Make 'the Pill' Over-the-Counter, Doctors Say

PHOTO: A case-control study provides new estimates of the risk of specific cancers of the female reproductive system associated with use of injectable and oral contraceptives.
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In an attempt to lower the alarmingly high rate of unplanned pregnancy -- and the high cost associated with it -- an expert panel of doctors recommended Tuesday that birth control pills be made available without a prescription.

Specifically, the committee said the potential benefits of over-the-counter birth control pills outweigh the danger, which includes a small risk of dangerous blood clots.

Nearly half of all pregnancies happen by accident, according to government data. These pregnancies cost taxpayers an estimated $11.1 billion each year, according to the American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice.

The birth control pill, commonly called "the pill," is a formulation of hormones, usually progestin and estrogen, that helps prevent pregnancy mainly by keeping the ovaries from releasing eggs. Right now "the pill" is only available in the United States with a prescription, which the committee said poses a significant barrier.

"Access to and cost issues are common reasons why women do not use contraception or use it inconsistently," said Dr. Kavita Nanda, one of the physicians on the committee.

A survey from 2004, cited by the committee, found that almost half of all uninsured women and 40 percent of low-income women who were not using birth control pills, the patch or the ring, said they would more likely use the pill if it were available over the counter.

This same survey also found that more than two out of three women at risk of an unintended pregnancy would use their pharmacy if more methods of birth control were available over the counter.

The committee said that birth control pills are good options for these women, with efficacy ranging from 92 to 99 percent depending on use.

Dr. Daniel Grossman, an American College of Obstetricians and Gynecologists fellow, who was not part of the committee, said oral contraceptives are also safe. "We have over 50 years of experience with this method," he said.

There are still many steps that would have to occur for the American College of Obstetricians and Gynecologists recommendation to translate into the availability of birth control pills over the counter. And not all doctors support the idea that birth control pills are safely sold without a prescription.

"I think that the risks far outweigh the benefits," said ABC News' senior medical contributor Dr. Jennifer Ashton, who is also an obstetrician and gynecologist.

"Even though they're hormones ... they're at much higher doses than our body makes, and as such there can be side effects ranging from minor to life threatening," Ashton said. She went on to list some of the side effects associated with birth control pills, including low risks of blood clot, stroke and heart attack. "It's a full spectrum of things that really needs a medical provider in the picture."

Still, the committee noted in its recommendation that the risk of blood clots associated with birth control pills was low, with three to 10 women out of 10,000 taking the pill experiencing such a problem each year. By comparison, past research has found that the risk of blood clots associated with being pregnant is five to 20 women out of 10,000 each year, while the risk of clots associated with having just given birth is 40 to 65 per 10,000.

Dr. Donnica Moore, a physician and women's health advocate, said the risk of side-effects from birth control pills are not very different than other medications available over the counter, such as Tylenol or aspirin -- medications that can cause severe liver damage or stomach bleeding if over-dosed or taken under the wrong conditions.

"There is really no reason that oral contraceptives should not be available over the counter," said Moore, who nonetheless acknowledged that side effects remain a concern for many women.

But another concern about making birth control over the counter is cost. The current price of birth control pills ranges from $10 to about $95 dollars per pack, Moore said. She said she is concerned that making the pill over-the-counter may lead to a situation in which it is not covered by health insurance – which means that women would have to bear the costs themselves.

One point on which experts agree, however, is that certain women should avoid the pill altogether.

"For anybody, smoking is stupid, but for anyone over 35, smoking and taking birth control pills... smoking is potentially suicidal," Moore said, adding that smoking has been shown to increase the risk of blood clots, stroke, and heart attack in women.

And while physicians on the committee said women should be able to "self-screen" for these serious risk factors, Moore said that women on the pill should still be on the lookout for serious warning signs that something is wrong -- symptoms such as leg pain, tenderness, and "the worst headache of their life."

American College of Obstetricians and Gynecologists' Nanda also said even if birth control is available over the counter, all women should receive a yearly well visit in addition to counseling about contraception and other preventive care.

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