It took more than a decade of political and legal battles to make emergency contraception — the so-called morning-after pill — a nonprescription product.
Now, support is growing to make hormonal birth control available over the counter.
The American College of Obstetricians and Gynecologists (ACOG) — which for seven years has urged over-the-counter sales of birth control pills — on Tuesday expanded its recommendation to include contraceptive patches, vaginal rings, and the Depo-Provera shot. ACOG also opposes age restrictions for adolescent girls who have started menstruation.
ACOG’s move comes as some Democrats in Congress are pushing for nonprescription access to, and full insurance coverage of, birth control pills. Massachusetts Rep. Ayanna Pressley in June introduced the “Affordability Is Access” bill. Companion legislation in the Senate is cosponsored by Democratic presidential aspirants Cory Booker, Kamala Harris, Bernie Sanders, and Elizabeth Warren.
Meanwhile, 13 states, including California and Maryland, now allow pharmacists to dispense hormonal contraception without a doctor’s visit or approval. And online services that cut out the doctor’s visit are multiplying.
Worldwide, fewer than a third of countries require a prescription to get birth control, according to a British study.
“The need to consistently obtain a prescription, get a refill approval, or schedule an appointment can lead to inconsistent use of a preferred birth control method,” said Michelle Isley, an Ohio State University obstetrician-gynecologist who coauthored ACOG’s new guidance. “Making more methods available over the counter would lead to reliable, equitable access for more women.”
The Affordable Care Act already requires insurance plans to cover contraception, including the long-acting IUD and implants, without deductibles or copays.
But as ACOG and lawmakers acknowledge, regulatory action would be needed to allow nationwide over-the-counter sales of hormonal methods. A drugmaker would have to submit an application to the U.S. Food and Drug Administration and conduct safety studies.
Some studies have already shown that women can accurately use a screening questionnaire to figure out whether they have one of the few “contraindications” — a medical condition such as a history of deep-vein blood clots that could make hormonal contraception risky.
Women’s health advocates point to evidence that increasing contraception access reduces unintended pregnancy — 45% of U.S. pregnancies are not planned — and abortion. Advocates agree that women would still need to see a doctor annually for preventive care and screening tests.
But “pelvic and breast exams, cervical cancer screening, and sexually transmitted infection screening are not required before initiating hormonal contraception,” ACOG’s guidance says.
If history is any guide, a regulatory switch to nonprescription status won’t be easy. Conservative political and religious groups fought an over-the-counter application filed in 2003 by the maker of Plan B emergency contraception. That product contains a single high dose of a hormone that can be used to reduce the chance of pregnancy after sex.
Daniel Grossman, an OB-GYN and contraceptive researcher at the University of California-San Francisco, hopes this time around will be different. He noted that at least two companies have begun studies to support over-the-counter status for their products.
“I am hopeful that there will be less of a political fight over over-the-counter oral contraceptives than there was with emergency contraception.” Grossman said, “especially given that both prominent Democrats and Republicans have expressed support for over-the-counter pills.”