OB/GYNs endorse over-the-counter birth control pills

Noting that half of all pregnancies in the United States are unintended—a rate unchanged in 20 years—ACOG said easier access to oral contraceptives could help reduce the number of unintended pregnancies.

"It's unfortunate that in this country where we have all these contraceptive methods available, unintended pregnancy is still a major public health problem," Dr. Kavita Nanda, a scientist with the North Carolina nonprofit FHI 360 (formerly known as Family Health International), told the Associated Press.

Many factors contribute to the high rate of unintended pregnancies in the United States, a situation that costs taxpayers an estimated $11.1 billion each year, ACOG said in a statement. Access and cost are common reasons why women either don't use contraception or have gaps in use. Making oral contraceptives available without a prescription could possibly reduce the unintended pregnancy rate, said ACOG, the nation's largest group of obstetricians and gynecologists.

But over-the-counter sales of birth control pills aren't likely to happen any time soon. A company would first have to get government approval, and it's not clear if any are thinking about doing so at this time, the AP reported.

It's also not clear how much birth control pills would cost women if they were no longer covered by insurance. ACOG estimates that young women and the uninsured currently pay an average of $16 for a month's supply.

In making its case for over-the-counter birth control pills, ACOG pointed to research from the U.S. Institute of Medicine that found that women with an unintended pregnancy are more likely to smoke or drink alcohol during pregnancy, struggle with depression, experience domestic violence, and are less likely to obtain prenatal care or breast-feed. Also, short intervals between pregnancies have been linked to low birth weight babies and prematurity, which increase the chances of health and developmental problems for the child, the physicians' group said.

ACOG acknowledged that all drugs carry risks, and birth control pills are no exception. Use of the Pill has been linked to an increased risk of blood clots, but the physicians' group said the risk is "extremely low."

Dr. Jill Rabin is chief of ambulatory care, obstetrics and gynecology, head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y. Responding to the ACOG recommendation, she said, "This isn't a new discussion, it's been in discussion for at least the last four years, and this isn't a committee opinion that they wrote lightly."

Noting that it's "not a black-and-white issue, obviously there are risks and benefits," Rabin said she supports the recommendation "because they (ACOG) looked at the literature very, very carefully. This is a spectrum of practitioners, academicians and they really weighed the data very carefully."

Addressing the prospect of younger girls buying over-the-counter birth control pills, Rabin said she hopes the ACOG recommendation doesn't lead to bypassing parent-child discussion.

She added, however, that "adolescents are adolescents. We want our children to be safe and we want them to not be pregnant and we want them to not contract a viral or bacterial illness. But the literature is that adolescents are sexually active—a significant percentage of them are sexually active.

"We want our kids to come to us [as parents] regardless and hopefully they will," Rabin said. "It's better to open the discussion. We stress abstinence but we want to be realistic, too, we want to keep our kids safe and healthy. The fact is that an unwanted pregnancy in a 14-year-old girl is a devastating thing. It interrupts school, it interrupts life, it's physically more difficult because their bodies aren't completely developed."

Earlier this year, the U.S. Food and Drug Administration held a meeting to collect ideas about how to sell regular birth control pills without a prescription. And on Tuesday, the FDA said it would meet with any company interested in making a non-prescription birth control pill to discuss what studies would be needed for approval, the AP reported.

The ACOG statement is published in the December issue of the journal Obstetrics & Gynecology.

More information: To learn more about oral contraceptives, visit the U.S. National Library of Medicine.

Journal reference: Obstetrics & Gynecology

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