Over-The-Counter Contraceptives ?

The right-wing fundamentalists in the United States have taken the ridiculous position of opposing the free and easy access to contraceptives for all American women. They claim they are doing this because their religion forbids it, but frankly, it looks more like a move to defend the patriarchy (men's dominance over women) that these people are used to and don't want to give up. They know that effective and available contraception has freed women to an extent never before seen, and has allowed women to pursue the equality they have always deserved.

President Obama has struck a blow for women by requiring insurance companies to provide for free contraception for the women they cover. Now a physicians group that knows more about the medical needs of women than anyone else -- the American College of Obstetricians and Gynecologists (ACOG) -- wants to go even further. They have come out in favor of making oral contraceptives an over-the-counter drug, available without a prescription at any pharmacy.

They say the oral contraceptives are safe enough to be sold over-the-counter, and doing so would help to make them even more available to all women. Currently, they are available only with a check-up and a prescription by a doctor. The only real concern they have is that insurance might stop paying for it, since insurance companies rarely cover over-the-counter medications. That could easily be fixed by the government requiring them to continue paying for it though.

If you would like to read the whole opinion written by ACOG you can go here, but I post a part of that opinion for you to read:

ABSTRACT: Unintended pregnancy remains a major public health problem in the United States. Access and cost issues are common reasons why women either do not use contraception or have gaps in use. A potential way to improve contraceptive access and use, and possibly decrease unintended pregnancy rates, is to allow over-the-counter access to oral contraceptives (OCs). Screening for cervical cancer or sexually transmitted infections is not medically required to provide hormonal contraception. Concerns include payment for pharmacist services, payment for over-the-counter OCs by insurers, and the possibility of pharmacists inappropriately refusing to provide OCs. Weighing the risks versus the benefits based on currently available data, OCs should be available over-the-counter. Women should self-screen for most contraindications to OCs using checklists.

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Unintended pregnancy remains a major public health problem in the United States. Over the past 20 years, the overall rate of unintended pregnancy has not changed and remains unacceptably high, accounting for approximately 50% of all pregnancies (1). The economic burden of unintended pregnancy has been recently estimated to cost taxpayers $11.1 billion dollars each year (2). According to the Institute of Medicine, women with unintended pregnancy are more likely to smoke or drink alcohol during pregnancy, have depression, experience domestic violence, and are less likely to obtain prenatal care or breastfeed. Short interpregnancy intervals have been associated with adverse neonatal outcomes, including low birth weight and prematurity, which increase the chances of children’s health and developmental problems (3).

Many factors contribute to the high rate of unintended pregnancy. Access and cost issues are common reasons why women either do not use contraception or have gaps in use (4). Although oral contraceptives (OCs) are the most widely used reversible method of family planning in the United States (5), OC use is subject to problems with adherence and continuation, often due to logistics or practical issues (6, 7). A potential way to improve contraceptive access and use, and possibly decrease the unintended pregnancy rate, is to allow over-the-counter access to OCs.

Interest in Over-the-Counter Access

A 2004 national telephone survey of 811 women aged 18–44 years found that 68% of women at risk of unintended pregnancy would utilize pharmacy access for OCs, the contraceptive patch, the contraceptive vaginal ring, and emergency contraception. Also, 47% of uninsured women and 40% of low-income women who were not using OCs, the contraceptive patch, or the contraceptive vaginal ring said they would start using those methods if they were available from pharmacies without a prescription (8). In another survey of 1,271 women aged 18–49 years, 60% of women not currently using a highly effective contraceptive method said they would be more likely to use OCs if they were available over-the-counter (9). A national survey of 2,725 pharmacists found that 85% were interested in providing hormonal contraception, with 66% expressing concerns about reimbursement (10).

Safety of Over-the-Counter Medications

No drug or intervention is completely without risk of harm. For example, common nonsteroidal antiinflammatory drugs, such as aspirin, have documented adverse effects, including gastrointestinal bleeding. These effects may occur even at doses used for prophylaxis of cardiovascular disease (11). Additionally, over-the-counter use of acetaminophen is linked to serious liver damage (12). Safety concerns about OCs frequently focus on the increased risk of venous thromboembolism. However, it is important to understand that the rate of venous thromboembolism for OC users is extremely low (3–10.22/10,000 women-years) (13, 14) and to put this risk in context by recognizing the much greater risk of venous thromboembolism during pregnancy (5–20/10,000 women-years) or in the postpartum period (40–65/10,000 women-years) (14). Overall, the consensus is that OC use is safe (15–17).