Last week the American College of Obstetricians and Gynecologists released new recommendations stating its support for over-the-counter oral contraceptives. Currently, birth control is only accessible per a doctor’s prescription. By making the drug available over the counter, patients would have definite benefits — potentially lowering the price of birth control, increasing access for women and saving health insurance companies money — but at what cost?
The biggest danger that would come with birth control becoming an over-the-counter drug is the loss of a very crucial role that doctors play in prescriptions. If it’s available over the counter, women will no longer be required to see a doctor before beginning the pill: They will not be screened by a doctor for risks prior to use of birth control, they will not be able to determine whether they are experiencing detrimental side effects after going on the pill and they will have no way of deciding which type of birth control is suited for them in conjunction with other prescription medications they might be taking or other health issues. Because of this, birth control should remain a drug that is solely prescribed by doctors after consultation.
There are numerous examples of the negative health impacts of over-the-counter availability. One is birth control’s interaction with a common antibiotic, rifampin. If a woman is taking rifampin and birth control at the same time, the contraceptive loses its ability to prevent pregnancies, and it is recommended by doctors to use a second type of birth control when prescribed rifampin. According to Women’s Health Magazine, birth control also puts women slightly more at risk for blood clots, especially those who already exhibit cardiovascular risk factors, such as high blood pressure or diabetes, or those who smoke.
A proponent might suggest including extra warning labels, which raises another issue: If birth control becomes an over-the-counter drug, are the drug’s warning labels enough of a precaution if the side effects are too serious?
The warnings that accompany any given birth control are endless, and as such over-the-counter birth control would require multiple warning labels that most women would not likely read. Even a warning provided in a supplemental small booklet might not be sufficient enough to warn someone that birth control will not be effective for them. There is no replacement for a doctor explaining to a woman in person not only the general known side effects of a drug, but how it will affect her specifically.
But one of the main side effects of birth control, mood swings, is one that can affect any person regardless of health conditions or habits, and a warning label would not suffice to address this.
In a 2008 Health.com article on common birth control side effects, Dr. Hilda Hutcherson, an ob-gyn professor at Columbia University explained the complexities of dealing with this.
“If it’s really the birth control and not some other factor that’s bringing you down, you may need to find a nonhormonal method,” she said.
How would a woman know that her depression is a result of her birth control without consulting a doctor, and then know what different kind of birth control to change to? A drug with a possible side effect as serious as depression renders a consultation with a doctor necessary.
Another pro-over-the-counter argument relates to money. The monetary advantages of making birth control more accessible are minimal, to such an extent that they do not justify the health risks. Under Obama’s Affordable Care Act, birth control is covered by insurance as a prescription medicine only. In 2010, 16.3 percent of Americans were uninsured according to CNN, meaning drug companies would be making a decision that would be cost beneficial to every one in nine people.
Though making birth control accessible over the counter would relinquish doctor fees and make it more affordable for those that cannot currently afford contraceptives, the health risks outweigh the cost benefits.
As Iowa State Daily reporter Leah Hansen wrote Monday, “It would be up to the women to know which brand and dose she needs, what are the side effects, what other medications may interfere with birth control and any other questions she might have regarding the product.”
Doctors are part of the birth control process for a reason: to warn patients of potential side effects, to monitor their health while on medications and to serve as a personal resource for a potentially risky drug. There is no substitution for that.
Morgan Greenwald is a freshman majoring in neuroscience and health promotion and disease prevention studies.