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Should Birth Control Pills Be Sold Over-The-Counter?

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Is it time to start selling birth control pills over-the-counter (OTC)? 

The easy answer is, yes.

 

BIRTH CONTROL PILLS ORAL CONTRACEPTIVES

But is it really an easy question to answer? No. Remember, we are living in a country where many parents are still against condoms being available to students, and where many schools are teaching abstinence only in place of sex-ed classes. I'm thinking this isn't going to be as easy of a switch as some of these articles make it appear.

From The New York Times Op-Ed -- Let the Pill Go Free:

The pill meets F.D.A. criteria for over-the-counter medications. Women don’t need a doctor to tell them whether they need the pill — they know when they are sexually active and want to avoid pregnancy. Pill instructions are easy to follow: Take one each day. There’s no chance of becoming addicted. Taking too many will make you nauseated, but won’t endanger your life, in contrast to some over-the-counter drugs, like analgesics. (There are even side benefits to taking the pill, like reduced risks of ovarian and uterine cancer.)

From RHRealityCheck.org -- Why Over-The-Counter Birth Control Access Makes Sense:

The bottom line is this: we believe an OTC switch for a birth control pill would increase access to contraception by providing a highly effective, woman-controlled option that can be obtained without a trip to the doctor’s office, and the difficulties that often entails. We think this will be good for women. And it may even have the potential to transform the way we think about birth control by decreasing stigma and normalizing contraceptive use.

From NewsWeek -- Should the Pill Be Sold Over the Counter?

Teenagers are particularly vulnerable to access problems because it is harder for them to get to a doctor without a parent’s help. Almost 20 percent of sexually active teens who do not want to become pregnant are not using contraceptives, according to the Guttmacher Institute. And teenage girls who do not use contraception during their first sexual experience are twice as likely to become teen mothers as their counterparts who use protection.

What do you think? Are you "cool" with knowing your 15 year-old (or younger) could walk into a Wallgreens or CVS to buy some chewing gum and also pick up birth control pills? As a mother who has a good relationship with my teen daughter, making birth control pills available OTC wouldn't be a problem for me. Personally, I think it's a great idea to give more women access to birth control pills. However, I do have a few concerns.

First, when it comes to issues of woman's health (particularly for teens and the uninsured), I think we need to see more access to health professionals, not less. I agree that not every woman should need to have consultations with a physician before getting birth control pills, but many -- specifically teens -- should. I would hate to see it become a situation where only the insured and the wealthy had access to medical consultations for birth control, while the rest have to rely on over-the-counter options with no access to medical advice.

And contrary to what many articles are reporting, birth control pills do have side-effects, and they can be different for each woman. The benefit of having a physician monitoring you when you first begin using birth control pills is the doctor's ability to recognize adverse effects and change to different pills accordingly.

It's not just major side-effects that concern me, it's the little ones too... If a teen girl buys birth control pills on her own, and then her face breaks out with acne or she begins to gain weight, what do you think she will do? Will she stop having sex so she can stop taking birth control pills? Or will she just stop taking the birth control pills? What would you have done at that age?

Another worry I have is with the cost. It seems that every time a prescription medication is released for over-the-counter use it is quite expensive. Could the key demographic for this change to OTC birth control

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ChritieP 5 pts

I agree with you completely. Excellent, well written article.

EllieLS 5 pts

I believe that girls and women should be well educated about sex and contraceptives but I do not think that the pill should be made available without a prescription. I know many women report stabilized emotions as one of the benefits of being on the pill but I had a very different experience. In high school, was was extremely depressed while on the pill. Had the medication been my secret I would not have had my Dr, my mom or my friends to help me figure out the cause of my severe depression. I hate to think what might have happened had I not been advised to stop taking the pill. In my opinion, the risks associated with this medication are too high for its use to go unsupervised.

KistenMoore 5 pts

Skipping the hormone free week, known formally as "extended use" of hormonal contraception, is perfectly safe. In fact, the monthly bleeding experienced by women on the pill (or the patch or the ring) isn't a true period at all. It is bleeding caused by withdrawal from hormones, and skipping it does not cause any harm.
~ Kirsten

TW 6 pts

As much as part of me thinks this should totally be an over the counter option, I just am not comfortable with it. So many women, particularly young women, don't understand how their birth control pills work or don't work even with supervision. I see posts on the Internet every day asking about side effects, about how long it will take to work, how long it will take to not work, etc. If there was better education around women's health in this country--I would be all for otc birth control pills.

Retro-Food.com

TW 6 pts

I know that when Claritin became over the counter-I had to eventually stop taking it because it didn't fit my budget. Instead I ended up on generic OTC benadryl.

