Editorial: Birth control pill proposal not easy to take

Oral contraception
  • The pill could end up more accessible but less affordable.
  • Many parents would want to know what drugs their children are taking and whether they are having sex.
  • Fortunately, the OB-GYNs’ recommendation is just the first step.
  • In a country where nearly half of pregnancies are unintended and an alarming 7% of teens get pregnant, it’s useful to look for ways to make birth control more accessible.

    That’s what the nation’s leading group of obstetricians and gynecologists is doing with its recommendation this month to put birth control pills on drugstore shelves, eliminating the need for prescriptions.

    From a strictly medical standpoint, this is a call the American College of Obstetricians and Gynecologists is well-equipped to make. The chief health risk of the pill — blood clots in veins — is rare, the group says, occurring in less than 1 in every 1,000 pill takers per year. The risk of clots is far greater with a pregnancy or right after a birth, the doctors say.

    This might be true. But beyond the science lie several thorny issues that make this decision more complex:.

  • Cost. The new health care law will bring the cost of contraceptives down to zero for most women with insurance. That’s a huge breakthrough. But if birth control pills were sold over the counter, which insurance doesn’t cover, the pills might end up more accessible but less affordable.
  • Side effects. Some women should not take the pill. These include smokers 35 or older, people who’ve had breast cancer, and people who have uncontrolled high blood pressure, blood clotting problems, heart or liver disease, or long-term diabetes. And certain types of pills, including Yaz, once the nation’s best-seller, could pose a higher risk of blood clots, according to the Food and Drug Administration. Without a doctor’s counseling, would women in the risk groups screen themselves out? Or have the knowledge to make the safest choices?
  • Preventive health. Many women visit a gynecologist or clinic only to obtain some form of birth control. With that need gone, more women might forgo health care until they get sick.
  • Underage access. Should the decision on birth control rest with underage teens who’d have easier access to the pills, or should it rest with their parents? Many parents would want to know what drugs their children are taking and whether they are having sex.
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    Fortunately, the doctors’ recommendation is just the first step toward putting the pill on store shelves between the condoms and the Tic Tacs. A manufacturer would have to seek FDA approval. The agency, after hearings and public comment, would have to decide which pills get the OK, under what circumstances and with what sort of information and labels.

    The potential downsides of over-the-counter sales suggest that there are better avenues to broader access.

    Perhaps doctors could counsel patients and write an initial prescription. Assuming the patient doesn’t have a bad reaction, pharmacies could be authorized to provide many refills without follow-up doctor visits or orders. The FDA has been looking at this idea for some other commonly prescribed drugs.

    Or, to deal with the issue of underage teens, birth control pills might be sold from behind the counter, where adults would have non-prescription access and underage teens would need a prescription. That’s the compromise the Obama administration imposed on the sale of the Plan B emergency contraceptive pill.

    The college of OB-GYNs should be applauded for thinking boldly and turning away some easy business. Making effective birth control more accessible is a worthy goal that will take plenty of time, thought and compromise. And that’s not such a bad thing, either.

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