New study shows over-the-counter birth control improves usage

A new study out today from Ibis Reproductive Health, in partnership with New York University and University of Texas, examines what over-the-counter (OTC) access to birth control (BC) might mean for women’s health.

The study is based on a group of women in El Paso/Juarez, a border area in Southwestern Texas.

In Mexico (and many other Latin American countries) you can walk into a farmacia (pharmacy) and get pretty much any prescription drug over the counter, without a prescription from a doctor. I’ve done this myself while traveling.

This reality gave researchers an opportunity to examine what it might look like for women if birth control (specifically oral contraceptives) were available in the US without prescription at pharmacies. This has been a topic of interest in the reproductive health community for some time as a possible way to improve access to contraception, particularly for low-income women and youth.

The study found two things:

1) Women who got their birth control directly from a pharmacy without a prescription were more likely to keep taking it consistently and not fall behind on pills;

2) The same women were also more likely to be taking the wrong birth control type, aka the wrong combination of hormones, for someone of their health status as compared to women who got their BC from a clinic with a prescription. This meant more negative side effects and health consequences for this group.

The first is great news. The more easily women are able to get their BC, the more likely they are to keep taking it and not fall behind or miss months. This makes a lot of sense, especially when you learn that the group they followed for this study was primarily uninsured and low-income. Having to pay for a doctor’s visit every time you need more pills is a HUGE financial burden. Not to mention other issues that might impact clinic access: transportation, language, ability to get off from work, family knowledge.

We know that birth control sabotage is a problem, and having to make an appointment and make excuses to a partner or family member about your whereabouts is much harder than walking into a pharmacy and picking up your pills. I could imagine for young people this also might be a huge benefit.

The second, not so great. It indicates that women who get their BC straight from a pharmacist are getting a lower quality of care because they aren’t being properly advised as to what BC is best for them. Trading access for quality of care isn’t an okay solution.

So what do we do? I think we should still advocate for birth control over the counter, but also figure out ways to improve the education mechanism with pharmacist interactions. It’s probable that a pharmacist could be equipped to guide a woman toward the right birth control choice, although follow-up and further tweaking would be harder (we know a lot of women take months to find the right drug combination for them.

I also think the second issue wouldn’t be such a problem for women who are insured (which, I believe, we should be working toward for all people). For example, folks with insurance are likely to go for a yearly exam, where they could get guidance on what BC to choose. They just wouldn’t have to go back every time they needed more pills–improving their access and likely usage of birth control.

I do think we should advocate for BC OTC–eliminating the doctor middleman is a good thing in the long run–be then we also need to make sure our education and counseling channels don’t leave some women with a lower quality of care. The study suggests starting with progestin-only pills OTC, because they have fewer side effects. While that’s a possibility, it might also encourage more women to use that type of pill, even if it wasn’t the best for them, because it was easier to access.

You can read the first study in full here and an abstract for the second here.

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7 Comments

  1. Posted February 23, 2011 at 11:58 am | Permalink

    I agree that birth control really needs to be more accessible. However, I don’t agree with the notion that the doctor is just a “middleman” in this situation. There are risks associated with taking birth control. They might be minimal, or rare, but a doctor will be able to assess if the woman is a good candidate for the pill, in order to minimize these risks, and I think this is too important of a step to get rid of.

    • Posted February 23, 2011 at 2:37 pm | Permalink

      This is a really good point. It brings to mind an example that synthetic estrogens in newer pills such as Yaz have a greater risk of causing blood clots, so people with a risk of clots should avoid them. Then again, until recently, most doctors weren’t even aware of this.

      Regarding the finding Miriam lists as #2 above: I was actually really surprised, looking at this data, how little difference there was in the rate of contraindication between women who got BC at a clinic vs women who got it OTC across the border. When you consider that the OTC group was older, less educated, more likely to smoke, less likely to have health insurance (and thus probably lower socioeconomic status)–so more likely to have contraindications anyway–how could there not be a difference? Given that, I am really unconvinced that going to the clinic is an important step.