The same thing happened to me in a way when Motrin became OTC. We were young marrieds in school still. I had horrid cramps every month and had been prescribed Ibuprofen for years and years. No more script meant no more affordable pain relief.

Retro-Food.com

Judy Schwartz Haley 6 pts

hormone driven cancers are being diagnosed at younger ages and at an ever increasing and alarming rate. while a connection to the pill has not yet been proven, there is still a great deal of research that has not yet been funded or completed. the fact that this increase has occurred during the life of the pill is worthy of note. Any chance that 15 years of taking artificial hormones could have anything to do with a hormone driven cancer?

Additionally, as you mentioned, the insurance companies take advantage of these situations to reduce their coverage, meaning this change could easily make the pill accessible only to those with financial resources.

Young girls need more access to medical care, not less.

Yes, they also need access to contraception, but this may not be the answer.

CoffeeJitters.net ( http://coffeejitters.net/blog )

Catherine Morgan 5 pts

Thanks for commenting, I totally agree. I find it odd that so many schools provide for pregnant students (even on-site day care), but they don't see the benefits of making birth control available at the school nurse? It seems school boards are putting their personal morals ahead of what's best for the students, not to mention the cost to the tax payers (it's more cost effective to help students prevent pregnancy, than it is to provide for a teen mother and her baby in school). It makes not sense to me, but I don't believe any of this will change any time soon.

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

jjelskamp@yahoo.com 5 pts

Why can't this be an 18 and over thing? By 18 you are an adult and should be able to buy this if you feel it is needed.

Catherine Morgan 5 pts

I agree, it's a bad idea to stop and start birth control pills (especially without seeing a doctor first), the fluctuating hormones can cause many negative effects (especially in teens who are already in the middle of a hormonal tsunami).

Thanks for commenting.

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

Catherine Morgan 5 pts

Thanks Robin. I agree. Like I said in my post, I don't like the aspect of this proposal that skips the middle-man, because the middle-man is the doctor. And women need to have more access to healthcare not less.

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

LMAshton 5 pts

"I mean we've come to a point where almost everyone knows if you skip the green pills and keep taking the regular ones you won't have a period. Everyone wants to not have a period. But when will a young girl decide to go ahead and have a period? Will they try to time it so they don't have a period during important times like prom? If they do, what does that hormone level shift do to the body? "

Thing is, the bleeding we do between cycles of the BCP is not the same bleeding as a true period. There's a term for it, but I don't recall what it is, nor can I find it through Google. Brain fart moment.

From the research I've done on the pill, it seems that the whole take it 21 days, take a break for 7 days thing was created for women to feel more normal and NOT because it's required for a woman's health.

Personally, I take the BCP every day simply because I need to NOT have fluctuations in my hormone levels that a 7 day break from the BCP causes. Other women's needs will differ.

Laurie in Sri Lanka

Chilli & Chocolate ( http://food.laurieashton.com ) | A Canadian in King Parakramabahu's Court ( http://srilanka.laurieashton.com ) ] Photos by LMAshton ( http://photos.lmashton.com ) |

Melissa Ford 5 pts

I can't use birth control pills because I have a clotting disorder and I'd be really against my daughter starting them before getting blood work done to check if she has inherited this trait too. Unlike condoms, pills affect the entire body. So, no, I'd rather take my daughter to the doctor and get her prescription whenever she wants one, but doing it under the guidance of a doctor who is going to monitor any ill effects.

Melissa writes Stirrup Queens ( http://stirrup-queens.com ) and Lost and Found ( http://lostandfoundandconnectionsabound.blogspot.c... ). Her book is Navigating the Land of If ( http://thelandofif.blogspot.com/ ).

lwheelr 5 pts

Birth control pills have long term negative side affects as well as short term. They INCREASE the risk for as many cancers as they decrease the risk for. The longer they are used, the more those risks increase, and those risks do NOT disappear when the pill is discontinued. For some women with family history of specific conditions, those risks become unacceptable. If they were available OTC, it is likely that this kind of information would be heeded less, and that many women would use them who should not - because there is a prevalent attitude associated with OTC meds that they are "safe" for the general public when they often are anything but.

I appreciate abstinence teaching in schools - it IS the only sure way to avoid pregnancy and STDs. I think that "safe sex" is completely a myth. Morally, I feel that sex outside of marriage is wrong - I don't think that society can consistently remove morals from sex, and then complain about the damage to society from STDs, teen pregnancy or single parenting - that's pretty backward and illogical. If an action is acceptable, it follows that the consequences from it must therefore be acceptable also - if the consequences are NOT acceptable, then the action should not be taken. Self control is not at all a negative thing.

