Lazenby: On Oral Contraception

It is past time for a medication that millions of American woman take daily – oral contraceptives – to be made available over-the-counter.

Last year, the American Congress of Obstetricians and Gynecologists (ACOG) recommended that the pill be made available without a physician’s prescription – pointing to studies showing that “women are able to self-screen with checklists to determine their health risks” and that they “will continue seeing their doctor for screening and preventive services even when allowed to purchase [oral contraceptives] without a prescription.”

This should be a non-controversial, common sense change for several reasons:

First, the pill is safe. Even though no drug is without risk, the overall consensus among doctors and pharmacists is that oral contraceptives, which have been used in the U.S. for over 50 years and have undergone rigorous testing during that time, are safe. There is a risk of blood clots with the pill, but it is extremely low (it is higher in women who are over 35 or who smoke). Oral contraceptives, used properly, can carry less of a risk than many other medications bought over-the-counter, including nonsteroidal pain pills like Advil and Motrin (which can lead to stomach bleeding) and decongestants like Sudafed (which have been shown to raise blood pressure). By including an insert in the box about proper use and precautions, which is common practice with many other over-the-counter meds, women would be capable of using over the counter contraceptives safely, according to ACOG.

Secondly, oral contraceptives, when used properly, are an effective way to prevent unintended pregnancies. Making the pill available without a prescription will make it easier for a woman to maintain her medication regimen when she loses a pack of pills, is traveling, or is unable to get an (often costly) appointment with her doctor in time. According to ACOG, “Cost, access, and convenience issues are common reasons why women do not use contraception or use it inconsistently.”

It is that inconsistent use that causes the medication to fail and leads to unintended pregnancies. And an increase in unintended pregnancies, it should be pointed out, can lead to an increase in abortions.

Lastly, tying these two issues together, the use of oral contraceptives poses fewer health risks to women than pregnancy itself. Dr. Eve Espey, a professor of obstetrics and gynecology at the University of New Mexico who was involved in writing the ACOG position paper   in a recent New York Times op-ed, “For most women, the absolute risk of taking birth control pills is far less than the risks incurred in pregnancy.” The same extremely low risk of blood clots from taking the Pill is much lower than the risk of blood clots during pregnancy and the postpartum period. And that’s just one of the many medical risks associated with pregnancy, not to mention the emotional and financial toll that an unintended – and even an intended – pregnancy can take on a woman and her family.

But because pregnancy and politics are inevitably intertwined, objections have been raised to making oral contraceptives over-the-counter by social conservatives, abstinence-only education groups, anti-abortion forces, and even some doctors, despite the ACOG’s recommendation. The abstinence-only education groups are denying the reality that young people will engage in sex before marriage, and in so doing, want to deny them access to a medication that could prevent an unintended pregnancy. Anti-abortion forces have raised the concern that young women who need the advice of a doctor regarding sexual activity won’t seek it if they can get the pill at their local pharmacy. No one can say for sure if that’s the case, but we can say for sure that more unintended pregnancies lead to more abortions.

As to the doctors who are opposed to this concept, a recent poll conducted by the University of Missouri “found that a majority of gynecologists and family doctors in training opposed the practice, worried mainly about safety.” The researchers “concluded that the fear was irrational, revealing ‘a knowledge deficit’ about ‘the safety of oral contraceptives,’ ” even among doctors. It is fundamentally unfair to penalize women because some doctors are not as informed as they should be about these medications. Additionally, other doctors may be worried for financial reasons. Many women visit the gynecologist solely for the purpose of an annual pap smear and to get their birth control prescriptions. Now that pap smears are recommended only every three years instead of annually for most women, some physicians may be concerned about the cost a further decreased frequency in visits may mean to their bottom lines. Let’s hope the physicians who put profits over patients are few and far between, especially when the ACOG, the nation’s leading authority in women’s health, is recommending this change.

There will be political battles to be fought and F.D.A. hurdles to clear to make this change a reality, but they are battles worth fighting. If we can reduce the number of unintended pregnancies (and the astronomical financial, physical, and emotional costs associated with them), by making an effective and safe medication available to women at their corner drugstores, we should do it.

Amy Lazenby is a wife, mother of three and small business owner with her husband who splits her time between South Carolina and Georgia. She writes with a liberal world view on most issues, but enjoys exploring where the liberal and libertarian political axes intersect. Follow her on Twitter @Mrs_Laz.