      There are other, much riskier drugs that are available OTC–Tylenol, dextromethorphan. If these are really safe enough to be OTC, I have yet to hear any evidence that convinces me BC should not be.

    • Posted February 23, 2011 at 11:24 pm | Permalink

      You’re right that seeing a doctor before taking the pill is done for some important reasons. However, having worked as a pharmacy technician, I can tell you that this country’s pharmacists are intelligent and well-educuated, and they could probably do a large part of what doctors currently do with regards to prescriptions for birth control.

  2. Posted February 23, 2011 at 3:35 pm | Permalink

    “folks with insurance are likely to go for a yearly exam, where they could get guidance on what BC to choose. They just wouldn’t have to go back every time they needed more pills”

    I guess I never realized that there are some situations where one needs to head back to the doctor in between exams, for more pills? I thought if someone had insurance, they got a prescription that would last them until the next yearly exam? At least that’s how my doc does it. I see her for the exam, she prescribes the pill, and once the pharmacy has confirmation from her that my prescription is legit, I can just walk in their, at anytime, to order more – all I need is the Rx # plus my ID. It’s pretty much the same as buying it over the counter, for these trips to the pharmacy in-between doctor visits (only they take an hour to fill it, so I have to wander around the store, or leave and come back).
    Actually, things got even easier now: at my last visit she informed me that that the annual exam is no longer annual: only required every 3 years now. I believe it’s because they discovered that the HPV virus takes a while to show up in our bodies…long enough that the annual visits are no longer needed every year. That means I go 3 years before seeing the doc…and I just head to the pharmacy each time I need more pills.
    Maybe I’m lucky…but I thought women with health insurance had the same type of situation. Why wouldn’t a doctor prescribe with X number of refills?

    • Posted February 27, 2011 at 11:33 am | Permalink

      my doc wouldn’t prescribe the whole year when I was a teenager because she didn’t believe I wasn’t slutting it up around the high school and wanted to drag me in every three or four months to try and convince me to admit I was a big slut and to make me take STI tests and pregnancy tests despite the fact I wasn’t having sex (and didn’t until much later).

      that’s when I started going to planned parenthood. :)

      but OTC pills would be helpful for women for whom getting to a doc is hard. I don’t have insurance anymore, I work full time and go to school full time, so it can be difficult to find time to sit at the Brooklyn planned parenthood for upwards of two hours. I agree there are not so hot elements of the OTC thing, but overall BC is safer than a lot of OTC medication.

  3. Posted February 24, 2011 at 7:12 am | Permalink

    Unfortunately, progestin-only Pills are also a lot less forgiving when it comes to the timing of doses — they have to be taken as closely to every 24 hours as possible — and they do not cause a reassuring menstrual bleed.

  4. Posted February 24, 2011 at 9:20 pm | Permalink

    I’m going to have to respectfully disagree with the idea of hormonal birth control being available OTC. Hormonal birth control has way, way too many side effects that women are very poorly informed of – from the obvious contraindications for stroke and blood clots, to side effects like severe depression and loss of sex drive. Women (and especially young girls) often have no idea about these side effects, even when they’ve discussed their method with their doctor. In addition to this, the hormone doses in each brand is different, and in order to get the best pill for them women need to be able to talk to someone about their concerns and brand choice.

    I don’t want to see more women being put on hormonal birth control with little to no guidance. The potential side effects are dangerous and life-altering. I was on hormonal birth control for a short time and was an emotional, depressed mess. I constantly talk with other women who have gone off birth control only to find their moods and sex drives elevated several times over – and few of them knew these side effects could be caused by the pill.

    The answer is not to make birth control OTC. The answer is to educate girls and women about the true side effects of birth control, all the available methods (since combined pills are but one method of hormonal birth control), and how to have informative discussions with their doctors about birth control choices that would be best for them.

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