If OTC birth control pills were made available, conversations between parents and children on the issue would become less, not more. Kids won't discuss what they feel they don't have to. When kids are relying on information about which birth control to use, how to use it and whether they should, from their peers, the risks involved and the psychological harm from casual relationships will increase (as has been amply proven with every increase in sex education in schools). If given the option of relying totally on their peers for this kind of information, kids will do that - they'll treat the pill the same way they treat condoms, spermacides, etc - very indifferent to using it either effectively, or appropriately.

You may say, "Oh, the schools will teach them about the pill and how to use it correctly." But they will generally pay more attention to what their friends say than what they are taught in the classroom - again, this has been amply proven with current programs. Parents CAN teach their kids, but the fact is, most WON'T (particularly because they feel that the schools will do it for them), and of those that TRY, many kids will simply ignore what their parents say, in favor of the easier daily repetition of less reliable information from their friends.

Making birth control OTC would also further remove parents from their children's important decisions in life. That is NOT a good thing. It is another major step in societal decay. The family is the central unit of society, and when it is systematically disenfranchised, society crumbles. This would make that problem worse, not better, while being highly unlikely to do much to affect teen pregnancy rates, because if you further remove teens from the family, you increase the number of teens that seek pregnancy deliberately as a replacement for absent family. These, are, first and last, family issues, and should be handled within the family.

OTC Birth Control would harm individuals and our society, without helping it in any way at all.

Mamikaze 5 pts

I agree with @JennaHatfied & @AlabamaSlackerMama BCPs are nothing to be comparison shopped.

When I was a teen, I went through at least 3 different types of BCPs before I was able to take them with out massive negative side effects.

Teen pregnancy happens in all demographics and most of them have access to clinics that do not require their parents. I see it as an education issue. Access to BCPs should be a part of sex ed in 5th/6th grade. Contraception is taught but not how to acquire it. Teaching kids that they can fill their own prescriptions is often overlooked.

Astacia is also known as @mamikaze ( http://twitter.com/mamikaze )
and blogs at a href="http://mamikaze.com" target="_blank" title="mamikaze">@mamikaze and loves to a href="http://expandsocialmedia.com/portfolio" target="_blank" title="expandsocialmedia">design blogs

LauraFaye 5 pts

I live in Spain and birth control pills are not only over-the-counter, they run about €10 a month (you can by them in packs of 3).

The government requires the brands to sell their particular pill cheaply or else it is not allowed on the market (there is no consumer advertising of pharmaceuticals allowed).

However, the decision to provide greater access to birth control pill access must be acompanied with comprehensive sex education.

elhatt 5 pts

elhatt.wordpress.com

From experience I think birth control pills have more of a negative effect on a woman than positive. It messes with your body too much. Therefore, ignoring any moral implications, a girl should definitely have to consult with a Dr before getting them. If they purchase them, and then a couple months later find themselves in a bad mental state... what do they do? It's better to find the pill you need/want with the help of a physician. And a GOOD physician... some will just put you on and take you off them like they are candy.

AlabamaSlackerMama 5 pts

My answer would have to be "NO!" I am a phone triage nurse for a busy OB/GYN office. I would have to say that well over half of my phone calls every single day are problems/questions regarding birth control pills.

Birth control pills are not as benign as something like multi-vitamins. Birth control pills are combinations of various forms of Estrogen and Progesterone. Each of these hormones have their own potentially serious side effects, such as blood clots, hypertension, strokes, and heart attacks. Birth control pills can also cause migraines, edema, weight gain, acne, irregular bleeding, vision changes, and many other side effects-side effects that need to be monitored by a medical professional.

By requiring at least a yearly visit to renew a birth control pill prescription, it gives the doctor an opportunity to screen for these side effects and it also allows opportunity for the doctor to do a pap smear and breast exam, which are valuable tools for early cancer detection.

Would my job be easier if birth control pills were available over the counter? Absolutely!

Would my patients be healthier if birth control pills were available over the counter?
Absolutely NOT!

Robin, BSN,RN
"Alabama Slacker Mama"

jennydecki 5 pts

The same girl who is going to get OTC birth control without talking to her parents or another family adult might just be the same one that shoplifts the pills.

I know, I know, you're thinking they'll be behind a glass case at the Walgreens like the condoms and other "high shrinkage" items...but there are other pharmacies, other places, and other ways.

My biggest fear is that the pills won't be used correctly. I mean we've come to a point where almost everyone knows if you skip the green pills and keep taking the regular ones you won't have a period. Everyone wants to not have a period. But when will a young girl decide to go ahead and have a period? Will they try to time it so they don't have a period during important times like prom? If they do, what does that hormone level shift do to the body?

