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Getting Birth Control Just Got Easier in Two US States — But Doctors Say It's Still Too Hard

Pharmacists in Oregon and California can now prescribe birth control, but some of America's top gynecologists want to know why it isn’t just sold over the counter.
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Pharmacists will be able to prescribe birth control to women in two states in 2016, but the nation's leading group of gynecologists wants to know why these women can't just get the pill over the counter.

The American College of Obstetrics and Gynecology (ACOG) says it has long supported over-the-counter birth control, and that allowing women in Oregon and California to obtain birth control prescriptions from their pharmacists isn't the same thing.

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"Requiring a pharmacist to prescribe and dispense oral contraceptives only replaces one barrier — a physician's prescription — with another," ACOG president Dr. Mark DeFrancesco said in a statement. "This is not going to allow us to reach women who remained underserved by the current prescribing requirements."

DeFrancesco said oral contraceptives are safe without a prescription, and that women are able to self-assess their own risks for blood clots, a side effect that occurs in some women, especially smokers. Pregnant women are also at a much higher risk of getting blood clots, however, so it's actually safer for them to take birth control.

ACOG announced first announced its support for over-the-counter oral contraceptives in 2012, citing 33 studies to support the move and explaining that screenings for cervical cancer and sexually transmitted infections are not medically necessary to provide the pills. The organization reaffirmed its opinion in 2014.

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The ACOG noted that the potential downside to both pharmacist-prescribed and over-the-counter birth control is that women may forgo annual exams if they are not required to see their doctors in order to obtain birth control. There's also a fear that insurance companies won't cover it if it's sold over the counter.

"Making birth control pills available over the counter, if done right, would meaningfully improve access for some groups of women," the Guttmacher Institute, a nonprofit reproductive rights group, wrote in 2014. "However, such a change is no substitute for public and private insurance coverage of contraceptives — let alone justification for rolling back coverage of all contraceptive methods and related services for the millions of women who currently have it."

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The American Association for Family Physicians and the Guttmacher Institute also support over-the-counter contraceptive pills. In 2013, the American Medical Association ruled that oral contraceptive manufacturers should be urged to submit applications for over-the-counter consideration to the Food and Drug Administration.

In 2006, 49 percent of pregnancies in the United States were unintended, according to a study published the medical journal Contraception in 2011. The Centers for Disease Control and Prevention says this leads to increased health problems for both mothers and babies.

Unintended pregnancies, which are more common among low-income and minority women, cost the US economy about $21 billion in 2010, and state and federal taxpayers bore the brunt of that burden, according to the Guttmacher Institute.

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"Access and cost issues are common reasons why women either do not use contraception or have gaps in use," ACOG wrote in its 2012 opinion, citing survey studies. "A potential way to improve contraceptive access and use, and possibly decrease the unintended pregnancy rate, is to allow over-the-counter access."

Although the move by Oregon and California to allow pharmacist prescriptions won't solve everything — and does not replace the need for annual doctor's appointments or urgent care for women — it is a move toward giving women "the ability to control their contraceptive destiny regarding when they want to become pregnant," said Dr. Jill Rabin, co-chief of ambulatory care for Women's Health Programs at Northwell Health in New York.

"It's the first step, I believe, to true over-the-counter contraceptives," Rabin said. "I think you have to start somewhere."

Follow Sydney Lupkin on Twitter: @slupkin

Photo via Flickr