medicaid whose prescriptions are now covered. In some states Medicaid already covers over-the-counter contraception like condoms; Medicaid coverage in all states should be extended to all over-the-counter methods, including the pill.

If you’re fortunate enough to have insurance, but not fortunate enough to have infinite funds to spend on monthly medications, getting the pill over the counter could be a burden. I wonder, though, if the great number of pill brands would help keep the cost low. There are only two brands of EC currently available in the United States—Plan B and Next Choice—and over forty brands of the pill. In any event, it would be great if such an essential piece of women’s health care a) was not treated like a dangerous drug and b) was as affordable as ibuprofen. After fifty years, it might be time.

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  • kiwia

    I’d agree that in the majority of cases, a doctor’s consult isn’t always necessary. But I have an inherited gene combination that means I can’t take certain hormones – I needed to talk this through with a doctor when I was first prescribed the pill & a couple of times since, when the brand I was using was discontinued & I had to change. My mother was aware of this possibility & made sure that I had the blood tests early in my teens & she made sure that I knew to bring up our family history with a new doctor, but some women might not have this backup. Would a pharmacist dispensing BC over the counter be able to check for things like that?

     

    I know in my case it was only really needed at the first consult, and because I’m not in the US I’m not hindered by a lot of the same cost problems that most of this audience encounter. I’m able to get BC from my GP, and since I only have to go twice a year to get my 6 month scripts (3 mths + 1 repeat), and I usually combine it with other regular med scripts, so it’s pretty effective.

  • juliejulie

    The pill should not be offered over the counter. There are many different types of birth control pills, with many different side effects, some of them life threatening.  It is a prescription drug because it impacts body chemistry in dramatic ways.  All women do not know that the pill doesn’t prevent birth defects. Many women do not know that if you take antibiotics your pill will cease to be effective.  All women who read this website may know these things, but all women in general do not.

     

    Additionally, I believe we have many more important medical freedom battles to fight than getting the pill over the counter. Some of those include V-Bac, and generally the right to choose how to have a baby instead of being forced into c-sections. Another important issue in medical treatment access more important than the pill is access to midwives and midwives access to medical facilities.  Even encouraging nursing by offering paid time off after delivery and protected place to pump or nurse after return to work is more important than trying to get the pill over the counter. 

  • anonymous99

    It looks like a couple people who seem to understand this issue have posted the answers.  But, nonetheless, it’s a good question.  There has to be a better, more efficient way to provide healthcare than what we have.  We’re never going to discover what that is unless we challenge the current system.

  • crowepps

    All women do not know that the pill doesn’t prevent birth defects.

    I’m sorry, I just don’t understand what this means.  Could you reword it?

    Many women do not know that if you take antibiotics your pill will cease to be effective. 

    While admittedly I was on the pill many years ago, neither my doctor nor my pharmacist ever told me this.

     

    The problem I would have with putting this over the counter is that the proportion of Americans who are functionally illiterate is about 10%, and packet inserts tend to be written at a college level because the assumption is that there will be a doctor or pharmacist explaining them.  There are contraindications for hormonal birth control including a previous history of  blood clots; breast, uterine, or liver cancers; a history of heart attack, stroke, or breast cancer and pregnancy.

     

    In addition, and I realize this is entirely frivolous and selfish, I really, REALLY don’t want to have to watch ads for Ovo-Go or Preg-Not during the news.

  • cycles

    Many women do not know that if you take antibiotics your pill will cease to be effective.

    That is an important point – BC loses effectiveness under certain conditions. But nobody’s saying that antibiotics should be over-the-counter (at least not in this thread). So when a doctor prescribes antibiotics, and when the pharmacist dispenses them, those are two opportunities to let you know about interactions with other drugs you’re taking such as BC.

     

    Why not give it the Plan B treatment: keep hormonal contraceptives behind the counter but available without a prescription. The first time you visit the pharmacist to buy the BC, you can get all the information that your doctor would normally convey. Pharmacists go through 4 years of graduate training to attain Doctor of Pharmacy status, so they know what they’re talking about. On subsequent visits, you could ask follow-up questions or zip right through without any questions. The costly prescription barrier would be removed while still allowing a venue to convey important information about the drug.

     

    Another suggestion I’ve seen is to require a single prescription, written by a doctor after the usual examination and medical history interview, which would never expire and would apply to all varieties of BC pill (so you can find the one that works best with your system without requiring costly doctor visits each time).

     

    And again, OTC birth control wouldn’t prevent you from talking to your doctor about the pill; if the pill is not working out for you, you can of course still make an appointment and use her expertise to give you recommendations for a different brand, which you would then buy OTC.

  • hmprescott

    I’m looking at the history of this issue — the first time this came up was in the early 1990s.  At that time, it was feminist health groups like the National Women’s Health Network that raised concerns about safety and the strong influence of the pharmaceutical industry in these efforts.  It’s an interesting story that overlaps with the one of getting emergency contraception available without prescription.

  • queenyasmeen

    I’d love it if we could hand out the Pill on street corners, what with so many unplanned pregnancies and contraceptive access issues in our world today, but I’m going to have to go with keeping the Pill Rx. 

     

    I’m on oral contraceptives myself, and have had several pesky infections requiring antibiotics over the years, and I fill my prescriptions in the same place.  NOT ONCE has anyone at the pharmacy counter advised me that the antibiotics could interrupt the Pill’s efficacy, though thankfully I did already know this, due to working in medical administration and chatting up my docs and nurses on a regular basis, in addition to doing my own research on many matters medical.  Even if your pharmacist is particularly astute, it’s highly possible that you’re filling different scripts at different places, and even the smartest pharmacist in the world can’t keep up with that.

     

    Did anyone here know that the first six weeks you’re on most oral contraceptives, they haven’t become effective yet?  Yup.  Just ask a friend of mine who’s got a now three-year-old who was conceived when she stopped taking one Pill, started a different brand the next day, and was never told by her doctor that there was a coverage gap (even though I’ve reviewed the package insert for my Rx and found that it does tell me this).  She didn’t miss one pill.  She loves her kid, but really, that information would have been helpful.  Yes, it does turn up at least in the package insert of my brand, but how many people read those things, and of those, how many people understand them?  Sure, we all ought to read the fine print before popping something into our mouths, but your doctor distilling out the key points for you is preferable, especially if you’re unlikely to understand it on your own.  And yes, even with doctor involvement my friend still experienced quite an oops.  But that’s about improving the communication that exists, and removing one more possible source of medical information from the process goes against that aim.

     

    Moreover, like Kiwi A, I’ve got a few other serious chronic conditions (yes, plural) that make Pill use far more complicated.  In fact, I originally started the Pill because it has the added, unintentional side effect of helping me with a condition that is not specifically reproductive system-related.  But my doctor and I discussed the posibility of this approach to my condition together, and we needed to do this because there are many other brands besides the one I’m using that would have had a disastrous rather than helpful effect on my condition.  In fact, there was a bit of a trial-and-error period, and I’m so glad I had physician help with that.  Imagine a woman who may have conditions she doesn’t know about because she can’t or won’t go to a doctor, and this gets pretty scary.

     

    In sum, there are many, many problems with American health care today: the extremely poor communication between patients and health care providers; health care access issues involving geography, time, education level of the patient, and, oh yeah, money and health insurance; the iron grip on the industry held by pharmaceutical companies; and so many, many more.  But the answer to those concerns isn’t giving people the impression that oral contraception can be a DIY affair.  What we really need to do is make sure that everyone can go to the doctor, be told the truth there, and work in partnership with their providers to make the right call.