But not allowing them OTC means that you're not just paying for the pills, but a doctor visit...which makes them really expensive. Even if you go to a Planned Parenthood (maybe yours doesn't have protesters) if a girl doesn't have parental support you can't buy them on a normal allowance, you know?

Since we're not really "health insurance" people I don't worry about the pricing difference, because generally it will only be one or two brands that will be available OTC. Much like allergy meds some are OTC and some are prescription. Once they become OTC then Walgreens and everyone else can come out with a generic. That will keep them from being overly pricey.

But birth control is a choice. It is not like insulin where you could die without it. I'm sorry but those of us who pay for our doctor appointments in cash want OTC for as many things as possible because those doctor visits are expensive. Co-pays are for people with the luxury of a job with benefits, not businesses that haven't hired employees and started group plans yet :) (and not for the underemployed, underinsured, and other demographics that would have to pay for the doctor AND the drugs out of pocket.)

So, basically, I'm not sure where I stand but I'm leaning toward OTC - and hoping that a not-for-profit birth control council pops up that explains the different side effects as well as different hormone levels so girls or women can make an informed decision. Because pills made me a horrible, awful person - my IUD? Lets me be me without the extra hormones making me a beast.

Information is always the key. Hopefully parents can give that information but if not, thank goodness for the Internet and public libraries.

Jen

Catherine Morgan 5 pts

Hi Jenna. Thanks for all the great information and insight, I totally agree.

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

JennaHatfield 9 pts

My first thought was how making it OTC would make it unaffordable for some (many?). I remember when Claritin went OTC. Those who had previously had a prescription found that it was now not covered and it priced too many out of using it. Finding an alternative sinus medication was difficult for some. But it also didn't result in an unexpected pregnancy. Boogers, yes. Babies, no.

The bigger truth is that birth control pills can have severe side effects, especially for those who aren't regularly seen by a doctor in the first place. I mean, let's just look at one type of warning (grabbed Yaz as that was the one that I hated the most):

Important information about Yaz
Yaz can cause birth defects in an unborn baby. Do not use if you are pregnant. Do not use Yaz if you have any of the following conditions: a history of stroke or blood clot, circulation problems (especially if caused by diabetes), a heart valve disorder, breast or uterine cancer, abnormal vaginal bleeding, kidney or liver disease, an adrenal gland disorder, severe high blood pressure, migraine headaches, or a history of jaundice caused by birth control pills.
Before taking Yaz
Do not take Yaz if you are allergic to drospirenone or ethinyl estradiol, or if you have:

*uncontrolled high blood pressure, migraine headaches, or a heart valve disorder;
*a history of stroke, blood clot, or circulation problems of diabetes;
* kidney or liver disease;
* adrenal gland disorder;
*unusual vaginal bleeding;
*any type of breast, uterine, or hormone-dependent cancer; or
*a history of jaundice caused by birth control pills.

Before using Yaz, tell your doctor if you have any of the following conditions.

*high blood pressure or heart disease;
* high cholesterol or if you are overweight;
*liver cancer;
* gallbladder disease;
*diabetes;
*seizures or epilepsy; or
*a history of depression, irregular menstrual cycles, or history of breast or uterine cancer.

FDA pregnancy category X. Yaz can cause birth defects. Do not use Yaz if you are pregnant. Tell your doctor right away if you become pregnant during treatment. The hormones in Yaz can pass into breast milk and may harm a nursing baby. Yaz may also slow breast milk production. Do not use if you are breast-feeding a baby. Drospirenone may raise potassium levels in your blood. Other medical conditions can also affect potassium levels, including liver disease, kidney disease, and adrenal gland disorders. Before using Yaz, tell your doctor if you have any of these conditions.

Read more: http://www.drugs.com/yaz.html#ixzz0wmLejDsA

The problem with this list is that, while the severe reactions are rare, some of these issues can masquerade as other more common problems. At first. If we have women taking the pill who don't see doctors regularly and thus aren't aware of other health issues that they have, they could ignore warning signs for far too long in some cases.

All that said, I am 100% in favor of women having easier access to affordable birth control. I was one of those who should have been taking the pill far before I started, but I was too afraid to ask my mom to take me to the doctor and I knew it would show up on our health insurance if I went by myself. Heck, even after I was married, our insurance didn't cover birth control for a few years. The out-of-pocket expense was ridiculous.

I don't have the answers. If push came to shove, I'd support it being OTC with a huge push of information as to side effects and when to actually see a doctor.

Jenna Hatfield (@FireMom ( http://twitter.com/FireMom )), from Stop, Drop and Blog ( http://stopdropandblog.com ) and The Chronicles of Munchkin Land ( http://thechroniclesofmunchkinland.com ), is a freelance writer and newspaper photographer.