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Should Birth Control Pills Be Available Over the Counter?

Monday, February 17th, 2014

It’s a hot debate topic: should women really be required to obtain a prescription for birth control pills? Shouldn’t the most popular form of birth control be available over the counter (OTC)?

Proponents of making oral contraceptives prescription-free say that more access to the pill would lead to fewer unintended pregnancies. To be sure, there are women who would take birth control pills if they didn’t have to see a physician to get them and if the overall cost were lower. Women commonly site access, convenience, and cost as reasons why they do not use a consistent contraception method.

Those in favor of OTC oral contraceptives also say that the benefits of making them more available outweigh the risks, as these pills are widely prescribed and generally safe. There is no argument that access to birth control is very important. Unintended pregnancy has devastating emotional and financial effects on a woman’s life, often ensuring poverty, inability to continue her education, and much more.

However, the risks of taking birth control pills without medical advice are substantial. If they were to start being sold without prescriptions, it’s a safe bet that many women would not receive important medical counseling. For example, one of the reasons birth controls require prescriptions is that they have known drug interactions and potentially dangerous side effects.

For example, antibiotics can interfere with the effectiveness of the pill. Physicians counsel women on drug interaction dangers like this when they dispense prescriptions. Women who buy the pill over the counter may not realize that if they also take an antibiotic, they need a backup method of birth control that month. In addition, birth controls pills are completely useless against sexually transmitted infections (STIs). They are not a replacement for condoms.

And if a woman doesn’t have to see her doctor to obtain a prescription for birth control pills, might she be more likely to skip seeing her doctor altogether for longer periods of time? This certainly would not be an issue for all women, but the ones who go to the doctor only because they must to get the pill would encounter the additional risks involved in not obtaining regular preventive checkups, which can reveal health problems such as STIs and some cancers in their early (and treatable) stages.

In addition, women who smoke and take birth control pills have a much higher risk of strokes, heart attacks, and death.

Birth control pills are a great option for contraception. They are easy to use, can’t be neglected in the heat of the moment (although they be forgotten earlier in the day), are noninvasive, and do not have lasting effects on fertility. However, the risks of using them and the need to use them properly call for medical advice before beginning them, at the very least.

You can find more information on birth control pills and other contraceptive methods in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.