by Lauren Sreicher, MD
Mexico is known for beautiful beaches, great guacamole and, as any woman who’s forgotten to bring along that all-important pack of pills knows, over-the-counter hormonal contraception. That’s right. You can wander into any pharmacy in Mexico and pick up a pack of birth control pills without a prescription – a convenience that until now, with Oregon's new law, has not existed in the US.
A lot of people, including most gynecologists, agree with the change. Even the American College of Obstetricians and Gynecologists (ACOG) released a position statement in 2012 recommending that oral contraceptive pills be sold over-the-counter.
The reasons for that endorsement are clear. According to the Guttmacher Institute, 50% of the pregnancies that occur in the United States each year are unplanned. By age 45, half of all American women will experience an unintended pregnancy. Every year, failed contraception, or no contraception, contributes to 3.2 million unintended pregnancies.
Barriers to obtaining contraception, such as the prescription requirement, contribute to our nation’s sky-high unintentional pregnancy rate. It is irrefutable that increasing availability of pills will improve usage of contraception. Other studies have consistently proven that when barriers such as cost and access are eliminated, unplanned pregnancy rates plummet.
Getting a prescription is a huge burden to many women who have no regular physician, no insurance, and a job that doesn’t allow the luxury of taking an afternoon off to go to see a doctor. The college student without a gynecologist (and without a car) doesn’t have it any easier. Not to mention, many insurance companies only release one month of pills at a time. It’s understandable how a prescription can lapse.
Opponents to the OTC initiative say it is too dangerous. They express concern that high-risk women are likely to take birth control pills which will lead to in an increase in serious side effects such as blood clots and heart attacks. Please! Women deserve a little more credit. The average woman is more than capable of self-screening and determining if taking pills would be dangerous or inappropriate. No woman wants to have a stroke. If someone is 40, overweight, and a smoker, she is going to be informed that she is not a candidate for hormonal contraception just as a man with kidney failure is informed that over-the-counter painkillers are not safe. ACOG, known to be a medically conservative organization, strongly states that the benefits far outweigh the risks.
Truth be told, the same people that say pills shouldn’t be sold over-the-counter are often the same people that think insurance shouldn’t cover contraception in the first place. And that abstinence education actually works. Or that easy access to contraception will increase teenage sexual activity. In other words, their political agenda, not women’s health, is their priority.
Mexican women are more likely to stay on their pills and have no higher rates of complications than American women! In addition, evidence shows that even if the pill is available without a prescription, women will continue to show up for their annual checkups, Pap tests and STD screens.
Most women spend the majority of their reproductive years trying to avoid becoming pregnant. The solution to lowering the country’s high unintended pregnancy rate is not going to be completely solved by increasing access to contraception, but it’s a really good start and I’m all for it.