Pro Quotes

Con 1: Over-the-counter (OTC) birth control would raise the cost of the drug.

Making birth control pills OTC means they would no longer be covered by insurance and women would have to pay for them on their own. With the Obamacare birth control mandate, insured women, who account for 89% of American women, can access free birth control. The National Women’s Law Center estimates that 64.2 million women had birth control coverage with no out-of-pocket cost. [45][46][125][126]

Stuart O. Schweitzer, University of California, Los Angeles professor of health policy and management, states that OTC is “more expensive to consumers than a prescribed drug that’s covered by insurance.” Before Plan B emergency contraception went OTC, the drug cost about $12 for the brand name and $5 for the generic for women using Medicaid. After the drug became OTC, the cost increased to $50 for the brand name and $41 for the generic. Kelly Cleland, research specialist at Columbia University, states, “When the generics [of Plan B] were about to go onto the shelves I thought there might be a price war that would push the cost down. But that really hasn’t happened, and I don’t see a sign that it will.” [47][48]

Con 2: OTC status for birth control pills could result in more unwanted pregnancies.

The birth control pill is not the most effective form of birth control. Among birth control methods, the Pill ranks seventh in effectiveness. Typical use of the Pill results in nine unintended pregnancies out of 100 women after one year of use and increases steadily to 61 unintended pregnancies out of 100 after 10 years of typical use. [49]

Meanwhile, typical use of copper IUDs results in eight unintended pregnancies per 100 women after 10 years of typical use, female sterilization results in five, the Levonorgestral IUD and male sterilization result in two, and hormonal implants result in just one. [49]

Robin Marty, health writer, notes that because the more effective options “would require a doctor’s visit and the Pill would just require a trip to the store, women may be inclined to use less effective contraception for the sake of convenience.” [50]

Con 3: Teens are not knowledgeable enough to have access to OTC birth control pills.

The American College of Obstetricians and Gynecologists states, “Adolescents need special attention at every visit for contraceptive services, including comprehensive counseling about sexuality, sexually transmitted disease and emergency contraception.” [51]

Some teens may mistakenly believe that they are at a lower risk of pregnancy just because they have access to OTC birth control, even though they may be taking it incorrectly. This lack of knowledge, combined with increased sexual activity due to mistaken confidence in the inability to get pregnant, could lead to more teen pregnancies. [52]

Peter Arcidiacono, professor of economics at Duke University, and his co-authors found that “increasing access to contraception may actually increase long run pregnancy rates even when short run pregnancy rates fall” because teens take readily available contraceptives for granted and are therefore more likely to ignore availability and have sex without contraceptive protection. [53]

Con 4: Women who take birth control pills without medical supervision can put themselves at risk.

Jennifer Ashton, gynecologist, states, “It’s generally accepted knowledge that the overall health literacy of the lay population is about at the 7th-grade level,” adding that even with one-on-one counseling and explanations about how the Pill works, patients are still confused. [54]

Birth control pills do have serious and sometimes fatal contraindications, meaning not every woman should take them. When a drug is OTC, 49% of people get information about the drug from mass media, and only 27% contact their doctors with questions about OTC drugs. This lack of communication and lack of awareness of contraindications can put women at risk. [56]

Contraindications for birth control pills include women over 35 years old and women who smoke, have a history of diabetes, heart disease, blood clots, cancer, stroke, liver disease, high blood pressure, migraines (and migraines with aura), and/or bladder disease. [57][58]

Poppy Daniels, obstetrician-gynecologist, calls OTC birth control without doctor involvement “ridiculous” and “absurd” and stated, “My concern is that you’re basically taking women who have no counseling, no family history, no risk assessment, and they’re just getting [hormonal birth control] with no guidance. Why would you take that risk?” [59]

If the Pill is prescribed, the doctor or pharmacist can tell the patient about any possible interactions and prevent bad drug combinations. Drugs that can interfere with birth control pills include the antibiotic rifampin, many anti-HIV drugs, some anti-fungal medications, some anti-seizure drugs, the stimulant modafinil, many drugs to treat epilepsy, some medications for bipolar disorder, and many herbal remedies including flaxseed and St. John’s wort. [60][61]

Con 5: Tying prescription birth control to a visit with a medical professional results in additional screenings, tests, and conversations that promote overall good health.

When the Pill is available by prescription only, a doctor usually requires a well-woman exam every one or three years in order to obtain or maintain a birth control prescription. The examination generally includes a Pap smear (the test for cervical cancer that may be combined with HPV screening), a breast exam, and a pelvic exam that, among other things, screens for ovarian cancer and STIs. Additionally, these yearly exams are a good opportunity to check in with the doctor about general wellness and other preventative screenings. [54]

Further, at least 14% of women on the Pill are using the drug exclusively for noncontraceptive reasons, such as acne and irregular menstrual cycles. That’s at least 1.5 million women who could be self-diagnosing medical conditions in a drug store aisle without medical help. [62]

Con 6: OTC status for birth control pills would decrease privacy.

