Birth control pills are so safe and important to women that theyshould be sold on drugstore shelves, without a doctor's prescription,says a group representing many of the doctors who prescribe them.
TheAmerican College of Obstetricians and Gynecologists (ACOG) takes theperhaps-surprising stance in an opinion released today and published inthe December issue of Obstetrics & Gynecology.
Thegroup says its aim is to reduce unintended pregnancies. And it says itdoes not expect to lose patients if the switch ever occurs - somethingthat experts agree will not happen quickly.
"Oral contraceptivesare very safe, and data show women can make these decisions forthemselves," says Kavita Nanda, a physician with FHI 360 (formerly knownas Family Health International) in Durham, N.C., and a member of thecommittee that wrote the opinion.
Many reproductive healthadvocates are "pleasantly surprised and excited" that a major physiciansgroup is endorsing an idea some have been pushing for years, saysKirsten Moore, president of the non-profit Reproductive HealthTechnologies Project, Washington, D.C.
Some doctors have expressedreservations about the idea in the past, citing concerns that womenmight skip Pap smears and other care if they don't need to go to doctorsfor reliable birth control. Others have expressed safety concerns.
"Iam mystified as to why ACOG would make a recommendation like this,because birth control pills do have some significant side effects," saysDonna Harrison, a physician in Berrien Center, Mich., and director ofpolicy and research at the American Association of Pro-lifeObstetricians and Gynecologists.
The new opinion says birth control pills have some risks, but so do aspirin and acetaminophen, which are sold over the counter.
Pills that contain both estrogen and progestin, which are the mostpopular kind, can raise the risk of blood clots and stroke. Yet thoserisks are much higher for women who get pregnant, Nanda says. Andstudies show women can use self-administered questionnaires about theirhealth and habits to determine if the pills are safe enough for them,she says. The checklists could be on labels or on posters or computerscreens at drugstores.
The committee also considered the riskthat women getting pills over the counter might stop coming to doctorsfor other care. Studies suggest that won't happen, the group says. Inone study, U.S. women who went to Mexico to buy birth control pillswithout prescriptions were nearly as likely as those who gotprescriptions to stay up to date with Pap smears, breast exams andscreening for sexually transmitted diseases.
Still, the doctors'group and other advocates say they are concerned about whether insurerswill pay for non-prescription pills. The Affordable Care Act saysinsurers must pay for methods approved by the Food and DrugAdministration (FDA), but it's not yet clear if nonprescription methodsare covered, Moore says.
For now, the idea an over-the-counterbirth control pill in the USA is just that: A change would require adrug company to ask for and receive FDA approval. Daniel Grossman, a SanFrancisco physician who is a leading advocate for over-the-counterbirth control, says he knows of no pharmaceutical company even startingthe studies that would be required for FDA review.
Grossman, vicepresident for research at Ibis Reproductive Health, does say the newsupport from doctors could encourage companies to try. He says it'slikely that the first pills considered would be so-called "mini-pills"that use progestin but not estrogen and are safe for larger groups ofwomen.
History suggests the road to approval could be rocky:Emergency contraceptive pills - Plan B "morning after" pills - are soldto women older than 17 without a prescription, but from behind pharmacycounters. An FDA decision to move those pills to shelves, where youngerteens could buy them without prescriptions, was overruled by the Obamaadministration a year ago.
The FDA did recently hold a hearing toair opinions about moving a variety of prescription medications tonon-prescription status. Proponents of over-the-counter birth controlpills spoke at that hearing.
And so did the American MedicalAssociation, which expressed concerns about the general idea of patientstaking medications for chronic conditions such as high blood pressure,asthma and migraine without prescriptions or a doctor's oversight. TheAMA had no comment Tuesday on the birth control pill opinion from theother physicians' group.