Over the Counter Birth Control Pills: Benefits and Risks

Abstract:

This paper examines the benefits and risks of over the counter birth control pills (OCPs). The push to get it over the counter has been an ongoing issue for women as it is considered a health barrier. There are concerns with the safety and side effects without the proper health screening and counseling provided by a doctor/physician. Since the Food and Drug Administration approved oral contraceptives in the 1960 women, it has always been accessed through medical prescription.

The Benefits and Risk Factors of Over the Counter Birth Control Pills

Birth control is a type of hormonal contraception for women to use to prevent pregnancy. There are different types of birth control such as pills, IUD, vaginal ring, diaphragm, birth control shot, birth control patch, and birth control implant. All these types of birth control require a prescription from a physician. This event has been right since 1960 from the time it’s been introduced by the Food and Drug Administration. Accordingly, the birth control pill is most recognized and common form of contraception. There has been a push the push to get it over the counter. Birth control pills can also be used for other medical problems such as menstrual cramps, irregular or absent menstrual periods, endometriosis, acne, Premenstrual Syndrome (PMS), Polycystic Ovary Syndrome (PCOS), and Primary Ovarian Insufficiency (POI) (Health Guides, 2018). These pills have different purposes and use depending upon the woman’s needs. Similarly, there are different types of birth control pills which are combination pills and progestin-only pills. Choosing and deciding the right birth control can be difficult the first time as the body needs to adjust to the given hormones. In some instances, the body reacts to the pill with a lot of side effects. This is why it is important to consult a doctor beforehand to be able to distinguish the correct birth control pill to use. The overlying question on birth control pills is as it follows: should it be over the counter or should it stay prescribed by a physician? Over the counter would mean no need for a prescription from a doctor/physician. As for some women trying to obtain birth control, acquiring a prescription from a healthcare provider stands in the way of using these pills (Bixby Center, Global Reproductive Health). This would mean underage teenagers and women of age can easily have access to go to a pharmacy and buy it through the help of a pharmacist. On the contrary, the worry is the safety of the pills and the health screening of these women. If a doctor were to prescribe a pill, there would be a list of questions to ask such as family history, counseling, and risk assessment.

A study was conducted by the University of California, San Francisco Bixby Center (UCSF) on how non-prescription use, unintended pregnancies, and the costs among low-income women (Foster, et.al 2015). Their study samples are low over the counter use and high over the counter use based upon the proportion of low-income oral contraceptives pills (OCPs) per pack (Foster, et.al 2015). The researchers compared and estimated the total public cost of providing OCPs and medical care for unintended pregnancy (Foster, et.al 2015). The researchers found that twenty-one percent of low-income women who are at risk of unintended pregnancy are very likely to use OCPs without the need of a prescription from a physician. There would be an additional increase of 11 to 21 percent in the number of women using the pill. Another 26 to 36 percent decrease in the number of women not using any contraceptive method of use (Foster, et.al 2015). And an overall decrease of unintended pregnancy between 7 to 25 percent depending upon the use and any side effect failure rates (Foster, et.al 2015). This would have a reduction in public health costs and expenditures if pill packs were available over the counter, as this would increase effective methods of contraception use and reduce unintended pregnancy for adolescents and women.  The researchers failed to mention the costs for both sides and the difference between the expenses for oral contraceptive pills and medical care. This study is biased as it only focused on low-income women and did not mention how they categorized these women to low-income without the background information on where they based it on from. This is also hasty generalization basing upon how the supporting evidence did not cite or provide enough support for low-income women and is an overall small sample. Also, the research study did not mention the age, demographics, marital status, parity, and the diversification of other women in the study.