If birth control pills were available on pharmacy aisles, purchases would be public and subject to the judgment and gossip of anyone in sight. Many people may prefer to keep their contraceptive use between them and their doctors.

Olivia Alperstein, communications and policy associate at the Congressional Progressive Caucus Center, states, “The concept of over-the-counter birth control ignores the grim reality that not all people can just go to a pharmacy and easily purchase birth control. Some face religious and social backlash for buying pills in full view of their pharmacist and people from their community.…Some are young and under a certain state’s law can’t purchase birth control without a parent’s consent. Some are transgender or gender-nonconforming.…The list goes on.” [63]

59% of sexually active teen girls would rather stop getting all reproductive health care services than have to tell their parents about their contraceptive use. But 99% of those teens would continue having sex. Teens want their contraceptive use kept private, and accessing birth control in the middle of a pharmacy where they might run into a neighbor or teacher could stop some teens from preventing pregnancy. [64]

Con 7: Drug manufacturers are unlikely to make the Pill OTC, so improved access has to be accomplished through other means.

Drug makers to date have little interest in going through the process to make a drug over the counter because it can take a long time and the costs are significant. Only the drug manufacturer can initiate this process with the FDA, which decides on the prescription or OTC status of a drug based on applications submitted voluntarily by the manufacturers. Lawmakers cannot change the status of a drug from prescription to OTC. Further, any decision involving birth control can be politically controversial. [30][65]

Instead, some states are making birth control available without a prescription but not over the counter. In those states, a pharmacist is required to ask the patient a few questions, note blood pressure and weight, and dispense birth control from behind the pharmacy counter. Many states, including California, Maryland, Tennessee, and Washington, allow birth control without a prescription. California, Maryland, and Washington, D.C. even allow 12-month supplies to be dispensed at once, which has been found to reduce unintended pregnancies by 30% and the odds of an abortion by 46%. The birth control in these cases is covered by insurance. A study found that 68% of women would use birth control if it were available via a pharmacist and 63% agreed the pharmacist consultation was an important step. [66][67][68][127]

Women in some states can access birth control via an app or website from private companies. Insurance covers some of these prescriptions, and all that is generally required is a brief consultation to assess risks and appropriate medication, sometimes by video chat. Some services deliver the birth control to the patient, eliminating the need to stop by a pharmacy. [69][70][71][72]

Con 8: OTC birth control pills would decrease birth control choice and access.

Vanessa Cullins, obstetrician-gynecologist, notes that there were over 40 brands of birth control pills and “not every formulation will go over the counter.” By making only a few choices available OTC, women are more likely to follow the path of least resistance and choose those available at a drug store rather than by prescription, even if it isn’t the right variety of birth control for them. [73]

The FDA-approved contraceptive methods that would not be available over the counter include IUDs (both copper and with progestin), the implantable rod, and shots such as Depo-Provera, plus sterilization procedures, all of which the FDA stated are more effective than the Pill. [74]

Journalist Sarah Elizabeth Richards notes, “Women visiting their pharmacists won’t have access to the most reliable forms of birth control on the market because those methods, such as implantable rods or intrauterine devices (IUDs), will still require a trip to a doctor’s office.” [75]

And even within birth control pill brands, choice will be limited. Most effort is focused on making the progestin-only pills (also called POP or Minipills) OTC, rather than the estrogen and progestin pills (also called combination pills). Only about 0.4% of American reproductive-aged women take progestin-only birth control pills, or about 2% of all women who take the Pill. [76][77]

Con 9: Making the Pill OTC would increase the use of hormonal drugs that may disrupt and damage the body.

The FDA notes the side effects of the Pill include changes in sexual desire, bleeding between periods, sore breasts, headaches, and nausea. Some medical practitioners believe that pharmaceutical contraceptives in general are harmful because women are not as aware of their bodies or their natural cycles when taking synthetic hormones. [74][78]

Holly Grigg-Spall, health author, states, “Health problems caused by hormonal contraceptives can appear a few months, a few years or longer into use as each woman processes the synthetic chemicals differently. Yet all women will be changed by these drugs. As a woman’s body changes so does her reaction to the pill. The pill’s repression of vital bodily functions that leads to ill health can build in such a way that years later a woman becomes very sick but can not make the connection.” [78]

Lara Briden, a naturopathic doctor, emphasizes these concerns are bigger for teens: “Making hormones is not easy. It requires regular ovulation, and that can take a few years to become established. That’s why the early years of menstruation are exactly the wrong time to take hormonal birth control.” [79]