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End the Ban on Over-The-Counter Oral Contraceptives

Jeffrey A. Singer

At his recent confirmation hearing, Alex Azar,
President Trump’s nominee for secretary of Health and Human
Services, was grilled by senators who wanted to know where he
stands on requiring employers to provide oral contraception
coverage in their employee health plans — even if employers
object on religious or moral grounds. While avoiding specifics,
Azar committed himself to finding a balance between making contraceptives
affordable and available to women, and respecting “the
conscience of their employers.”

Lost in the back and forth was the opportunity to ask Azar if he
would press the Food and Drug Administration to let the U.S. join
the 102 countries that currently allow birth
control pills to be sold over the counter without a
prescription.

It is patronizing to
still require women to get an exam and what amounts to a permission
slip from a health care practitioner in order to get oral
contraceptives.

The American College of Obstetricians and Gynecologists (ACOG)
has called for making birth control pills available without a
prescription for many years; its Committee on Gynecologic Practice
reiterated that opinion in 2012. The American
Academy of Family Physicians agrees. And a 2015
survey
of nearly 500 reproductive health care providers found
that 74 percent of them supported expanding access to oral
contraceptives.

In response to concerns that women may forgo necessary
preventive care visits if birth control pills are available over
the counter, ACOG states that “cervical cancer screening or
sexually transmitted infection (STI) screening is not required for
initiating OC [oral contraceptive] use and should not be used as
barriers to access.” In fact, there is currently a debate among gynecologists regarding the need
and benefits of annual
pap exams
.

Another worry has been that women may misuse oral contraceptives
without pre-screening by a health care professional. But OTC
advocates point to a 2006 report from Seattle showing women’s
self-evaluation regarding whether or not they should take the pill
matched those of doctors about 90 percent of the time — and
the 10 percent of the time they didn’t match was mostly
because the women erred on the side of caution.

In light of this medical consensus, it is patronizing to still
require women to get an exam and what amounts to a permission slip
from a health care practitioner in order to get oral
contraceptives. Men certainly don’t have to get a men’s
wellness exam and a prescription for condoms.

The prescription status of birth control pills also places a
financial burden on women. Leaving work or home to wait in a
doctor’s office for a prescription costs time and money.

Several states have tried to work around the FDA’s
prescription classification by allowing pharmacists to prescribe birth control
pills. While that’s an improvement over the status quo, it
still negatively affects women’s comfort and
privacy. As shown in a 2015
report
in the journal Sexual and Reproductive Healthcare, many
women who seek emergency contraception (the so-called morning after
pill, which has been available over-the-counter since 2006) prefer to purchase this kind of medication
discreetly and avoid unwanted discussion or counseling, even if
offered by a health care professional.

The obstacles created by the prescription status of oral
contraceptives may be one reason why many women stop taking them after just one year. Removing
these obstacles may help women take oral contraceptives longer and
thus prevent unwanted pregnancies. In its 2012 call to reclassify
birth control pills as nonprescription drugs, ACOG cites research from the University of Texas that compared
the use of oral contraceptives across the U.S.-Mexico border at El
Paso/Ciudad Juarez — oral contraceptives are available over
the counter in Mexico. The researchers concluded that providing
users of oral contraceptive pills “with more pill packs and
removing the prescription requirement would both lead to increased
continuation.”

Finally, prices of oral contraceptives, which currently average
between $20 to $50 per month but range as low as $9 per month,
might come down further once they can be sold
over the counter and are rendered vulnerable to greater competition
and consumer scrutiny.

According to FDA regulations, a petition to reclassify a
drug from prescription to nonprescription/over-the-counter status
can come from a manufacturer, any “interested party,”
or the FDA commissioner. Congress can also legislate
reclassification.

With heath care costs continuing to climb, with many people
living paycheck to paycheck, and with the health care professions
united in their call to make oral contraceptives available without
a prescription, it is lamentable that the senators questioning Azar
at his confirmation hearing didn’t dive into this matter. If
he’s confirmed, I hope he will do the right thing and lift
this burden off of millions of American women.

Dr. Jeffrey A.
Singer
is a general surgeon in Phoenix and a senior fellow at
the Cato Institute.