The most cited concern of OCPs is regarding the potential harm that could result if women with contraindications use them without the proper health screening of physicians (Fedorova & Feldman, 2017). The absolute risk is the side effects in larger populations. A study was conducted in the United Kingdom that showed similar findings that women take a more conservative approach when taking OCPs also demonstrated that none of the 328 women studied would have incorrectly used OCPs based on self-screening (Fedorova & Feldman, 2017). With this in mind, the study is from the United Kingdom and the laws that apply in their country doesn’t necessarily mean it’s the same for the United States. No matter how similar the results are, it doesn’t speak to the same population of women in the United States. The access of OCPs could differ from these two countries. The American College of Obstetricians and Gynecologists recognizes that the pill can increase a patient’s risk of blood clots and stroke, particularly if she is obese or smokes (Wilson, 2012). But coincides that women can self-screen themselves with these conditions by doing a questionnaire. In this situation, this is downplayer and a weaseler. The claim is weakening and watering the argument and the situation between the increase of the side effects of OCPs among these women but also addressing that women can identify these conditions on their own. It is insinuating that these side effects aren’t a big deal. With the possibility of an increase of risk of blood clots and stroke, this is an alarming side effect of OCPs which is why some doctors aren’t in favor of selling these over the counter. Without the proper counseling and health assessment for the right birth control pill, a patient’s life could be put in danger. Making the argument weak as it outweighs more benefits in making it over the counter does not justify the possible and harmful side-effects of the pill.

Furthermore, there are other concerns on OCPs that the American College of Obstetricians Gynecologists addressed. Women who choose over the counter (OCs) might result to being less adherent, less likely to continue their method or less likely choose more effective long-acting methods of contraception (Fedorova & Feldman, 2017). They also mention that this should not exclude the efforts to increase access to other methods of OCs. A U.S. cohort study was done on a sample of 1,000 women over 9 months to see the if long term continuation would increase with improved access to OCs. As a result of this study, there was an increase of 79 percent of women who obtained OCs in Mexican pharmacies compared to the women who acquired OCs in U.S. public health (Fedorova & Feldman, 2017). This percentage from the study is insignificant because there is no correlation between Mexican pharmacies and U.S. public health. This is considered a weak analogy. A weak analogy is defined as an argument based on unimportant between two or more things (Moore and Parker, 2016). The comparison of Mexican pharmacies and U.S. public health are two different things and are not close to being distinct. To start with, it is two different countries with different laws, different accessibility to healthcare and oral contraceptives for women. Public health and pharmacy have two different meanings, so it does not support the contention of the study provided.

Lastly, over the counter would mean the reduce of number of women to get health screening by a doctor. While a survey questionnaire is easy to fill out, other preventative services would decrease as women who choose OCPs would forgo these services. Although cervical screening, or sexually transmitted infection (STI) is not required for acquiring OCPs, the American College of Obstetricians and Gynecologists do recommend getting an annual assessment for women as a fundamental part of medical care (Fedorova & Feldman, 2017). With a physician visit, women are able to talk about their reproductive health plan, birth control uses, concerns, and the side-effects of the chosen OCP. In a 2012 study, a research was done to compare women who obtained their OCs from U.S. clinics with women who obtained their OCs Mexico pharmacies. As it turns out, both groups reported high rates of Pap tests within the past 3 years with the percentage of 88, women who ever had received STI testing was 71 percent, and women who had ever had a clinical breast examination was greater than 88 percent. However, women who acquire OCs from clinics were at a higher rate. As for women who did not acquire Pap testing were due to inconvenience, cost, and not knowing where to get screened (). To mention, these studies were compared between two different countries and different standards of care.

References:

• Bixby Center, Repr. (2015, May). Over-the-counter birth control would reduce unintended pregnancies save money. Retrieved July 23, 2019, from https://bixbycenter.ucsf.edu/news/over-counter-birth-control-would-reduce-unintended-pregnancies-save-money
• Fedorova, E., & Feldman, S. (2017). Oral Contraceptives. Is It Time for Over-the-Counter? Access? [13F]. Obstetrics & Gynecology, 129, 1-5. doi: 10.1097/01.aog.0000514842.05602.7c
• Foster, D. G., Biggs, M. A., Phillips, K. A., Grindlay, K., & Grossman, D. (2015). Potential public sector cost-savings from over-the-counter access to oral contraceptives. Contraception, 91(5), 373-379. doi: 10.1016/j.contraception.2015.01.010
• Health Guides. (2018, July 19). Medical Uses of the Birth Control Pill. Retrieved from https://youngwomenshealth.org/2011/10/18/medical-uses-of-the-birth-control-pill/
• Moore, B., & Parker, R. (2016). Critical Thinking (12th ed.). McGraw Hill.
• Wilson, J. (2012, November 21). Physicians: Birth control should be sold without a prescription. Retrieved July 24, 2019, from https://www.cnn.com/2012/11/20/health/birth-control-over-the-counter/index.html