The American College of Obstetricians and Gynecologists (ACOG) recently updated its existing recommendations on the availability of OTC contraception.

By Julia Guerra
October 01, 2019

The fight to make hormonal birth control more widely accessible continues.

In the October edition of Obstetrics & Gynecology, the American College of Obstetricians and Gynecologists (ACOG) suggests that all forms of hormonal contraception—including the pill, vaginal ring, contraceptive patch, and depot medroxyprogesterone acetate (DMPA) injections—are safe enough to access over-the-counter without age restrictions, according to a press release issued by the committee. (IUDs should still be done at your ob-gyn's office; more on that below.) This is an updated, stronger stance than the previous reccomendations from 2012, which suggested that only oral contraception should be available over-the-counter. Importantly, though, the ACOG also states in its press release that annual ob-gyn check-ups are still recommended, regardless of access to birth control.

"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," Michelle Isley, M.D., M.P.H., who co-authored the ACOG's opinion, said in the press release. By making all forms of hormonal contraception available over-the-counter, women would have access to a variety of options without these common obstacles, she explained.

In the event that all hormonal birth control methods do become available over-the-counter at some point, it should not be at the expense of affordability, added ACOG committee member, Rebecca H. Allen, M.D., M.P.H., in the committee's press release. In other words, the price of these medications should not go up just because they'll be more readily available. "Insurance coverage and other financial support for contraception should still apply," said Dr. Allen. (Related: 7 Common Birth Control Myths, Busted By An Expert)

In fact, it is vital that the cost of birth control is addressed when considering these recommendations, Luu Ireland, M.D., M.P.H., FACOG, assistant professor of obstetrics and gynecology and treasurer of the ACOG's Massachusetts Section, tells Shape. "Currently, hormonal contraception is covered at no cost to the patient under the Affordable Care Act," explains Dr. Ireland. "These cost protections must remain in place. We cannot trade in one barrier (need for prescription) for another (out-of-pocket costs)."

So, why the push for over-the-counter contraception? Statistically and scientifically, it simply makes more sense, says Dr. Ireland.

"Almost half of all pregnancies in the United States are unplanned, and women deserve easy access to effective methods to prevent pregnancy," she explains. The hope is that more accessible birth control options will mean fewer unwanted pregnancies, she says. (Plus, let's not forget that birth control is often used to treat women's health conditions like polycystic ovary syndrome.)

Of course, the recent political climate around birth control access has been—to put it lightly—tense. President Trump has previously set sights on defunding Planned Parenthood, the largest provider of women's health and reproductive services in the US. Plus, Senate Republicans have repeatedly pushed for legislation that would limit Planned Parenthood's ability to provide services like physicals, cancer screenings, and contraceptive care. All of this makes birth control access even more important.

There's also no science that suggests it's a must to make an ob-gyn visit to obtain birth control, adds Dr. Ireland. Rather, doctor's visits and the need for a prescription often "present real barriers for women in accessing the contraception they desire," she explains. These barriers include physicians not understanding how certain contraceptives work, misperceptions about the medication, and exaggerated concerns about safety, according to a 2015 opinion published by the ACOG.

But just because you shouldn't have to go to the ob-gyn to get hormonal birth control, doesn't mean you shouldn't see them at all. Annual visits and check-ups are still necessary for preventive healthcare (think: pap smears, screening for sexually transmitted diseases and infections, immunizations, breast, and pelvic exams, etc.), says Dr. Ireland. Doctor visits also give you an opportunity to discuss any concerns you might have about your menstrual cycle, sexual function, or vaginal health in general, she adds. Note: Those who prefer an IUD or contraceptive implant would also still need to make an appointment with their physician for initial insertion of the device, explains Dr. Ireland. (Related: Lena Dunham's Op-Ed Is a Reminder That Birth Control Is So Much More Than Pregnancy Prevention)

As for those who might be looking to try birth control for the first time, an ob-gyn would still remain a valuable resource in helping you choose which method is right for your body, says Dr. Ireland. But FWIW, multiple "high-quality research studies" have shown that women are able to safely self-screen and determine whether or not they're candidates for hormonal birth control, she adds. Plus, if birth control were to become available over-the-counter, the medication's labeling would serve as an additional guide on how to use it, as well as provide any warnings/concerns users should be aware of, she explains.

If the idea of over-the-counter birth control sounds too good to be true, that's because, as of now, it is. (See: What the Election of Donald Trump Could Mean for the Future of Women's Health)

Bottom line: Don't cancel your ob-gyn appointment just yet. These statements from the ACOG are, as of now, general recommendations. Policies have not changed, and hormonal birth control is still only accessible with a prescription in the United States.

"These changes will not happen immediately," says Dr. Ireland. "There is a process that must take place through the US Food and Drug Administration (FDA) [before] over-the-counter status can be achieved."


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